80069

Kidney function blood test panel

Code 80069. Medicare covered 1,098,129 of these. Here is what providers billed and what Medicare allowed, state by state.

$56.14Billed, national avg
$8.48Medicare allowed
6.6xBilled vs allowed
10.6xHighest vs lowest state

Providers in North Dakota billed the most for this, at $101.34. In Puerto Rico the average was $9.60. 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
North Dakota$101.34$8.3512.1x908
Wisconsin$97.04$8.4211.5x6,598
Alaska$94.19$8.4711.1x850
Illinois$93.28$8.4911.0x34,380
New Mexico$88.76$8.4810.5x7,255
Mississippi$83.68$8.449.9x10,535
Florida$80.76$8.499.5x89,632
New York$75.15$8.488.9x22,352
Nevada$70.50$8.508.3x15,635
Kansas$70.00$8.508.2x38,343
Pennsylvania$67.05$8.497.9x16,589
Georgia$66.29$8.487.8x49,162
Maryland$63.40$8.507.5x11,966
Iowa$62.95$8.457.5x8,139
Texas$62.73$8.507.4x122,425
Massachusetts$61.97$8.517.3x16,314
Missouri$61.75$8.507.3x8,577
California$61.09$8.507.2x106,391
New Jersey$55.98$8.446.6x49,476
Montana$55.83$8.476.6x645
Nebraska$55.27$8.506.5x2,501
Minnesota$54.35$8.486.4x11,005
Connecticut$53.73$8.476.3x816
Arkansas$52.22$8.476.2x3,303
West Virginia$51.31$8.516.0x654
South Dakota$50.58$8.496.0x2,559
Idaho$49.71$8.485.9x2,431
Rhode Island$47.86$8.415.7x1,059
North Carolina$47.44$8.485.6x104,576
New Hampshire$47.22$8.515.5x105
Colorado$46.54$8.445.5x10,280
Washington$44.03$8.485.2x24,397
Wyoming$43.20$8.475.1x591
Alabama$42.73$8.495.0x32,380
District of Columbia$42.28$8.225.1x18
Hawaii$38.43$8.474.5x9,039
Ohio$38.31$8.454.5x51,552
Louisiana$38.16$8.494.5x14,291
Michigan$38.08$8.464.5x4,372
Indiana$37.94$8.494.5x6,644
Arizona$37.68$8.494.4x62,477
Oklahoma$34.57$8.474.1x23,739
Tennessee$34.38$8.484.1x48,943
South Carolina$33.52$8.464.0x18,956
Oregon$31.79$8.463.8x12,430
Virginia$30.29$8.453.6x17,121
Kentucky$28.94$8.453.4x2,753
Maine$28.84$8.463.4x876
Armed Forces Europe$25.81$8.513.0x27
Utah$20.52$8.482.4x8,461
Delaware$15.74$8.511.8x328
Virgin Islands$13.58$8.511.6x246
Puerto Rico$9.60$8.481.1x2,955

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

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