87150

Identification of organisms by genetic analysis, amplified probe technique

Code 87150. Medicare covered 1,457,908 of these. Here is what providers billed and what Medicare allowed, state by state.

$64.75Billed, national avg
$34.30Medicare allowed
1.9xBilled vs allowed
5.4xHighest vs lowest state

Providers in South Dakota billed the most for this, at $202.66. In Oklahoma the average was $37.21. 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
South Dakota$202.66$34.395.9x137
Minnesota$170.42$34.365.0x271
Maryland$148.39$34.394.3x4,728
Washington$146.01$34.394.2x90
Ohio$145.16$34.314.2x896
Wisconsin$142.90$34.394.2x128
Alabama$130.83$34.393.8x352
Kansas$121.86$34.393.5x26
Connecticut$105.36$34.393.1x17
North Carolina$97.25$34.222.8x1,613
New York$86.75$33.032.6x19,424
Illinois$84.70$34.372.5x18,988
Texas$83.80$34.242.4x348,647
Iowa$75.63$34.392.2x238
New Jersey$74.40$33.712.2x63,952
Florida$72.86$34.382.1x219,504
Missouri$70.18$34.392.0x760
Mississippi$70.00$34.392.0x5,324
Pennsylvania$69.01$34.382.0x136,109
Nevada$68.84$34.392.0x1,529
Tennessee$57.35$34.391.7x129
Idaho$55.01$34.391.6x2,277
California$51.66$34.391.5x256,843
Arizona$50.08$34.391.5x169,329
Louisiana$49.85$34.181.5x5,560
Arkansas$48.74$34.391.4x19
Colorado$46.03$34.391.3x2,297
Virginia$44.19$34.371.3x25,589
Indiana$39.04$34.391.1x112,545
Oklahoma$37.21$34.391.1x60,464

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

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