87185

Detection of antimicrobial drug (antibiotic, antifungal, antiviral)

Medicare pricing data for 369 providers across 34 states

🤖AI Overview

This procedure has a 6.6x markup — hospitals charge $30.33 but Medicare allows only $4.63. Uninsured patients may face bills 6.6 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

Detection of antimicrobial drug (antibiotic, antifungal, antiviral) (HCPCS code 87185) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $4.63, but hospitals typically charge $30.33 — a 6.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$0.93

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $4.63, your out-of-pocket cost would be approximately $0.93. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$4.63
Average Hospital Charge
$30.33
Markup Ratio
6.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$30.33
Medicare Allowed$4.63
Medicare Payment$4.63

Hospitals charge 6.6x more than what Medicare allows for this procedure. Medicare actually pays $4.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$5$582331+0.4%
Hawaii$5$7169+0.4%
Iowa$5$31288+0.4%
Maryland$5$286604+0.4%
Massachusetts$5$5515172+0.4%
Michigan$5$8424+0.4%
Mississippi$5$72220+0.4%
Missouri$5$51191+0.4%
Nebraska$5$16120+0.4%
New Jersey$5$608265+0.4%
New York$5$16742,238+0.4%
North Carolina$5$65165+0.4%
Pennsylvania$5$3710238+0.4%
South Dakota$5$36217+0.4%
Tennessee$5$182105+0.4%
Utah$5$132744+0.4%
Washington$5$40787+0.4%
Wisconsin$5$39550+0.4%
Alabama$5$83711+0.4%
Arizona$5$17221+0.4%
California$5$31402,518+0.4%
Colorado$5$55132+0.4%
Illinois$5$4014589+0.2%
Kansas$5$487225+0.2%
Texas$5$3445804+0.2%
Oregon$5$93430.0%
Minnesota$5$4929100-0.4%
Virginia$5$134156-0.4%
Puerto Rico$5$6833-1.7%
Oklahoma$5$323259-2.6%
Ohio$4$31698-3.2%
Indiana$4$32266-3.5%
Florida$4$4610747-3.7%
Kentucky$4$141326-12.3%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber