87186

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution

Code 87186. Medicare covered 2,748,294 of these. Here is what providers billed and what Medicare allowed, state by state.

$55.03Billed, national avg
$8.47Medicare allowed
6.5xBilled vs allowed
12.1xHighest vs lowest state

Providers in Virgin Islands billed the most for this, at $119.89. In Delaware the average was $9.87. 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
Virgin Islands$119.89$8.4814.1x30
West Virginia$92.67$8.4211.0x279
Wyoming$81.21$8.459.6x259
North Carolina$80.83$8.479.5x167,138
Missouri$75.92$8.489.0x12,147
South Carolina$75.21$8.478.9x20,263
Washington$72.06$8.468.5x44,938
Colorado$69.97$8.478.3x27,143
California$69.62$8.488.2x241,756
Kansas$69.41$8.488.2x54,227
Nevada$68.80$8.478.1x11,135
Massachusetts$67.61$8.488.0x63,821
Alabama$64.67$8.477.6x75,434
Maine$63.78$8.467.5x1,741
New Jersey$61.87$8.477.3x274,802
Louisiana$61.53$8.437.3x27,276
Georgia$60.89$8.477.2x69,231
Wisconsin$59.84$8.377.1x25,414
Ohio$57.03$8.476.7x104,009
Illinois$55.79$8.476.6x85,026
Texas$53.57$8.476.3x276,847
Virginia$53.56$8.466.3x56,112
Pennsylvania$52.64$8.476.2x50,651
Montana$51.00$8.036.4x15
New York$50.71$8.476.0x101,091
Mississippi$50.55$8.466.0x8,831
South Dakota$48.36$8.465.7x6,533
Maryland$48.04$8.475.7x85,015
Arizona$47.26$8.475.6x82,954
Hawaii$45.57$8.475.4x14,189
Minnesota$45.54$8.435.4x17,115
Oklahoma$44.39$8.475.2x54,994
Oregon$40.82$8.464.8x20,335
Florida$40.07$8.464.7x490,453
Tennessee$40.05$8.464.7x70,385
North Dakota$39.14$8.414.7x1,835
Iowa$37.76$8.464.5x10,673
Indiana$35.58$8.464.2x13,183
Connecticut$34.67$8.464.1x1,339
Idaho$34.36$8.454.1x2,109
Utah$32.38$8.453.8x9,520
New Hampshire$29.33$8.463.5x1,019
Michigan$28.99$8.213.5x11,082
Rhode Island$27.28$8.473.2x4,397
New Mexico$26.81$8.453.2x4,293
Nebraska$25.59$8.463.0x6,333
Kentucky$18.59$8.462.2x18,608
Puerto Rico$15.71$8.461.9x6,573
Arkansas$15.56$8.471.8x7,071
District of Columbia$13.81$8.481.6x152
Delaware$9.87$8.481.2x8,474

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

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