87476

Detection by nucleic acid for borrelia burgdorferi (bacteria), amplified probe technique

Medicare pricing data for 103 providers across 19 states

🤖AI Overview

This procedure has a 11.4x markup — hospitals charge $392.28 but Medicare allows only $34.34. Uninsured patients may face bills 11.4 times higher than what insurance negotiates. 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

Detection by nucleic acid for borrelia burgdorferi (bacteria), amplified probe technique (HCPCS code 87476) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.34, but hospitals typically charge $392.28 — a 11.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.87

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $34.34, your out-of-pocket cost would be approximately $6.87. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$34.34
Average Hospital Charge
$392.28
Markup Ratio
11.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$392.28
Medicare Allowed$34.34
Medicare Payment$34.34

Hospitals charge 11.4x more than what Medicare allows for this procedure. Medicare actually pays $34.34 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$34$533349+0.1%
Kansas$34$583419+0.1%
Massachusetts$34$346847+0.1%
Minnesota$34$196652+0.1%
New Mexico$34$143111+0.1%
New York$34$2448399+0.1%
Pennsylvania$34$263366+0.1%
Tennessee$34$97242+0.1%
Texas$34$308677+0.1%
Utah$34$70127+0.1%
Washington$34$489217+0.1%
Wisconsin$34$380220+0.1%
Alabama$34$613143+0.1%
Arizona$34$562217+0.1%
Connecticut$34$265117+0.1%
California$34$14761,367+0.1%
New Jersey$34$43892,037+0.1%
North Carolina$34$59841,600+0.0%
Ohio$34$4764164-1.0%

⚠️ 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