87081

Screening test for pathogenic organisms

Medicare pricing data for 2,188 providers across 49 states

🤖AI Overview

This procedure has a 9.2x markup — hospitals charge $59.77 but Medicare allows only $6.48. Uninsured patients may face bills 9.2 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

Screening test for pathogenic organisms (HCPCS code 87081) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $6.48, but hospitals typically charge $59.77 — a 9.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.30

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $6.48, your out-of-pocket cost would be approximately $1.30. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$6.48
Average Hospital Charge
$59.77
Markup Ratio
9.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$59.77
Medicare Allowed$6.48
Medicare Payment$6.48

Hospitals charge 9.2x more than what Medicare allows for this procedure. Medicare actually pays $6.48 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$7$734349+0.5%
District of Columbia$7$24434+0.3%
Florida$7$72334,146+0.3%
Hawaii$7$232181+0.3%
Idaho$7$37519+0.3%
Indiana$7$4919200+0.3%
Maine$7$242579+0.3%
Michigan$7$2022290+0.3%
Mississippi$7$477455+0.3%
Nebraska$7$201118+0.3%
Nevada$7$822251+0.3%
New Hampshire$7$2139283+0.3%
New Mexico$7$443168+0.3%
Oklahoma$7$709393+0.3%
Rhode Island$7$431206+0.3%
South Dakota$7$431091+0.3%
West Virginia$7$37745+0.3%
California$7$646218,078+0.3%
Colorado$7$80101,378+0.3%
Georgia$6$98151,025+0.2%
Kansas$6$82171,745+0.2%
Louisiana$6$2949367+0.2%
Massachusetts$6$654375,291+0.2%
New Jersey$6$56258,948+0.2%
New York$6$391648,464+0.2%
North Carolina$6$74778,275+0.2%
North Dakota$6$269177+0.2%
Ohio$6$72123,549+0.2%
Tennessee$6$6326686+0.2%
Arizona$6$601552,643+0.2%
Illinois$6$80523,4110.0%
Maryland$6$49463,0040.0%
Missouri$6$75102330.0%
Pennsylvania$6$59121,9720.0%
Texas$6$821044,3310.0%
Virginia$6$24946,5310.0%
Alabama$6$66252,1090.0%
Iowa$6$28751,015-0.3%
Kentucky$6$3087395-0.3%
Utah$6$2064681-0.5%
Washington$6$75904,915-0.5%
Wisconsin$6$56791,611-0.9%
Wyoming$6$49846-1.1%
Montana$6$41543-1.2%
Oregon$6$2610217-1.2%
Connecticut$6$55640-2.2%
Minnesota$6$2533271-3.1%
Arkansas$6$2141188-4.8%
South Carolina$6$2456267-4.9%

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

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