73564

X-ray of knee, 4 or more views

Code 73564. Medicare covered 1,800,995 of these. Here is what providers billed and what Medicare allowed, state by state.

$128.99Billed, national avg
$33.80Medicare allowed
3.8xBilled vs allowed
5.8xHighest vs lowest state

Providers in Alaska billed the most for this, at $247.91. In Puerto Rico the average was $42.84. 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$247.91$42.545.8x4,893
Virgin Islands$222.94$47.674.7x23
Wisconsin$195.82$26.927.3x29,934
Nevada$194.93$36.365.4x17,688
New Hampshire$171.75$31.445.5x14,374
Georgia$165.17$37.034.5x45,990
Delaware$155.52$34.344.5x8,713
Virginia$151.47$33.264.6x68,833
Illinois$149.69$33.794.4x102,987
New Jersey$149.68$40.423.7x59,269
New York$148.71$35.474.2x99,357
Foreign Country$147.00$52.752.8x13
Florida$144.31$38.333.8x134,585
Indiana$142.40$34.684.1x38,295
California$136.41$37.413.6x157,917
Arizona$133.86$38.813.4x43,953
Wyoming$133.40$33.724.0x4,152
South Carolina$130.70$35.763.7x39,987
Rhode Island$130.19$38.863.4x5,793
Connecticut$126.55$37.633.4x21,125
Tennessee$126.22$36.563.5x34,608
Mississippi$125.72$34.723.6x16,854
Vermont$122.68$13.599.0x4,883
Kansas$122.21$35.783.4x17,375
Louisiana$121.49$30.544.0x25,080
Missouri$121.23$28.074.3x34,130
Texas$120.40$37.243.2x110,694
Nebraska$119.49$35.133.4x14,488
District of Columbia$119.33$28.294.2x2,405
Oregon$119.17$34.893.4x16,080
Washington$118.10$33.653.5x39,383
Colorado$117.85$36.353.2x28,744
North Carolina$116.03$32.813.5x57,895
Armed Forces Central/South America$114.07$16.017.1x132
Massachusetts$111.56$28.533.9x58,334
Pennsylvania$110.68$28.833.8x88,911
Kentucky$110.65$34.973.2x16,678
Iowa$108.71$28.853.8x17,696
Minnesota$107.81$25.794.2x30,947
Maryland$107.71$37.332.9x50,027
New Mexico$107.12$29.573.6x8,792
Alabama$103.86$30.143.4x22,488
Arkansas$103.66$32.283.2x14,682
Utah$100.64$34.162.9x8,297
Hawaii$99.83$30.853.2x4,028
North Dakota$96.19$19.285.0x3,781
Ohio$94.33$26.823.5x64,100
Michigan$93.04$28.963.2x46,766
South Dakota$91.38$26.733.4x7,120
Idaho$89.97$20.974.3x10,503
Montana$89.92$30.662.9x8,983
West Virginia$82.44$16.555.0x8,578
Oklahoma$76.93$29.102.6x23,108
Maine$64.20$19.343.3x5,753
Guam$52.68$36.531.4x253
Armed Forces Pacific$52.52$19.162.7x119
Puerto Rico$42.84$32.601.3x403

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

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