69210

Removal of impacted ear wax

Code 69210. Medicare covered 1,499,606 of these. Here is what providers billed and what Medicare allowed, state by state.

$136.96Billed, national avg
$42.00Medicare allowed
3.3xBilled vs allowed
4.3xHighest vs lowest state

Providers in Alaska billed the most for this, at $262.99. In Virgin Islands the average was $61.60. 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$262.99$51.805.1x2,148
Wisconsin$248.61$37.016.7x18,621
New York$233.00$46.345.0x122,538
New Hampshire$176.15$37.834.7x7,658
New Jersey$169.59$47.693.6x71,774
Massachusetts$167.06$44.873.7x48,867
Minnesota$164.77$38.864.2x14,003
Connecticut$159.31$46.023.5x18,533
Illinois$146.81$43.023.4x59,177
Mississippi$144.09$39.153.7x11,541
Georgia$143.20$41.893.4x28,622
Wyoming$142.10$42.393.4x2,403
Iowa$138.47$38.083.6x17,104
Oregon$136.45$42.113.2x8,858
Ohio$135.84$38.893.5x46,194
North Carolina$133.54$40.673.3x38,079
Armed Forces Europe$132.82$41.583.2x11
Tennessee$131.99$39.033.4x23,837
Maryland$130.21$46.652.8x41,491
Louisiana$130.08$40.283.2x20,340
Washington$128.64$43.373.0x25,301
Foreign Country$128.18$39.603.2x80
West Virginia$127.38$38.463.3x5,556
Nevada$126.74$42.913.0x6,673
District of Columbia$126.69$41.993.0x3,230
California$125.45$40.183.1x209,015
Texas$124.11$41.073.0x75,111
Colorado$123.18$42.912.9x17,146
Idaho$122.49$36.623.3x5,894
Missouri$121.48$38.813.1x24,726
Virginia$121.02$43.092.8x38,142
Nebraska$120.31$37.633.2x10,068
Rhode Island$117.94$45.292.6x2,621
South Carolina$117.07$40.782.9x34,437
South Dakota$115.20$36.843.1x4,749
Maine$112.95$35.603.2x4,115
Utah$111.99$40.542.8x8,311
Montana$111.77$38.532.9x4,957
Kansas$111.64$38.472.9x12,970
Indiana$111.63$39.782.8x24,748
Pennsylvania$111.05$42.042.6x76,322
Hawaii$109.51$43.532.5x2,893
Oklahoma$109.49$39.832.7x13,517
Delaware$109.29$43.112.5x7,546
Florida$109.21$42.792.6x160,790
Arkansas$107.61$38.242.8x10,527
Armed Forces Pacific$106.62$41.412.6x58
Arizona$104.73$41.362.5x27,852
Vermont$104.25$30.733.4x2,239
North Dakota$101.72$32.633.1x2,689
New Mexico$101.42$39.462.6x5,885
Michigan$99.27$41.972.4x33,566
Kentucky$92.35$38.522.4x19,386
Alabama$83.68$39.282.1x14,149
Guam$69.73$47.621.5x27
Puerto Rico$63.40$40.201.6x2,145
Virgin Islands$61.60$41.931.5x359

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

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