73562

X-ray of knee, 3 views

Code 73562. Medicare covered 2,338,418 of these. Here is what providers billed and what Medicare allowed, state by state.

$102.81Billed, national avg
$27.32Medicare allowed
3.8xBilled vs allowed
4.2xHighest vs lowest state

Providers in Alaska billed the most for this, at $165.61. In Puerto Rico the average was $39.50. 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$165.61$27.995.9x4,774
New Jersey$158.68$35.694.4x71,624
Wisconsin$158.36$21.827.3x36,827
Delaware$154.58$32.734.7x14,857
Nevada$141.92$30.714.6x15,249
New Hampshire$135.84$27.854.9x13,491
Georgia$127.98$28.784.4x59,353
New York$120.36$29.714.1x150,907
Virgin Islands$119.71$35.653.4x366
Illinois$117.54$24.834.7x103,560
Rhode Island$116.06$34.453.4x9,423
Connecticut$115.53$31.433.7x23,136
Arizona$115.15$29.893.9x49,762
Virginia$114.29$28.664.0x66,458
Wyoming$111.33$25.034.4x4,728
Florida$111.15$31.783.5x150,481
California$106.23$29.763.6x221,034
Indiana$101.70$24.144.2x45,814
Texas$98.68$26.433.7x154,228
New Mexico$98.26$22.884.3x13,354
North Carolina$97.68$28.443.4x79,703
Tennessee$97.30$28.163.5x67,780
Pennsylvania$96.21$27.533.5x97,083
District of Columbia$95.98$28.033.4x4,985
Washington$94.60$25.693.7x41,187
Foreign Country$94.38$19.274.9x63
Massachusetts$94.21$24.683.8x63,933
Minnesota$92.99$22.464.1x53,302
South Carolina$92.78$28.133.3x47,716
Alabama$92.14$28.383.2x26,050
Louisiana$92.04$25.333.6x28,934
Mississippi$91.58$25.323.6x21,910
Colorado$90.62$28.173.2x47,196
Armed Forces Europe$90.32$27.453.3x39
Idaho$88.82$19.604.5x10,066
Iowa$88.31$23.643.7x32,243
Maryland$88.07$30.792.9x77,103
Vermont$87.56$12.996.7x3,485
Missouri$85.42$20.954.1x50,656
Kentucky$84.30$29.232.9x32,182
Armed Forces Central/South America$83.90$12.846.5x240
Michigan$82.81$24.553.4x56,663
West Virginia$82.79$17.854.6x10,470
South Dakota$79.49$21.113.8x9,522
Oregon$79.44$24.393.3x24,340
Nebraska$79.43$22.033.6x19,283
Utah$78.24$27.522.8x19,887
Ohio$77.83$22.943.4x74,493
Kansas$77.82$24.573.2x33,232
Hawaii$73.52$22.573.3x5,807
Oklahoma$72.31$21.803.3x37,393
Montana$72.10$23.013.1x7,677
Arkansas$72.08$25.192.9x25,854
North Dakota$67.56$16.154.2x9,273
Armed Forces Pacific$59.97$21.332.8x185
Maine$55.27$17.973.1x7,879
Unknown$50.00$9.195.4x47
Guam$43.51$32.151.4x258
Puerto Rico$39.50$28.581.4x863

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

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