81002

Urinalysis, manual test

Code 81002. Medicare covered 2,205,818 of these. Here is what providers billed and what Medicare allowed, state by state.

$15.04Billed, national avg
$3.39Medicare allowed
4.4xBilled vs allowed
6.6xHighest vs lowest state

Providers in Alaska billed the most for this, at $30.16. In Guam the average was $4.56. 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$30.16$3.408.9x2,632
Wisconsin$29.33$3.378.7x9,853
Armed Forces Europe$26.39$3.417.7x95
Virgin Islands$21.75$3.406.4x284
Armed Forces Pacific$20.07$3.415.9x61
South Dakota$19.99$3.405.9x499
New York$19.79$3.405.8x222,735
Illinois$19.73$3.405.8x48,834
Minnesota$19.44$3.385.7x6,164
New Mexico$18.38$3.395.4x12,877
West Virginia$17.18$3.395.1x7,822
Georgia$17.16$3.395.1x88,885
Maine$17.03$3.405.0x2,474
Mississippi$16.53$3.384.9x23,170
Texas$16.47$3.404.8x136,379
Nevada$16.39$3.384.8x24,130
Nebraska$16.24$3.394.8x6,659
Indiana$16.03$3.394.7x32,780
South Carolina$15.83$3.404.7x54,050
Tennessee$15.82$3.374.7x61,940
North Carolina$15.69$3.394.6x57,028
Montana$15.46$3.404.6x2,990
Iowa$15.12$3.394.5x7,594
New Hampshire$15.06$3.404.4x5,282
New Jersey$15.06$3.404.4x100,449
Kentucky$14.94$3.384.4x27,366
California$14.88$3.404.4x197,423
Oklahoma$14.74$3.404.3x16,473
Louisiana$14.73$3.394.3x18,641
Washington$14.72$3.384.4x27,877
Massachusetts$14.71$3.414.3x58,908
North Dakota$14.69$3.404.3x972
Ohio$14.63$3.394.3x88,128
Vermont$14.56$3.414.3x2,835
District of Columbia$14.48$3.384.3x3,850
Oregon$14.15$3.364.2x17,969
Maryland$14.05$3.384.2x68,438
Wyoming$14.02$3.384.1x6,006
Missouri$13.87$3.384.1x30,188
Connecticut$13.73$3.404.0x31,942
Florida$13.46$3.404.0x203,886
Kansas$13.17$3.403.9x21,756
Colorado$12.96$3.393.8x26,959
Virginia$12.83$3.393.8x79,500
Pennsylvania$12.36$3.403.6x100,496
Arkansas$11.97$3.393.5x23,750
Idaho$11.92$3.393.5x6,662
Arizona$11.46$3.393.4x90,681
Hawaii$11.28$3.333.4x6,464
Rhode Island$11.23$3.393.3x6,199
Michigan$10.98$3.373.3x60,450
Puerto Rico$10.27$3.403.0x1,080
Utah$10.14$3.393.0x9,775
Delaware$9.89$3.402.9x6,630
Alabama$9.82$3.372.9x48,581
Unknown$9.24$3.412.7x55
Guam$4.56$3.411.3x142

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

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