The billed number was never a price
A provider billed $188 for a routine office visit. Medicare paid $83.79. Neither number is wrong. Only one of them is real.
We publish CMS pricing for the 60 procedures Medicare pays for most often. Two columns sit side by side on every page. Billed, and allowed.
They rarely agree. Across the top 60, the widest gap runs past 10x.
What each column is
Billed is the charge a provider submitted. Allowed is what Medicare agreed to pay. The provider takes the allowed amount and the difference evaporates.
It does not get collected. It was never going to be. For a Medicare patient the billed figure is a number on a form and nothing else.
Code 99213 gets billed at about $188 across the country. Medicare allows $83.79. The same code in the highest-billing state carries 2.7x what the lowest-billing state does.
Why the gap exists at all
Hospitals keep a chargemaster. It is a list of prices almost nobody pays. Medicare sets its own rates by formula, private insurers negotiate their own, and each lands well under the list.
So the chargemaster drifts. Nothing anchors it, because the number it produces is a starting position rather than a bill anyone settles.
Who the gap lands on
Medicare patients never see this gap. Insured patients rarely do.
The uninsured start from that first column. They are the only group negotiating against the number nobody else pays, without the leverage a payer brings. A 10x gap is abstract until you are the one holding the invoice.
What to do with these pages
- Look up the procedure code before a scheduled visit. It appears on your paperwork.
- Compare your state against the national allowed amount, not against the billed one.
- Treat the allowed column as the anchor when you ask a provider what something costs.
- If you have no cover, ask what they accept from Medicare. It is a real number and it is public.
The full data sits here, procedure by procedure and state by state.
Sources
All figures come from CMS Medicare data we publish in full. These are Medicare amounts. They are not what an uninsured patient pays and not what a private insurer negotiates.