73560

X-ray of knee, 1-2 views

Code 73560. Medicare covered 1,364,130 of these. Here is what providers billed and what Medicare allowed, state by state.

$73.62Billed, national avg
$18.85Medicare allowed
3.9xBilled vs allowed
6.2xHighest vs lowest state

Providers in Virgin Islands billed the most for this, at $185.82. In Guam the average was $29.76. 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$185.82$32.955.6x82
New Hampshire$121.65$19.266.3x7,781
Alaska$111.02$17.526.3x2,402
Wisconsin$105.52$13.837.6x21,352
Georgia$97.33$20.744.7x33,942
New Jersey$95.49$24.513.9x40,676
Arizona$92.66$21.614.3x20,087
Wyoming$91.83$17.905.1x2,818
Nevada$91.69$18.744.9x7,760
Armed Forces Central/South America$87.88$11.247.8x118
Florida$85.06$23.163.7x93,897
New York$83.87$20.494.1x76,022
California$83.72$22.243.8x121,542
Illinois$83.24$15.805.3x56,339
Texas$80.34$18.984.2x100,894
South Carolina$77.46$19.354.0x23,943
Indiana$77.41$17.524.4x26,023
Connecticut$75.53$19.303.9x13,566
Delaware$75.45$18.954.0x6,945
Virginia$75.08$20.653.6x34,949
District of Columbia$73.62$18.134.1x3,339
Mississippi$73.45$19.283.8x27,236
Idaho$73.37$14.345.1x6,445
Alabama$72.42$21.413.4x25,983
New Mexico$71.95$18.014.0x4,482
Tennessee$71.62$18.143.9x36,448
Michigan$67.74$18.633.6x30,109
Louisiana$67.26$18.283.7x24,758
Colorado$66.90$18.763.6x19,840
North Carolina$65.46$16.953.9x38,981
Foreign Country$65.00$7.718.4x12
Kentucky$64.98$19.513.3x20,266
West Virginia$64.63$14.274.5x6,416
Oklahoma$64.08$18.163.5x18,929
North Dakota$63.47$17.653.6x3,776
Iowa$61.47$15.843.9x13,213
Missouri$61.46$15.583.9x36,094
Massachusetts$61.44$16.193.8x31,706
Minnesota$61.19$14.224.3x29,997
Oregon$59.67$16.993.5x11,448
Kansas$59.53$18.113.3x15,577
Washington$59.06$14.574.1x25,470
Pennsylvania$58.68$17.273.4x57,772
Rhode Island$57.84$17.583.3x6,853
Utah$57.57$19.193.0x5,225
Ohio$57.03$15.473.7x53,162
Maryland$53.98$18.982.8x62,808
Vermont$53.52$9.885.4x2,166
Nebraska$53.07$13.913.8x10,908
Hawaii$52.14$18.422.8x4,777
Arkansas$51.54$17.333.0x24,551
Unknown$50.00$8.136.1x14
Montana$44.64$12.333.6x3,175
South Dakota$44.16$13.493.3x4,937
Armed Forces Pacific$43.99$13.993.1x119
Maine$42.98$12.343.5x3,344
Puerto Rico$31.00$24.831.2x2,479
Guam$29.76$21.361.4x156

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

← All procedures