Virus isolation
Medicare pricing data for 116 providers across 22 states
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
Virus isolation (HCPCS code 87255) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $33.02, but hospitals typically charge $134.03 — a 4.1x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $33.02, your out-of-pocket cost would be approximately $6.60. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 4.1x more than what Medicare allows for this procedure. Medicare actually pays $33.02 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Illinois | $33 | $107 | 1 | 199 | +0.5% |
| Kansas | $33 | $107 | 3 | 111 | +0.5% |
| Maryland | $33 | $109 | 4 | 102 | +0.5% |
| Massachusetts | $33 | $107 | 6 | 366 | +0.5% |
| Nevada | $33 | $108 | 1 | 14 | +0.5% |
| New York | $33 | $132 | 7 | 177 | +0.5% |
| Oklahoma | $33 | $107 | 2 | 16 | +0.5% |
| Tennessee | $33 | $118 | 2 | 55 | +0.5% |
| Texas | $33 | $104 | 9 | 191 | +0.5% |
| Utah | $33 | $71 | 5 | 29 | +0.5% |
| Alabama | $33 | $162 | 2 | 236 | +0.5% |
| Arizona | $33 | $152 | 4 | 33 | +0.5% |
| Ohio | $33 | $148 | 5 | 173 | +0.5% |
| New Jersey | $33 | $133 | 4 | 1,270 | +0.4% |
| Florida | $33 | $110 | 6 | 304 | +0.3% |
| Washington | $33 | $135 | 3 | 136 | +0.3% |
| North Carolina | $33 | $165 | 6 | 2,026 | +0.2% |
| West Virginia | $33 | $147 | 1 | 35 | +0.2% |
| Georgia | $33 | $107 | 2 | 162 | +0.1% |
| Pennsylvania | $33 | $107 | 3 | 125 | +0.0% |
| California | $33 | $105 | 22 | 744 | -0.6% |
| Virginia | $27 | $47 | 5 | 65 | -18.3% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber