00142

Anesthesia for lens surgery

Code 00142. Medicare covered 1,702,334 of these. Here is what providers billed and what Medicare allowed, state by state.

$887.34Billed, national avg
$94.93Medicare allowed
9.3xBilled vs allowed
7.6xHighest vs lowest state

Providers in Foreign Country billed the most for this, at $1,536.60. In Guam the average was $202.40. 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
Foreign Country$1,536.60$104.3114.7x155
Arizona$1,281.21$107.0512.0x35,051
New York$1,233.88$97.3212.7x95,244
Texas$1,177.75$85.2213.8x130,859
Wisconsin$1,131.52$86.3413.1x26,040
Armed Forces Europe$1,092.44$114.229.6x155
New Jersey$1,021.92$106.089.6x44,836
Illinois$1,006.63$98.8010.2x63,964
New Mexico$973.80$102.129.5x10,469
Maryland$964.03$112.128.6x39,036
North Carolina$961.60$71.3913.5x65,417
California$955.30$122.277.8x130,515
Florida$921.31$100.589.2x113,239
Virginia$914.10$82.5511.1x57,618
Georgia$912.60$83.5410.9x55,172
District of Columbia$910.16$85.4710.6x4,594
Connecticut$889.70$77.1911.5x23,891
New Hampshire$886.62$103.068.6x11,125
Alaska$881.88$139.996.3x3,753
Colorado$861.46$96.868.9x23,386
Louisiana$849.24$101.548.4x22,195
Delaware$844.91$94.259.0x5,098
Missouri$843.64$97.178.7x36,280
Pennsylvania$840.70$82.3710.2x92,946
Hawaii$835.17$114.387.3x3,859
Michigan$832.93$80.9810.3x49,766
Rhode Island$818.83$96.828.5x5,501
Massachusetts$797.26$97.788.2x45,089
South Carolina$793.79$83.369.5x40,589
Nevada$793.19$102.777.7x13,289
Wyoming$777.24$111.407.0x1,956
Tennessee$775.15$96.018.1x49,580
Minnesota$730.81$79.359.2x27,481
Armed Forces Pacific$730.00$118.246.2x12
Indiana$714.11$96.727.4x29,259
Montana$701.78$110.336.4x6,021
Maine$688.02$102.396.7x6,515
North Dakota$687.10$100.966.8x6,596
Oregon$672.51$107.356.3x12,748
Ohio$662.32$90.427.3x62,081
Iowa$660.78$105.106.3x19,991
Utah$640.19$104.666.1x10,308
Vermont$631.32$87.117.2x3,634
Idaho$617.62$100.096.2x7,786
West Virginia$612.42$84.187.3x10,087
Kansas$611.80$100.846.1x24,077
Washington$608.70$104.805.8x35,721
Alabama$603.56$65.609.2x29,950
Arkansas$599.90$101.415.9x16,667
Kentucky$587.54$98.026.0x26,255
Nebraska$571.76$101.145.7x14,712
Oklahoma$564.18$99.095.7x20,420
Mississippi$529.74$89.855.9x18,994
South Dakota$481.78$94.795.1x10,812
Northern Mariana Islands$357.98$147.232.4x21
Puerto Rico$355.11$184.791.9x852
Virgin Islands$305.11$135.732.2x99
Guam$202.40$132.591.5x518

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

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