87101

Fungal culture (mold or yeast) of skin, hair, or nail

Medicare pricing data for 759 providers across 43 states

🤖AI Overview

This procedure has a 8.8x markup — hospitals charge $66.60 but Medicare allows only $7.55. Uninsured patients may face bills 8.8 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

Fungal culture (mold or yeast) of skin, hair, or nail (HCPCS code 87101) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $7.55, but hospitals typically charge $66.60 — a 8.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.51

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $7.55, your out-of-pocket cost would be approximately $1.51. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$7.55
Average Hospital Charge
$66.60
Markup Ratio
8.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$66.60
Medicare Allowed$7.55
Medicare Payment$7.55

Hospitals charge 8.8x more than what Medicare allows for this procedure. Medicare actually pays $7.55 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$8$334717,537+0.1%
Georgia$8$38303,115+0.1%
Hawaii$8$693111+0.1%
Idaho$8$23819+0.1%
Illinois$8$82261,117+0.1%
Indiana$8$581232+0.1%
Iowa$8$6430172+0.1%
Kentucky$8$35613+0.1%
Maine$8$17218+0.1%
Maryland$8$1008507+0.1%
Michigan$8$4116138+0.1%
Mississippi$8$41318+0.1%
Missouri$8$1044555+0.1%
Nevada$8$793123+0.1%
New Jersey$8$92187,818+0.1%
New Mexico$8$70116+0.1%
Pennsylvania$8$11722458+0.1%
South Carolina$8$261466+0.1%
South Dakota$8$51821+0.1%
Tennessee$8$7815160+0.1%
Texas$8$108213,400+0.1%
Utah$8$171426+0.1%
Wyoming$8$628138+0.1%
Alaska$8$49343+0.1%
Arizona$8$7610577+0.1%
California$8$741024,356+0.1%
Colorado$8$9619444+0.1%
Connecticut$8$30765+0.1%
Massachusetts$8$99196360.0%
North Carolina$8$89216,8500.0%
New York$8$5645665-0.1%
Ohio$8$8911935-0.1%
Oregon$8$3222262-0.1%
Alabama$8$9371,840-0.1%
Oklahoma$8$934188-0.3%
Washington$8$7822789-0.3%
Minnesota$8$6244183-0.4%
Nebraska$8$3710137-0.4%
Louisiana$8$5914100-0.5%
Kansas$7$6318254-1.1%
North Dakota$7$38260-1.5%
Virginia$7$3334175-1.5%
Wisconsin$7$7713194-2.9%

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

Related from TheDataProject.ai

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