87634

Detection test by nucleic acid for respiratory syncytial virus, amplified probe technique

Medicare pricing data for 3,118 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 respiratory syncytial virus, amplified probe technique (HCPCS code 87634) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $68.63, but hospitals typically charge $130.42 — a 1.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$13.73

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $68.63, your out-of-pocket cost would be approximately $13.73. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$68.63
Average Hospital Charge
$130.42
Markup Ratio
1.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$130.42
Medicare Allowed$68.63
Medicare Payment$68.63

Hospitals charge 1.9x more than what Medicare allows for this procedure. Medicare actually pays $68.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$69$722112+0.2%
Idaho$69$1602146+0.2%
Maine$69$1511898+0.2%
Montana$69$1661350+0.2%
Nevada$69$176520+0.2%
New Hampshire$69$295855+0.2%
Oklahoma$69$12044742+0.2%
Rhode Island$69$143368+0.2%
South Dakota$69$1651976+0.2%
Utah$69$1072643+0.2%
West Virginia$69$158925+0.2%
Wisconsin$69$230272,974+0.2%
Wyoming$69$1031241+0.2%
Alaska$69$2891321+0.2%
Florida$69$137709,527+0.2%
Illinois$69$16222013,075+0.2%
Pennsylvania$69$107382,237+0.2%
California$69$10827230,662+0.2%
New York$69$1472269,904+0.1%
Texas$69$12614738,322+0.1%
Kentucky$69$10458156+0.1%
Hawaii$69$18310192-0.1%
Massachusetts$69$238133714-0.1%
Maryland$69$21121149-0.1%
Tennessee$69$117127541-0.1%
Arkansas$69$13743243-0.2%
Washington$69$17989643-0.2%
Colorado$68$161127405-0.2%
New Mexico$68$20022410-0.2%
Michigan$68$16675913-0.3%
Arizona$68$22112152-0.3%
Missouri$68$136117279-0.5%
Ohio$68$12448218-0.5%
Iowa$68$17659193-0.5%
Minnesota$68$19159129-0.5%
North Carolina$68$148228972-0.6%
Virginia$68$15032365-0.7%
Louisiana$68$1521161,081-0.7%
Mississippi$68$144113874-0.7%
Nebraska$68$7618175-0.7%
South Carolina$68$15459161-0.8%
New Jersey$68$90617,535-1.5%
Alabama$68$9870516-1.5%
Oregon$68$13630116-1.6%
Georgia$67$17074550-1.7%
Kansas$67$18245157-2.0%
Connecticut$67$10623249-2.7%
Indiana$64$8944215-7.0%

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

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