72125

Ct scan of upper spine without contrast

Code 72125. Medicare covered 1,546,919 of these. Here is what providers billed and what Medicare allowed, state by state.

$296.72Billed, national avg
$47.63Medicare allowed
6.2xBilled vs allowed
2.8xHighest vs lowest state

Providers in Armed Forces Central/South America billed the most for this, at $482.99. In South Dakota the average was $170.85. 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
Armed Forces Central/South America$482.99$44.9110.8x353
Wisconsin$476.12$44.7310.6x25,860
Alaska$457.28$63.577.2x3,015
Arizona$403.63$47.968.4x25,279
New Hampshire$393.27$46.078.5x9,843
Texas$387.66$46.898.3x117,469
Wyoming$370.06$47.367.8x2,345
Nevada$360.23$47.067.7x11,449
Florida$349.17$49.397.1x106,617
California$334.38$52.126.4x126,109
Georgia$329.63$46.817.0x40,816
Colorado$328.05$48.126.8x32,226
Illinois$314.12$47.166.7x70,498
Tennessee$308.81$45.096.8x35,908
Ohio$308.06$45.456.8x54,301
New York$302.55$52.195.8x84,478
Foreign Country$300.25$45.396.6x117
North Carolina$298.68$45.526.6x57,711
Armed Forces Europe$291.56$46.706.2x51
South Carolina$289.73$45.496.4x26,055
Oklahoma$289.43$45.336.4x17,936
Idaho$288.98$44.356.5x6,302
New Jersey$284.39$51.495.5x41,470
Minnesota$276.47$47.285.8x66,505
Louisiana$275.56$46.485.9x18,431
New Mexico$268.76$46.035.8x6,149
Mississippi$261.26$44.375.9x13,482
Vermont$260.82$44.735.8x2,620
Missouri$259.52$45.545.7x40,326
Connecticut$258.64$48.695.3x24,356
Hawaii$257.34$47.425.4x4,451
Virginia$255.23$46.425.5x47,197
District of Columbia$254.81$51.654.9x5,215
Kentucky$251.55$45.255.6x15,572
Indiana$251.24$44.885.6x28,632
Iowa$249.29$45.025.5x11,970
Delaware$248.49$46.815.3x6,887
Rhode Island$248.23$47.675.2x9,685
Pennsylvania$245.45$46.235.3x69,044
Maryland$244.25$51.714.7x34,016
Unknown$235.00$47.025.0x97
Washington$234.85$47.874.9x27,776
Oregon$231.54$46.465.0x11,327
West Virginia$230.88$44.725.2x10,159
Michigan$229.29$46.015.0x48,853
Alabama$228.72$44.965.1x23,354
Armed Forces Pacific$223.58$47.204.7x191
Maine$217.03$46.064.7x4,670
Massachusetts$214.32$47.884.5x58,032
Nebraska$213.62$44.244.8x12,185
Puerto Rico$213.53$49.634.3x1,394
North Dakota$212.84$44.804.8x2,617
Montana$212.80$46.364.6x3,708
Virgin Islands$210.00$45.064.7x16
Arkansas$201.33$43.594.6x15,897
Guam$193.86$55.423.5x124
Kansas$190.85$44.184.3x14,641
Utah$188.98$45.014.2x8,699
South Dakota$170.85$45.123.8x2,427

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

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