66821

Removal of recurring cataract in lens capsule using a laser

Code 66821. Medicare covered 1,333,141 of these. Here is what providers billed and what Medicare allowed, state by state.

$645.84Billed, national avg
$193.28Medicare allowed
3.3xBilled vs allowed
11.8xHighest vs lowest state

Providers in Virgin Islands billed the most for this, at $1,991.39. In Minnesota the average was $168.08. 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
Virgin Islands$1,991.39$306.906.5x114
Guam$1,758.63$407.084.3x147
Alaska$1,715.89$349.234.9x1,565
New Jersey$1,453.63$345.394.2x19,372
New Hampshire$1,444.61$320.904.5x3,767
New York$1,360.78$326.774.2x31,703
Connecticut$1,319.77$348.693.8x5,219
Nebraska$1,279.56$271.554.7x9,500
California$1,233.39$352.973.5x70,779
South Dakota$1,124.31$296.263.8x5,510
Hawaii$1,096.56$334.913.3x2,264
Kansas$1,078.40$266.054.1x14,907
Texas$1,050.50$306.843.4x61,371
Georgia$1,035.93$237.614.4x31,694
District of Columbia$1,023.33$368.742.8x855
Missouri$1,008.90$268.813.8x23,286
Pennsylvania$1,004.19$301.823.3x33,689
Vermont$974.35$315.553.1x1,072
Delaware$972.35$307.113.2x4,450
Louisiana$969.97$290.913.3x12,580
Washington$916.41$296.603.1x24,697
Nevada$915.23$311.042.9x7,997
Rhode Island$903.09$295.343.1x1,530
Mississippi$893.58$270.343.3x13,315
Oregon$872.79$303.752.9x11,561
Indiana$861.41$254.333.4x31,971
Maryland$848.60$328.852.6x15,542
Arizona$845.41$296.672.8x26,880
Colorado$816.66$310.872.6x12,155
Florida$795.26$296.712.7x79,630
North Dakota$791.54$225.703.5x4,488
Utah$765.86$308.662.5x6,167
Wyoming$759.19$275.412.8x1,985
Arkansas$756.84$271.792.8x13,935
New Mexico$733.94$308.992.4x3,727
Montana$730.74$269.202.7x6,268
Michigan$717.97$277.862.6x19,746
Iowa$708.75$242.482.9x11,095
Idaho$677.41$250.582.7x6,063
Oklahoma$676.73$273.132.5x17,094
Massachusetts$655.54$200.893.3x29,703
Virginia$603.26$241.142.5x29,780
Maine$519.51$162.513.2x5,327
West Virginia$493.82$187.472.6x4,644
Ohio$475.51$131.143.6x59,412
Puerto Rico$469.84$319.091.5x531
South Carolina$440.90$152.972.9x38,969
Tennessee$334.97$101.903.3x69,160
North Carolina$298.23$99.243.0x69,363
Wisconsin$296.68$44.046.7x76,607
Illinois$270.35$68.543.9x116,152
Alabama$266.10$85.023.1x36,865
Kentucky$181.93$57.603.2x61,329
Minnesota$168.08$39.314.3x85,596

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

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