87800

Detection test by nucleic acid for multiple organisms, direct probe(s) technique

Medicare pricing data for 395 providers across 20 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 organisms, direct probe(s) technique (HCPCS code 87800) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $42.65, but hospitals typically charge $172.73 — a 4.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$8.53

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $42.65, your out-of-pocket cost would be approximately $8.53. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$42.65
Average Hospital Charge
$172.73
Markup Ratio
4.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$172.73
Medicare Allowed$42.65
Medicare Payment$42.65

Hospitals charge 4.0x more than what Medicare allows for this procedure. Medicare actually pays $42.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Iowa$43$1802137+0.4%
Massachusetts$43$6040367+0.4%
Nebraska$43$395618+0.4%
Ohio$43$104321+0.4%
Oklahoma$43$78169+0.4%
Oregon$43$89915+0.4%
South Carolina$43$200226+0.4%
Wisconsin$43$19622104+0.4%
Alaska$43$295726+0.4%
Arkansas$43$112666+0.4%
California$43$557539+0.4%
New York$43$257132,359+0.3%
Connecticut$43$12636483+0.1%
Georgia$43$1386246-0.1%
Pennsylvania$43$1641998-0.3%
Texas$42$106173669-0.4%
Kansas$42$138276-0.6%
Maryland$42$1752143-0.8%
Washington$42$1231265-0.8%
Mississippi$42$99322-2.5%

⚠️ 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