87498

Detection test by nucleic acid for enterovirus (intestinal virus), amplified probe technique

Medicare pricing data for 196 providers across 24 states

🤖AI Overview

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 test by nucleic acid for enterovirus (intestinal virus), amplified probe technique (HCPCS code 87498) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.38, but hospitals typically charge $58.64 — a 1.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.88

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $34.38, your out-of-pocket cost would be approximately $6.88. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$34.38
Average Hospital Charge
$58.64
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$58.64
Medicare Allowed$34.38
Medicare Payment$34.38

Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $34.38 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$34$351109+0.0%
Florida$34$69142,456+0.0%
Georgia$34$67421+0.0%
Illinois$34$4651,967+0.0%
Indiana$34$393486+0.0%
Kansas$34$211212+0.0%
Michigan$34$546108+0.0%
Mississippi$34$705134+0.0%
Nevada$34$159213+0.0%
New York$34$654418+0.0%
North Carolina$34$613247+0.0%
Ohio$34$709385+0.0%
Pennsylvania$34$932154+0.0%
Texas$34$605845,499+0.0%
Arkansas$34$513285+0.0%
California$34$521515,911+0.0%
Louisiana$34$842658-0.1%
New Jersey$34$6791,433-0.1%
Maryland$34$462292-0.1%
Oklahoma$34$647486-0.1%
Virginia$34$674177-0.5%
Missouri$34$5321,613-0.6%
Alabama$34$4710440-2.3%
New Mexico$34$78539-2.5%

⚠️ 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