87807

Detection test by immunoassay with direct visual observation for respiratory syncytial virus

Medicare pricing data for 9,896 providers across 51 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 immunoassay with direct visual observation for respiratory syncytial virus (HCPCS code 87807) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.76, but hospitals typically charge $45.48 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $12.76, your out-of-pocket cost would be approximately $2.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$12.76
Average Hospital Charge
$45.48
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$45.48
Medicare Allowed$12.76
Medicare Payment$12.73

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $12.73 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$13$4435101+0.6%
Hawaii$13$381271+0.6%
Idaho$13$2339132+0.6%
Kansas$13$5695165+0.6%
Minnesota$13$454365+0.6%
Montana$13$341225+0.6%
Oregon$13$504385+0.6%
South Dakota$13$511116+0.6%
Wyoming$13$6445155+0.6%
Colorado$13$43163308+0.6%
Massachusetts$13$372672,174+0.5%
Michigan$13$35217550+0.4%
Rhode Island$13$3129178+0.4%
Florida$13$435081,835+0.3%
Maryland$13$372881,213+0.3%
New Jersey$13$58173734+0.3%
Arizona$13$55126340+0.3%
Arkansas$13$34216549+0.3%
California$13$397183,200+0.3%
Nebraska$13$4784169+0.2%
New York$13$553771,840+0.2%
North Carolina$13$684481,372+0.2%
Iowa$13$37117198+0.2%
Missouri$13$47182350+0.2%
New Mexico$13$4875222+0.2%
Connecticut$13$38129300+0.2%
Ohio$13$42250592+0.1%
West Virginia$13$5067190+0.1%
Oklahoma$13$523291,0890.0%
Texas$13$559093,9450.0%
Virginia$13$444651,8140.0%
Illinois$13$423721,027-0.2%
Louisiana$13$51248615-0.2%
Delaware$13$4224112-0.2%
Mississippi$13$36195554-0.2%
Nevada$13$5646113-0.2%
Washington$13$39117280-0.2%
Indiana$13$353581,419-0.4%
Georgia$13$444211,277-0.5%
South Carolina$13$532701,261-0.5%
Pennsylvania$13$4287224-0.6%
Kentucky$13$37417968-0.8%
Alabama$13$31297736-0.9%
Alaska$13$522096-0.9%
New Hampshire$13$6286188-0.9%
Wisconsin$13$6743123-0.9%
Tennessee$13$39318680-1.0%
Maine$13$421350-1.1%
Utah$13$355794-2.0%
North Dakota$12$57411-7.8%
Vermont$12$252436-8.8%

⚠️ 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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