78452

Nuclear medicine studies of heart muscle at rest and with stress and spect

Code 78452. Medicare covered 1,244,326 of these. Here is what providers billed and what Medicare allowed, state by state.

$826.68Billed, national avg
$231.55Medicare allowed
3.6xBilled vs allowed
9.4xHighest vs lowest state

Providers in Alaska billed the most for this, at $2,516.15. In South Dakota the average was $267.31. 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$2,516.15$295.158.5x1,460
Wyoming$1,719.27$299.695.7x1,872
Mississippi$1,390.58$195.597.1x12,728
Wisconsin$1,364.48$126.1310.8x18,557
New York$1,337.88$344.443.9x77,988
District of Columbia$1,214.02$425.232.9x2,654
New Jersey$1,098.26$297.683.7x55,649
Maryland$1,097.47$391.492.8x33,584
Texas$1,019.54$265.203.8x92,660
California$993.37$308.973.2x105,713
South Carolina$991.53$222.064.5x34,749
Nevada$972.28$276.823.5x11,252
Connecticut$949.75$228.434.2x10,467
Arizona$923.03$333.832.8x38,858
North Carolina$901.17$210.834.3x37,157
Vermont$874.68$84.7010.3x1,450
Georgia$868.19$219.764.0x41,603
Louisiana$865.08$239.603.6x17,016
Illinois$811.23$172.144.7x50,269
Florida$805.47$310.582.6x124,614
Alabama$795.66$233.433.4x18,322
Delaware$785.60$290.612.7x8,648
West Virginia$770.31$152.865.0x7,644
Massachusetts$744.41$197.643.8x27,936
Kansas$726.71$187.603.9x17,623
Rhode Island$687.07$231.733.0x2,207
Virginia$617.54$209.572.9x35,219
Pennsylvania$590.70$162.403.6x44,392
Oregon$573.66$149.603.8x6,339
Michigan$567.95$195.382.9x36,167
Hawaii$564.74$165.113.4x1,028
Guam$559.64$434.301.3x492
Nebraska$556.47$173.783.2x8,384
Utah$547.21$149.713.7x2,723
New Hampshire$545.38$77.457.0x5,000
Tennessee$541.32$155.173.5x33,958
Maine$534.70$79.976.7x2,957
New Mexico$522.80$152.023.4x4,205
Iowa$504.49$134.873.7x11,373
Colorado$470.38$129.603.6x10,516
Ohio$454.21$123.273.7x41,649
North Dakota$446.33$79.765.6x2,672
Indiana$442.13$105.354.2x28,479
Washington$440.13$133.173.3x18,229
Missouri$435.18$105.884.1x20,750
Kentucky$418.07$121.083.5x18,850
Arkansas$409.63$107.743.8x15,406
Minnesota$406.73$92.364.4x9,066
Puerto Rico$369.11$259.941.4x960
Idaho$358.10$96.073.7x4,762
Montana$341.79$89.403.8x2,188
Oklahoma$334.41$99.463.4x19,507
Armed Forces Central/South America$272.00$72.213.8x19
South Dakota$267.31$72.743.7x6,355

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

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