82043

Urine microalbumin (protein) level

Code 82043. Medicare covered 4,470,806 of these. Here is what providers billed and what Medicare allowed, state by state.

$57.23Billed, national avg
$5.64Medicare allowed
10.1xBilled vs allowed
11.6xHighest vs lowest state

Providers in Nevada billed the most for this, at $75.84. In Puerto Rico the average was $6.55. 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
Nevada$75.84$5.6513.4x38,254
Wisconsin$74.48$5.5913.3x64,105
Kansas$73.11$5.6612.9x129,331
Texas$72.57$5.6512.8x449,933
Illinois$70.72$5.6512.5x108,769
New Jersey$68.29$5.6512.1x498,914
Colorado$65.61$5.6411.6x24,517
North Carolina$64.02$5.6511.3x372,456
Georgia$61.97$5.6411.0x120,273
Florida$61.44$5.6310.9x469,571
Guam$61.20$5.6110.9x285
Massachusetts$60.55$5.6610.7x105,034
Maryland$59.83$5.6510.6x82,719
California$58.92$5.6610.4x552,727
Alabama$54.30$5.649.6x131,237
Pennsylvania$54.24$5.659.6x69,368
Ohio$52.30$5.659.3x145,562
Arizona$49.12$5.658.7x194,581
Alaska$48.27$5.618.6x4,027
Mississippi$47.57$5.618.5x24,826
Oklahoma$45.73$5.648.1x40,722
South Carolina$45.36$5.618.1x41,605
Washington$43.37$5.647.7x73,295
New York$43.07$5.657.6x134,607
North Dakota$39.08$5.646.9x4,242
Louisiana$38.16$5.636.8x21,941
West Virginia$38.12$5.616.8x2,235
Minnesota$37.10$5.636.6x39,588
South Dakota$35.40$5.656.3x6,152
Missouri$34.98$5.646.2x12,900
Idaho$34.93$5.636.2x3,551
Rhode Island$33.02$5.645.9x7,390
Oregon$31.61$5.635.6x33,702
Tennessee$31.34$5.625.6x126,395
New Mexico$30.36$5.655.4x15,798
Armed Forces Europe$27.80$5.944.7x36
Wyoming$27.41$5.644.9x2,010
Connecticut$27.21$5.654.8x6,876
District of Columbia$26.94$5.604.8x238
Montana$26.81$5.634.8x2,737
Iowa$26.65$5.644.7x20,373
Nebraska$26.54$5.644.7x17,926
New Hampshire$25.81$5.654.6x2,347
Indiana$25.68$5.644.6x30,238
Hawaii$25.50$5.644.5x40,667
Kentucky$25.23$5.624.5x19,461
Arkansas$25.13$5.624.5x17,094
Michigan$24.22$5.644.3x28,480
Virginia$22.47$5.644.0x84,156
Maine$20.08$5.633.6x5,501
Vermont$19.27$5.653.4x572
Utah$18.89$5.643.4x23,036
Delaware$16.26$5.642.9x1,309
Virgin Islands$13.06$5.662.3x2,240
Puerto Rico$6.55$5.641.2x14,852

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

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