87077

Bacterial culture for aerobic isolates

Code 87077. Medicare covered 1,941,666 of these. Here is what providers billed and what Medicare allowed, state by state.

$32.76Billed, national avg
$7.91Medicare allowed
4.1xBilled vs allowed
9.1xHighest vs lowest state

Providers in Wyoming billed the most for this, at $82.49. In Puerto Rico the average was $9.03. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Wyoming$82.49$7.8910.5x218
South Dakota$70.68$7.908.9x7,609
Wisconsin$60.63$7.847.7x21,534
Mississippi$47.91$7.886.1x3,939
Minnesota$47.84$7.886.1x12,880
Montana$47.43$7.476.4x14
New York$45.22$7.915.7x88,394
Kentucky$43.76$7.875.6x6,369
North Dakota$42.88$7.845.5x1,630
Tennessee$40.73$7.905.2x70,257
Idaho$39.15$7.895.0x2,371
Kansas$38.57$7.924.9x50,218
Virginia$37.49$7.914.7x39,457
Pennsylvania$37.35$7.924.7x39,732
Missouri$35.53$7.924.5x12,277
California$35.29$7.904.5x216,704
Massachusetts$34.46$7.924.4x63,276
Maryland$33.86$7.914.3x27,437
Connecticut$33.52$7.904.2x1,191
Georgia$33.15$7.914.2x66,444
Florida$33.14$7.924.2x212,344
Utah$33.12$7.904.2x8,037
Illinois$32.60$7.914.1x72,539
Nevada$30.29$7.913.8x12,215
Ohio$30.27$7.913.8x69,424
North Carolina$29.86$7.913.8x118,789
New Jersey$29.22$7.913.7x221,591
Louisiana$29.08$7.883.7x12,253
Colorado$28.98$7.903.7x19,092
Michigan$28.93$7.903.7x8,491
Texas$28.90$7.913.7x181,383
West Virginia$28.81$7.893.7x252
Iowa$28.78$7.903.6x11,882
Oklahoma$27.96$7.913.5x27,582
Virgin Islands$27.95$7.923.5x35
Washington$26.86$7.903.4x37,799
New Hampshire$26.36$7.903.3x1,021
Hawaii$25.44$7.913.2x8,494
New Mexico$25.31$7.893.2x5,083
Nebraska$25.10$7.913.2x7,022
Indiana$24.46$7.903.1x10,362
Alabama$24.41$7.913.1x57,625
Arizona$24.30$7.903.1x63,953
Rhode Island$24.13$7.913.1x4,372
South Carolina$22.82$7.872.9x8,903
Arkansas$20.64$7.912.6x7,020
Oregon$18.58$7.852.4x18,313
Maine$18.05$7.902.3x1,827
Delaware$16.08$7.922.0x1,245
District of Columbia$9.79$7.921.2x146
Puerto Rico$9.03$7.891.1x577

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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