52000

Diagnostic exam of bladder and urethra using an endoscope

Code 52000. Medicare covered 826,866 of these. Here is what providers billed and what Medicare allowed, state by state.

$804.76Billed, national avg
$197.91Medicare allowed
4.1xBilled vs allowed
7.0xHighest vs lowest state

Providers in Alaska billed the most for this, at $2,032.42. In Puerto Rico the average was $291.67. 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$2,032.42$210.159.7x1,674
New Jersey$1,432.90$239.066.0x23,914
Colorado$1,379.23$201.146.9x15,442
Wisconsin$1,305.78$158.188.3x11,419
Maryland$1,302.85$191.976.8x37,117
New York$1,038.81$218.154.8x52,693
South Dakota$998.98$142.227.0x3,842
Georgia$960.04$186.225.2x28,663
Minnesota$883.36$195.734.5x11,527
Connecticut$877.19$210.444.2x7,984
Texas$875.33$204.124.3x46,044
Massachusetts$862.77$221.643.9x24,814
Nebraska$843.58$168.815.0x8,856
Guam$826.46$250.263.3x194
Wyoming$821.77$209.743.9x1,400
Oregon$818.57$206.924.0x10,581
Illinois$815.35$205.744.0x30,675
Arizona$792.50$205.953.8x27,952
New Hampshire$771.97$162.194.8x4,396
California$768.35$229.403.3x66,430
Kentucky$732.72$194.483.8x10,942
Tennessee$728.61$186.883.9x20,584
West Virginia$703.79$104.226.8x3,132
Florida$687.41$210.843.3x72,853
Iowa$687.11$164.424.2x7,643
Nevada$678.16$210.513.2x7,011
Pennsylvania$671.03$184.923.6x40,710
Foreign Country$657.75$81.798.0x55
Indiana$657.47$176.463.7x18,521
Arkansas$653.80$180.433.6x8,680
North Dakota$653.52$82.467.9x1,947
North Carolina$651.73$195.843.3x22,352
Louisiana$649.35$170.113.8x9,126
District of Columbia$643.15$227.002.8x2,368
Kansas$639.49$169.843.8x9,741
Hawaii$635.22$185.643.4x1,512
Mississippi$626.15$175.143.6x10,062
South Carolina$622.87$196.403.2x16,058
Virgin Islands$612.09$235.772.6x173
Oklahoma$609.31$195.273.1x9,178
Washington$601.78$191.013.2x16,797
Missouri$598.72$198.423.0x14,817
Ohio$590.93$155.843.8x30,243
Delaware$586.54$222.092.6x3,902
Rhode Island$582.64$208.762.8x2,446
Virginia$577.58$209.852.8x22,468
Utah$540.73$198.782.7x4,962
Michigan$519.45$184.272.8x19,605
New Mexico$478.02$171.732.8x2,556
Alabama$449.83$188.932.4x7,697
Idaho$431.32$149.232.9x4,347
Montana$409.50$142.372.9x3,269
Maine$381.22$117.733.2x2,848
Vermont$293.39$82.893.5x1,976
Puerto Rico$291.67$221.121.3x664

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

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