87084

Screening test for pathogenic organisms with colony count

Medicare pricing data for 94 providers across 10 states

🤖AI Overview

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

Screening test for pathogenic organisms with colony count (HCPCS code 87084) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $26.38, but hospitals typically charge $42.03 — a 1.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.28

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $26.38, your out-of-pocket cost would be approximately $5.28. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$26.38
Average Hospital Charge
$42.03
Markup Ratio
1.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$42.03
Medicare Allowed$26.38
Medicare Payment$26.38

Hospitals charge 1.6x more than what Medicare allows for this procedure. Medicare actually pays $26.38 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Iowa$27$35171+0.6%
Kentucky$27$424121+0.6%
Missouri$27$40111+0.6%
Ohio$27$355204+0.6%
California$27$4042,569+0.5%
Mississippi$26$451214+0.1%
Louisiana$26$45183,675-0.0%
Kansas$26$3520644-0.1%
New York$26$4325966-0.3%
Puerto Rico$14$14421-47.3%

⚠️ 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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