80307

Testing for presence of drug, by chemistry analyzers

Code 80307. Medicare covered 1,905,331 of these. Here is what providers billed and what Medicare allowed, state by state.

$211.28Billed, national avg
$60.30Medicare allowed
3.5xBilled vs allowed
3.3xHighest vs lowest state

Providers in New Jersey billed the most for this, at $365.58. In Utah the average was $110.93. 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
New Jersey$365.58$60.556.0x88,213
Nevada$361.60$60.366.0x39,904
Rhode Island$342.43$60.665.6x21,693
New Hampshire$329.30$59.185.6x4,516
Delaware$284.34$59.814.8x3,351
Alaska$269.78$60.074.5x4,186
Texas$260.65$60.044.3x176,013
Louisiana$255.36$59.914.3x25,376
Iowa$249.23$60.294.1x1,333
Florida$243.64$60.664.0x113,949
Oregon$242.90$59.924.1x10,251
Nebraska$241.17$59.914.0x1,418
Maryland$240.63$60.314.0x61,658
Wisconsin$233.69$59.953.9x9,544
Illinois$230.69$60.343.8x27,518
South Carolina$227.81$59.893.8x26,633
Pennsylvania$221.22$60.633.6x60,309
Arizona$218.85$60.273.6x29,583
Georgia$218.51$60.333.6x102,727
Tennessee$217.91$60.173.6x118,558
Arkansas$206.13$60.563.4x31,449
Colorado$201.03$59.493.4x12,389
Idaho$199.08$60.183.3x3,375
Minnesota$195.67$60.183.3x9,880
South Dakota$194.66$60.543.2x201
Mississippi$185.86$60.163.1x25,236
Oklahoma$184.69$60.133.1x64,502
Indiana$182.88$59.693.1x40,706
California$180.36$60.733.0x178,152
Virginia$179.58$60.193.0x17,647
Montana$179.29$60.902.9x2,291
Hawaii$178.52$60.213.0x2,498
Massachusetts$173.98$60.752.9x68,447
New Mexico$173.39$60.132.9x4,073
North Dakota$167.25$60.772.8x6,845
Washington$166.10$59.922.8x32,867
Alabama$165.15$59.142.8x35,243
Kansas$164.89$59.522.8x11,570
Missouri$159.66$59.862.7x6,193
North Carolina$156.25$60.622.6x215,853
New York$155.88$60.162.6x42,078
Connecticut$151.69$60.472.5x8,444
Wyoming$148.25$59.952.5x87
Kentucky$146.85$59.802.5x73,077
Michigan$146.03$60.352.4x44,462
Ohio$138.23$59.502.3x27,790
West Virginia$137.89$60.562.3x3,876
Vermont$131.38$60.022.2x1,339
District of Columbia$126.57$59.412.1x503
Maine$119.88$60.902.0x232
Utah$110.93$58.691.9x7,274

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

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