87631

Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets

Medicare pricing data for 2,352 providers across 48 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 multiple types of respiratory virus, multiple types or subtypes, 3-5 targets (HCPCS code 87631) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $139.21, but hospitals typically charge $296.41 — a 2.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$27.84

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $139.21, your out-of-pocket cost would be approximately $27.84. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$139.21
Average Hospital Charge
$296.41
Markup Ratio
2.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$296.41
Medicare Allowed$139.21
Medicare Payment$139.21

Hospitals charge 2.1x more than what Medicare allows for this procedure. Medicare actually pays $139.21 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$140$206621+0.4%
Idaho$140$200938+0.4%
Kansas$140$286171,374+0.4%
Maine$140$205259+0.4%
Montana$140$2691658+0.4%
Nevada$140$3806525+0.4%
New Hampshire$140$279476+0.4%
North Dakota$140$409557+0.4%
South Carolina$140$21813144+0.4%
Vermont$140$2501040+0.4%
West Virginia$140$233559+0.4%
Wisconsin$140$48058311+0.4%
Alaska$140$5002456+0.4%
Mississippi$140$190231,195+0.4%
Illinois$140$286844,939+0.4%
Massachusetts$140$696921,159+0.3%
Kentucky$140$29950231+0.3%
Pennsylvania$140$286868,050+0.3%
New York$140$4052155,321+0.3%
Virginia$140$42318868+0.3%
Colorado$140$214371,506+0.3%
Arizona$140$278171,307+0.3%
Washington$140$3312464,212+0.3%
Maryland$140$55925956+0.3%
Missouri$140$33023154+0.2%
Texas$140$24617961,019+0.2%
Delaware$139$21116410+0.2%
California$139$24011819,425+0.2%
Iowa$139$43246380+0.1%
New Jersey$139$50621415,905+0.1%
Connecticut$139$156921,450+0.1%
Oklahoma$139$2489942+0.0%
Georgia$139$31221326+0.0%
Arkansas$139$24668927-0.0%
North Carolina$139$22442968-0.0%
Michigan$139$26451619-0.2%
Oregon$139$26129156-0.2%
Minnesota$139$37628774-0.2%
Florida$139$3229910,378-0.3%
Hawaii$139$417474-0.4%
South Dakota$138$283821-0.5%
Tennessee$138$36346265-0.6%
Nebraska$138$25418256-0.7%
Wyoming$138$18110132-0.9%
Indiana$137$25731195-1.4%
Ohio$136$30016995-2.6%
Louisiana$135$259351,265-2.9%
Alabama$130$200733,061-6.4%

⚠️ 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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