72100

X-ray of lower and sacral spine, 2-3 views

Code 72100. Medicare covered 1,655,257 of these. Here is what providers billed and what Medicare allowed, state by state.

$99.88Billed, national avg
$23.92Medicare allowed
4.2xBilled vs allowed
5.2xHighest vs lowest state

Providers in Virgin Islands billed the most for this, at $185.94. In Puerto Rico the average was $35.72. 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$185.94$35.625.2x188
Alaska$166.40$27.186.1x4,042
Foreign Country$151.43$26.315.8x37
Wisconsin$147.76$19.097.7x28,869
New Hampshire$146.97$22.246.6x11,913
New Jersey$145.94$32.164.5x37,907
Wyoming$134.14$25.775.2x3,204
Georgia$127.01$26.264.8x50,364
Nevada$126.66$26.504.8x11,940
Arizona$122.03$27.804.4x29,641
New York$120.96$28.064.3x87,697
California$120.14$29.054.1x149,077
Florida$119.24$28.844.1x108,782
Texas$110.74$24.704.5x112,315
Virginia$108.72$24.914.4x46,359
Illinois$108.61$21.575.0x68,260
Connecticut$103.26$26.513.9x19,361
South Carolina$103.24$24.334.2x38,041
Armed Forces Europe$100.22$27.643.6x36
Indiana$100.15$21.884.6x31,517
New Mexico$98.79$22.114.5x6,127
Alabama$95.30$26.223.6x30,841
Delaware$94.81$24.133.9x6,754
North Carolina$91.48$24.603.7x67,399
Armed Forces Central/South America$90.96$17.035.3x128
Louisiana$90.67$21.904.1x27,599
Washington$90.31$21.724.2x34,049
Rhode Island$90.22$25.533.5x6,057
Colorado$88.97$24.143.7x25,554
Tennessee$88.89$24.793.6x57,607
Idaho$87.21$16.725.2x7,130
Minnesota$86.46$19.964.3x38,172
District of Columbia$85.79$24.793.5x3,644
Mississippi$85.07$22.373.8x22,449
Maryland$81.06$26.883.0x53,430
Michigan$79.22$19.774.0x35,179
Pennsylvania$77.97$20.113.9x57,540
Iowa$77.73$18.954.1x21,179
Kentucky$76.87$22.063.5x21,884
Ohio$76.05$18.224.2x62,101
Oklahoma$75.70$20.173.8x24,119
Vermont$74.76$14.095.3x2,401
Massachusetts$73.58$18.723.9x43,752
Missouri$73.00$17.594.2x39,554
Armed Forces Pacific$72.78$18.124.0x167
North Dakota$72.58$16.584.4x4,058
Kansas$72.30$20.193.6x18,462
Oregon$67.51$19.813.4x17,983
West Virginia$65.50$13.674.8x5,974
Nebraska$65.44$18.343.6x15,392
Hawaii$65.14$19.463.3x5,061
South Dakota$64.68$19.333.3x6,458
Utah$63.42$21.283.0x10,277
Arkansas$63.03$19.963.2x25,094
Montana$57.07$16.673.4x5,191
Maine$50.03$13.803.6x5,286
Unknown$50.00$10.834.6x47
Guam$45.11$25.451.8x109
Puerto Rico$35.72$27.511.3x1,495

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

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