87071

Bacterial culture and colony count

Medicare pricing data for 288 providers across 15 states

🤖AI Overview

This procedure has a 5.0x markup — hospitals charge $48.51 but Medicare allows only $9.68. Uninsured patients may face bills 5.0 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Bacterial culture and colony count (HCPCS code 87071) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.68, but hospitals typically charge $48.51 — a 5.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.94

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $9.68, your out-of-pocket cost would be approximately $1.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$9.68
Average Hospital Charge
$48.51
Markup Ratio
5.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$48.51
Medicare Allowed$9.68
Medicare Payment$9.68

Hospitals charge 5.0x more than what Medicare allows for this procedure. Medicare actually pays $9.68 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Massachusetts$10$263356+0.1%
Missouri$10$60221+0.1%
Pennsylvania$10$123638+0.1%
Puerto Rico$10$122044+0.1%
Alabama$10$142392+0.1%
Connecticut$10$14889+0.1%
New Jersey$10$10269810.0%
New York$10$251495620.0%
Texas$10$5381,4540.0%
California$10$61232,0260.0%
Iowa$10$404286-0.1%
Florida$10$3441,292-0.2%
Minnesota$10$5635135-0.5%
Illinois$10$204107-0.6%
Georgia$9$38219-4.4%

⚠️ 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