87088

Bacterial urine culture

Code 87088. Medicare covered 2,217,560 of these. Here is what providers billed and what Medicare allowed, state by state.

$31.20Billed, national avg
$7.92Medicare allowed
3.9xBilled vs allowed
8.5xHighest vs lowest state

Providers in Wyoming billed the most for this, at $77.21. In Puerto Rico the average was $9.11. 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$77.21$7.939.7x373
Wisconsin$61.64$7.847.9x11,113
Iowa$43.29$7.725.6x32
South Dakota$42.76$7.925.4x1,057
Vermont$40.11$7.935.1x18
North Dakota$38.64$7.924.9x424
Minnesota$36.91$7.904.7x7,947
Missouri$36.12$7.934.6x15,525
Kansas$36.05$7.934.5x64,698
Maryland$36.03$7.934.5x33,958
Georgia$35.85$7.934.5x83,274
Virginia$35.67$7.924.5x29,223
Idaho$34.65$7.924.4x900
Illinois$34.44$7.934.3x90,731
Nevada$33.86$7.934.3x20,760
Massachusetts$33.70$7.934.2x90,257
California$33.29$7.914.2x244,988
Florida$32.67$7.934.1x271,368
New Jersey$31.67$7.924.0x302,196
Texas$31.65$7.924.0x215,558
Indiana$31.53$7.914.0x8,340
Louisiana$31.40$7.924.0x15,851
Colorado$31.35$7.924.0x28,795
Arkansas$30.78$7.574.1x317
South Carolina$30.15$7.923.8x19,727
Pennsylvania$29.36$7.933.7x51,871
North Carolina$29.23$7.923.7x143,292
Mississippi$28.41$7.913.6x853
Oklahoma$28.29$7.923.6x33,066
Montana$28.06$7.853.6x67
Washington$27.75$7.923.5x45,855
New Hampshire$27.75$7.933.5x20
Michigan$27.49$7.913.5x10,264
Ohio$26.76$7.923.4x68,013
Maine$26.54$7.903.4x245
Connecticut$26.50$7.893.4x1,133
New York$26.24$7.933.3x85,930
Tennessee$25.63$7.913.2x13,353
Alabama$24.52$7.923.1x63,963
Arizona$24.26$7.923.1x97,626
Oregon$23.14$7.862.9x9,407
West Virginia$22.02$7.932.8x209
Utah$21.99$7.892.8x5,770
Nebraska$21.85$7.912.8x266
New Mexico$20.93$7.892.7x130
Hawaii$19.94$7.912.5x7,247
Delaware$16.01$7.932.0x1,529
Kentucky$15.88$7.922.0x9,341
Virgin Islands$12.00$7.931.5x1,233
District of Columbia$11.18$7.881.4x153
Puerto Rico$9.11$7.891.2x9,253

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

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