87015

Concentration of specimen for infectious agents

Medicare pricing data for 420 providers across 39 states

🤖AI Overview

This procedure has a 5.7x markup — hospitals charge $37.29 but Medicare allows only $6.54. Uninsured patients may face bills 5.7 times higher than what insurance negotiates. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Concentration of specimen for infectious agents (HCPCS code 87015) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $6.54, but hospitals typically charge $37.29 — a 5.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.31

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $6.54, your out-of-pocket cost would be approximately $1.31. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$6.54
Average Hospital Charge
$37.29
Markup Ratio
5.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$37.29
Medicare Allowed$6.54
Medicare Payment$6.54

Hospitals charge 5.7x more than what Medicare allows for this procedure. Medicare actually pays $6.54 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Minnesota$7$6056991+0.3%
Florida$7$48184,217+0.2%
Georgia$7$531568+0.2%
Hawaii$7$2421,651+0.2%
Indiana$7$42352+0.2%
Iowa$7$257269+0.2%
Kansas$7$525579+0.2%
Kentucky$7$16138+0.2%
Maine$7$49191+0.2%
Maryland$7$525284+0.2%
Michigan$7$14425+0.2%
Missouri$7$49223+0.2%
New Hampshire$7$224393+0.2%
New Mexico$7$981108+0.2%
New York$7$50281,903+0.2%
North Carolina$7$4144,972+0.2%
North Dakota$7$44367+0.2%
Pennsylvania$7$575117+0.2%
Rhode Island$7$11231+0.2%
Tennessee$7$544623+0.2%
Utah$7$19439+0.2%
Virginia$7$369300+0.2%
Puerto Rico$7$7934+0.2%
California$7$43508,774+0.2%
Colorado$7$36448+0.2%
Nevada$7$5216230.0%
Texas$7$222213,0270.0%
Alabama$7$3741,3840.0%
Arizona$7$3241,3810.0%
Illinois$7$526297-0.2%
New Jersey$7$4393,659-0.2%
Ohio$7$369759-0.2%
Washington$7$329569-0.2%
Massachusetts$7$506410-0.5%
Oklahoma$7$473640-0.5%
Oregon$7$1831234-0.5%
South Dakota$6$4019185-0.9%
Wisconsin$6$417693-2.9%
Mississippi$6$31314-14.5%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber