87640

Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique

Code 87640. Medicare covered 876,008 of these. Here is what providers billed and what Medicare allowed, state by state.

$58.61Billed, national avg
$34.35Medicare allowed
1.7xBilled vs allowed
5.1xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $180.42. In North Carolina the average was $35.59. 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
Wisconsin$180.42$33.575.4x2,060
Wyoming$151.07$34.344.4x469
North Dakota$142.69$34.394.1x13
Missouri$124.75$34.363.6x4,429
Maine$106.62$34.393.1x48
New York$103.22$34.343.0x23,302
Utah$98.74$34.392.9x3,298
Massachusetts$96.37$34.362.8x5,833
Oregon$84.12$34.332.5x416
Minnesota$83.31$34.392.4x276
New Hampshire$80.65$34.252.4x549
Maryland$79.72$34.362.3x27,644
New Mexico$79.24$34.132.3x599
Kansas$77.86$34.342.3x465
New Jersey$77.76$34.342.3x22,626
Iowa$73.14$34.392.1x509
Mississippi$71.85$34.312.1x16,667
Connecticut$70.70$34.392.1x1,066
Arkansas$70.67$34.282.1x26,214
Nevada$70.49$34.392.0x184
Tennessee$70.23$34.332.0x3,405
Michigan$68.90$34.262.0x2,423
Nebraska$67.92$34.312.0x707
Florida$65.43$34.321.9x82,973
Virginia$62.22$34.011.8x5,230
Delaware$61.86$34.341.8x4,322
Illinois$61.04$34.351.8x30,384
Georgia$60.19$34.311.8x1,006
Idaho$57.54$34.391.7x68
South Carolina$56.40$31.891.8x117
Kentucky$55.81$34.391.6x105
Rhode Island$55.80$34.171.6x300
Pennsylvania$55.31$34.381.6x48,966
Washington$54.64$34.181.6x358
Oklahoma$54.42$34.321.6x16,340
Texas$53.69$34.371.6x312,660
Ohio$53.00$34.381.5x1,315
Louisiana$50.10$34.071.5x20,770
California$49.30$34.391.4x133,828
Colorado$47.91$34.381.4x22,049
West Virginia$47.09$34.391.4x50
Arizona$42.92$34.381.2x26,635
Indiana$40.57$34.391.2x15,032
Alabama$38.61$33.081.2x1,406
District of Columbia$36.47$34.391.1x46
North Carolina$35.59$34.391.0x8,824

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

← All procedures