87045

Stool culture

Medicare pricing data for 1,063 providers across 45 states

🤖AI Overview

This procedure has a 6.0x markup — hospitals charge $55.28 but Medicare allows only $9.23. Uninsured patients may face bills 6.0 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

Stool culture (HCPCS code 87045) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.23, but hospitals typically charge $55.28 — a 6.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.85

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $9.23, your out-of-pocket cost would be approximately $1.85. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$9.23
Average Hospital Charge
$55.28
Markup Ratio
6.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$55.28
Medicare Allowed$9.23
Medicare Payment$9.23

Hospitals charge 6.0x more than what Medicare allows for this procedure. Medicare actually pays $9.23 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$9$534913,410+0.2%
Georgia$9$55382,120+0.2%
Indiana$9$586201+0.2%
Iowa$9$388309+0.2%
Kansas$9$448252+0.2%
Louisiana$9$6019403+0.2%
Massachusetts$9$53103,207+0.2%
Missouri$9$5462,707+0.2%
Nebraska$9$20192+0.2%
Nevada$9$444869+0.2%
New Hampshire$9$304292+0.2%
New Mexico$9$51338+0.2%
Utah$9$615207+0.2%
Wyoming$9$63120+0.2%
Puerto Rico$9$1093240+0.2%
Colorado$9$536443+0.2%
Maryland$9$52101,195+0.1%
New Jersey$9$621812,675+0.1%
New York$9$71973,550+0.1%
North Carolina$9$561417,884+0.1%
Ohio$9$59274,438+0.1%
Pennsylvania$9$51101,119+0.1%
Tennessee$9$34101,384+0.1%
Texas$9$548310,839+0.1%
Arizona$9$60628,908+0.1%
Hawaii$9$3028610.0%
Illinois$9$52242,3210.0%
California$9$538011,7320.0%
Kentucky$9$3641554-0.1%
Minnesota$9$5732127-0.1%
Oklahoma$9$56141,353-0.1%
Rhode Island$9$1531257-0.1%
Virginia$9$37252,056-0.1%
Alabama$9$65234,468-0.1%
Oregon$9$29421,092-0.2%
South Dakota$9$5220342-0.2%
Michigan$9$3313317-0.3%
Mississippi$9$8211262-0.4%
Maine$9$27395-0.5%
Wisconsin$9$7161,441-0.5%
North Dakota$9$3811132-1.1%
Washington$9$49243,586-1.6%
Arkansas$9$373682-1.8%
Connecticut$9$56352-2.9%
South Carolina$9$281360-6.1%

⚠️ 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