87561

Detection test by nucleic acid for mycobacteria avium-intracellulare (bacteria), amplified probe technique

Medicare pricing data for 46 providers across 5 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 mycobacteria avium-intracellulare (bacteria), amplified probe technique (HCPCS code 87561) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.38, but hospitals typically charge $57.77 — 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
$57.77
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$57.77
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
Illinois$34$53196+0.0%
Pennsylvania$34$522452+0.0%
California$34$5497,193+0.0%
Texas$34$65173,469-0.0%
Louisiana$34$701316-0.6%

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

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