Cost analysis for CPT 95165 — Professional service for preparation and provision of 1 or more antigens
Average Medicare Payment
$10.71
2023 data
Total Payments (2023)
$58.5M
Services (2023)
5.3M
Price Change (2014–2023)
+17.2%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $9.14 | $53.3M | 5.8M | — |
| 2015 | $9.10 | $55.8M | 6.1M | -0.4% |
| 2016 | $9.01 | $58.3M | 6.4M | -1.0% |
| 2017 | $9.18 | $58.2M | 6.3M | +1.9% |
| 2018 | $9.23 | $61.6M | 6.6M | +0.5% |
| 2019 | $10.21 | $70.1M | 6.8M | +10.6% |
| 2020 | $10.52 | $63.1M | 5.9M | +3.0% |
| 2021 | $11.51 | $69.5M | 5.9M | +9.4% |
| 2022 | $11.13 | $63.9M | 5.6M | -3.3% |
| 2023 | $10.71 | $58.5M | 5.3M | -3.8% |
The most expensive state pays 2.0x more than the cheapest for this procedure. DC averages $13.94 vs ND at $6.86.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| DC | $13.94 | $160.1K | 11.5K | 8 |
| CA | $12.98 | $5.9M | 454.6K | 212 |
| NJ | $12.97 | $1.9M | 147.4K | 86 |
| NY | $12.79 | $3.2M | 253.2K | 139 |
| AK | $12.35 | $12.2K | 991 | 4 |
| MD | $12.29 | $1.0M | 84.2K | 56 |
| HI | $12.28 | $73.6K | 6.0K | 5 |
| CT | $12.08 | $267.2K | 22.1K | 31 |
| WA | $11.92 | $725.1K | 60.8K | 43 |
| MA | $11.90 | $1.2M | 98.9K | 62 |
| RI | $11.72 | $142.5K | 12.2K | 14 |
| CO | $11.30 | $688.1K | 60.9K | 44 |
| DE | $11.20 | $295.1K | 26.3K | 17 |
| VA | $11.20 | $2.9M | 254.8K | 130 |
| VT | $11.17 | $20.0K | 1.8K | 2 |
| WY | $11.17 | $84.4K | 7.6K | 7 |
| FL | $11.16 | $4.5M | 403.6K | 245 |
| OR | $11.13 | $326.6K | 29.4K | 36 |
| NH | $11.11 | $153.4K | 13.8K | 13 |
| IL | $11.08 | $985.8K | 89.0K | 81 |
| PA | $11.01 | $2.3M | 208.7K | 145 |
| NV | $10.97 | $565.7K | 51.6K | 20 |
| TX | $10.91 | $7.3M | 670.1K | 386 |
| PR | $10.75 | $24.5K | 2.3K | 3 |
| AZ | $10.72 | $2.9M | 269.6K | 87 |
| WI | $10.61 | $106.6K | 10.0K | 19 |
| MI | $10.57 | $1.0M | 96.6K | 94 |
| UT | $10.42 | $192.2K | 18.4K | 21 |
| NC | $10.31 | $1.8M | 176.5K | 139 |
| GA | $10.30 | $1.3M | 121.8K | 83 |
| NM | $10.26 | $486.8K | 47.4K | 22 |
| MN | $10.19 | $123.1K | 12.1K | 22 |
| OH | $10.08 | $1.2M | 123.0K | 88 |
| NE | $10.06 | $227.6K | 22.6K | 22 |
| SC | $10.01 | $2.0M | 198.5K | 95 |
| IN | $9.99 | $1.0M | 101.1K | 79 |
| LA | $9.95 | $846.1K | 85.0K | 60 |
| OK | $9.91 | $1.2M | 118.3K | 40 |
| TN | $9.89 | $3.0M | 307.6K | 133 |
| ID | $9.87 | $114.0K | 11.6K | 16 |
| IA | $9.81 | $300.3K | 30.6K | 29 |
| MO | $9.79 | $1.1M | 112.7K | 77 |
| WV | $9.76 | $405.3K | 41.5K | 23 |
| ME | $9.73 | $18.1K | 1.9K | 4 |
| AL | $9.70 | $951.4K | 98.0K | 73 |
| SD | $9.70 | $81.1K | 8.4K | 15 |
| KS | $9.68 | $549.4K | 56.7K | 46 |
| KY | $9.65 | $1.5M | 155.0K | 79 |
| AR | $9.53 | $658.0K | 69.1K | 48 |
| MS | $9.26 | $545.5K | 58.9K | 35 |
| MT | $9.05 | $89.3K | 9.9K | 10 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Matthew Miller | Nurse Practitioner | AZ | $438.4K | 44.7K | $9.81 |
| Stacy Silvers | Allergy/ Immunology | TX | $280.1K | 25.0K | $11.19 |
| Peter Logalbo | Allergy/ Immunology | NY | $239.6K | 17.0K | $14.08 |
| George Bensch | Allergy/ Immunology | CA | $235.5K | 19.0K | $12.42 |
| Jessica Gerhart | Nurse Practitioner | TX | $232.0K | 22.4K | $10.36 |
| Murtaza Ghadiali | Otolaryngology | TX | $226.1K | 19.8K | $11.43 |
| Marek Pienkowski | Allergy/ Immunology | TN | $211.0K | 21.1K | $10.01 |
| Jason Acevedo | Otolaryngology | TX | $198.6K | 17.3K | $11.51 |
| Alan Keyes | Otolaryngology | VA | $190.5K | 17.0K | $11.22 |
| Michael Mccormick | Allergy/ Immunology | CA | $186.5K | 15.5K | $12.07 |
| Claudia Macias | Nurse Practitioner | AZ | $185.3K | 19.0K | $9.76 |
| Hava Ladinsky | Allergy/ Immunology | MD | $169.1K | 13.4K | $12.65 |
| Dimple Agarwal | Internal Medicine | CA | $166.5K | 12.8K | $13.05 |
| Tidence Prince | Allergy/ Immunology | TN | $164.6K | 15.7K | $10.48 |
| William Cain | Allergy/ Immunology | TN | $163.8K | 15.8K | $10.34 |
| Laura Chong | Allergy/ Immunology | OK | $162.6K | 16.2K | $10.01 |
| Safa Nsouli | Allergy/ Immunology | CA | $160.7K | 10.5K | $15.35 |
| Chad Gunnlaugsson | Otolaryngology | SC | $160.0K | 15.5K | $10.36 |
| Dean Atkinson | Allergy/ Immunology | OK | $158.0K | 16.2K | $9.75 |
| Thomas Beller | Allergy/ Immunology | SC | $154.0K | 17.3K | $8.90 |
Based on the data, CPT 95165 shows a 2.0x variation in pricing across states — moderate variation by Medicare standards.
Costs have increased 17.2% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.