11102

Biopsy of related skin growth, first growth

Code 11102. Medicare covered 3,491,138 of these. Here is what providers billed and what Medicare allowed, state by state.

$225.32Billed, national avg
$83.05Medicare allowed
2.7xBilled vs allowed
3.5xHighest vs lowest state

Providers in Alaska billed the most for this, at $400.34. In Puerto Rico the average was $113.68. 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
Alaska$400.34$97.514.1x4,051
Wisconsin$386.20$67.965.7x36,020
Guam$334.28$94.953.5x179
Massachusetts$314.76$89.693.5x96,255
New York$282.99$97.562.9x194,626
Minnesota$280.52$75.263.7x32,689
Iowa$263.19$71.913.7x29,636
New Hampshire$258.77$74.123.5x20,367
Illinois$255.66$82.663.1x106,121
Oregon$254.83$82.013.1x37,026
Rhode Island$253.55$83.343.0x13,408
New Jersey$247.98$97.232.6x116,424
Connecticut$246.32$94.662.6x37,825
Nebraska$240.43$72.763.3x17,349
California$235.98$94.042.5x327,361
Georgia$233.81$79.652.9x121,458
Colorado$233.40$87.372.7x57,315
New Mexico$231.71$76.683.0x17,655
Wyoming$231.71$78.063.0x7,256
Indiana$226.86$76.473.0x52,847
Texas$226.78$81.282.8x228,660
Maine$225.03$81.422.8x11,037
Maryland$224.33$90.452.5x71,284
Washington$222.24$81.832.7x59,796
Hawaii$218.93$89.982.4x6,989
Missouri$215.71$76.792.8x52,721
Arizona$214.83$81.552.6x122,567
Kansas$214.31$76.032.8x32,243
Michigan$212.07$80.242.6x62,809
Louisiana$211.76$76.642.8x32,885
North Carolina$209.96$78.052.7x123,030
Nevada$209.83$80.542.6x24,038
Ohio$209.74$76.082.8x83,575
Montana$207.08$78.072.7x12,942
Virginia$206.04$84.502.4x106,434
South Carolina$205.50$77.812.6x79,364
District of Columbia$203.96$94.152.2x4,795
Utah$203.89$77.212.6x26,262
Alabama$201.50$74.022.7x49,954
Oklahoma$201.15$74.382.7x32,889
West Virginia$200.56$69.072.9x13,629
Pennsylvania$197.34$81.482.4x145,015
Tennessee$196.85$74.022.7x84,332
Florida$196.36$82.042.4x534,018
Kentucky$193.52$76.482.5x39,863
South Dakota$189.42$58.223.3x13,748
Idaho$187.37$71.932.6x17,461
Vermont$183.26$66.862.7x6,423
Mississippi$177.48$74.262.4x29,173
Delaware$175.77$85.192.1x15,862
Arkansas$157.28$68.652.3x32,967
North Dakota$148.05$48.043.1x6,415
Virgin Islands$114.71$89.981.3x63
Puerto Rico$113.68$92.661.2x2,016

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

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