67028

Injection of drug into eye

Code 67028. Medicare covered 3,585,910 of these. Here is what providers billed and what Medicare allowed, state by state.

$582.86Billed, national avg
$122.04Medicare allowed
4.8xBilled vs allowed
6.7xHighest vs lowest state

Providers in Northern Mariana Islands billed the most for this, at $1,529.03. In Delaware the average was $227.80. 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
Northern Mariana Islands$1,529.03$113.5213.5x138
Alaska$1,432.12$145.649.8x3,756
Wisconsin$1,401.54$112.1412.5x56,680
Virgin Islands$1,172.28$106.6311.0x426
Georgia$992.90$117.108.5x67,289
New Hampshire$870.44$114.547.6x11,557
Guam$837.62$123.286.8x344
Tennessee$833.54$118.667.0x94,725
California$723.07$132.135.5x356,667
Connecticut$717.90$128.105.6x33,454
South Carolina$709.52$120.445.9x68,306
Kansas$688.14$120.165.7x42,537
Minnesota$669.53$123.875.4x54,371
Massachusetts$666.79$125.085.3x108,010
Iowa$651.34$114.875.7x51,120
District of Columbia$647.11$126.665.1x3,609
New York$644.62$131.244.9x200,012
Illinois$635.33$118.335.4x129,770
North Carolina$617.93$116.825.3x107,266
Louisiana$602.37$109.905.5x37,761
Nevada$597.42$121.404.9x24,353
Hawaii$597.18$121.044.9x9,152
North Dakota$596.87$115.965.1x13,636
Texas$595.82$121.514.9x250,120
Indiana$579.39$114.105.1x79,851
Arkansas$574.47$105.335.5x26,550
Rhode Island$544.52$115.684.7x9,855
Mississippi$534.09$116.914.6x36,539
Pennsylvania$532.39$122.944.3x186,129
Kentucky$513.74$116.654.4x42,273
New Jersey$502.62$129.223.9x98,565
Florida$499.53$120.814.1x309,324
Ohio$496.70$115.154.3x111,708
Vermont$489.91$105.564.6x7,153
Maryland$482.09$125.313.8x126,030
Utah$463.09$121.983.8x39,433
Alabama$459.06$110.994.1x36,990
Washington$458.42$124.693.7x77,898
Nebraska$454.09$108.904.2x30,223
Virginia$449.45$123.353.6x107,010
Missouri$442.40$117.013.8x69,464
Maine$438.55$116.183.8x15,578
Montana$435.32$121.233.6x19,110
Oregon$433.12$126.913.4x57,758
Colorado$419.96$128.273.3x68,499
West Virginia$413.36$112.893.7x15,071
Michigan$387.78$118.613.3x97,802
Idaho$379.26$117.613.2x21,359
Armed Forces Europe$377.18$117.343.2x1,240
Oklahoma$355.20$114.953.1x39,295
Wyoming$322.05$129.892.5x3,375
South Dakota$315.03$122.902.6x18,237
New Mexico$314.75$115.782.7x18,836
Puerto Rico$311.35$119.682.6x2,694
Arizona$272.41$123.752.2x80,524
Foreign Country$250.00$106.692.3x148
Delaware$227.80$116.981.9x6,302

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

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