87481

Detection test for candida species (yeast), amplified probe technique

Medicare pricing data for 2,964 providers across 47 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 2.0 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Detection test for candida species (yeast), amplified probe technique (HCPCS code 87481) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.16, but hospitals typically charge $63.14 — a 1.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.83

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $34.16, your out-of-pocket cost would be approximately $6.83. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$34.16
Average Hospital Charge
$63.14
Markup Ratio
1.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$63.14
Medicare Allowed$34.16
Medicare Payment$34.16

Hospitals charge 1.8x more than what Medicare allows for this procedure. Medicare actually pays $34.16 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Idaho$34$6411194+0.7%
Louisiana$34$667148,517+0.7%
New Hampshire$34$422169+0.7%
Rhode Island$34$66140+0.7%
South Carolina$34$6310212+0.7%
Utah$34$105154,064+0.7%
Virginia$34$695737,976+0.7%
West Virginia$34$103281+0.7%
Wyoming$34$355153+0.7%
Pennsylvania$34$4522317,357+0.6%
Maryland$34$817879,427+0.6%
Michigan$34$512911,257+0.6%
Ohio$34$691812,673+0.6%
Oklahoma$34$584173,671+0.6%
Colorado$34$828337,792+0.6%
North Carolina$34$46117,181+0.6%
Texas$34$60489542,327+0.6%
Massachusetts$34$84698,566+0.6%
Nevada$34$7810920+0.6%
Arizona$34$6111015,607+0.6%
Kansas$34$74334,738+0.5%
Arkansas$34$684736,674+0.5%
Delaware$34$85243,148+0.5%
Minnesota$34$684024,018+0.5%
Mississippi$34$846970,159+0.5%
New York$34$12313758,782+0.5%
Florida$34$58129167,947+0.4%
Nebraska$34$62201,635+0.4%
Kentucky$34$65201,742+0.4%
New Mexico$34$92132,152+0.4%
Tennessee$34$74357,299+0.4%
Illinois$34$559783,130+0.3%
California$34$58182204,171+0.3%
Washington$34$822148,301+0.2%
Puerto Rico$34$415148+0.0%
Maine$34$5511170.0%
Wisconsin$34$132182,965-0.1%
Iowa$34$709807-0.2%
Connecticut$34$6610670-0.4%
Oregon$34$641142,310-0.6%
New Jersey$34$9511190,977-0.6%
Georgia$34$65381,022-1.0%
Alabama$34$46272,572-1.1%
District of Columbia$33$45387-3.0%
Alaska$32$109339-7.1%
Missouri$32$51136,204-7.4%
Indiana$23$265026,372-32.8%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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