87581

Detection test by nucleic acid for mycoplasma pneumoniae (bacteria), amplified probe technique

Medicare pricing data for 641 providers across 39 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 mycoplasma pneumoniae (bacteria), amplified probe technique (HCPCS code 87581) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.36, but hospitals typically charge $59.50 — a 1.7x 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 $34.36, 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
$34.36
Average Hospital Charge
$59.50
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$59.50
Medicare Allowed$34.36
Medicare Payment$34.36

Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $34.36 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$34$37117+0.1%
District of Columbia$34$351111+0.1%
Idaho$34$42215+0.1%
Indiana$34$536525+0.1%
Iowa$34$13231227+0.1%
Kansas$34$94492+0.1%
Michigan$34$6111119+0.1%
Minnesota$34$6020590+0.1%
Nebraska$34$608102+0.1%
Nevada$34$826457+0.1%
New Mexico$34$1086530+0.1%
North Carolina$34$929255+0.1%
North Dakota$34$124228+0.1%
Pennsylvania$34$51177,868+0.1%
Utah$34$1051170+0.1%
Virginia$34$615409+0.1%
West Virginia$34$105258+0.1%
Wisconsin$34$10552,944+0.1%
Puerto Rico$34$39611+0.1%
Arizona$34$5161,283+0.1%
Arkansas$34$504290+0.1%
Florida$34$66628,242+0.1%
New Jersey$34$85257,297+0.1%
New York$34$731616,928+0.1%
California$34$496740,249+0.1%
Colorado$34$4471,004+0.1%
Texas$34$5912463,923+0.0%
Illinois$34$50183,3200.0%
Oklahoma$34$41125,703-0.0%
Mississippi$34$56271,489-0.1%
Ohio$34$698444-0.1%
Maryland$34$909661-0.2%
Kentucky$34$1034184-0.4%
Missouri$34$5321,543-0.5%
Oregon$34$6324151-0.5%
Louisiana$34$7121988-0.6%
Washington$34$5223265-1.3%
Tennessee$34$52781-2.2%
Alabama$31$4315541-8.6%

⚠️ 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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