84153

Psa (prostate specific antigen) measurement, total

Code 84153. Medicare covered 3,278,858 of these. Here is what providers billed and what Medicare allowed, state by state.

$102.68Billed, national avg
$17.98Medicare allowed
5.7xBilled vs allowed
10.8xHighest vs lowest state

Providers in Alaska billed the most for this, at $201.40. In Virgin Islands the average was $18.69. 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$201.40$17.8111.3x1,529
West Virginia$153.72$17.858.6x1,867
Kansas$135.69$18.007.5x67,610
Nevada$133.80$17.977.4x21,741
Wisconsin$131.70$17.827.4x28,728
Massachusetts$130.23$18.007.2x77,587
Georgia$124.87$17.986.9x70,553
District of Columbia$118.73$17.996.6x707
New Jersey$118.30$18.006.6x408,229
Illinois$117.42$17.996.5x88,058
Minnesota$116.79$17.956.5x29,609
Florida$113.21$18.016.3x345,438
Pennsylvania$111.96$18.006.2x52,486
California$111.11$18.006.2x423,526
Colorado$110.76$17.996.2x30,573
North Carolina$106.32$18.005.9x197,504
Texas$104.72$17.985.8x288,140
Arizona$104.63$18.005.8x135,995
Wyoming$98.48$17.945.5x2,673
New York$96.31$17.995.4x172,005
Maryland$94.54$17.995.3x71,700
Washington$93.03$17.985.2x55,011
South Dakota$88.33$17.964.9x8,718
Ohio$86.52$17.994.8x87,825
Missouri$86.00$17.964.8x18,157
Montana$82.52$17.974.6x2,783
Guam$80.47$17.104.7x51
Alabama$78.36$17.914.4x78,123
Connecticut$78.13$17.954.4x3,667
South Carolina$77.55$17.934.3x26,581
Oklahoma$71.58$17.984.0x34,652
Mississippi$71.43$17.854.0x30,683
Iowa$70.87$17.973.9x18,015
Tennessee$70.38$17.923.9x108,618
Kentucky$68.14$17.853.8x12,128
Louisiana$67.47$17.933.8x21,474
North Dakota$67.26$17.973.7x2,825
Oregon$66.25$17.953.7x23,758
Nebraska$66.11$17.963.7x18,018
Virginia$65.97$17.943.7x72,074
Arkansas$64.19$17.903.6x21,451
New Hampshire$63.30$17.993.5x1,291
Indiana$62.03$17.973.5x28,811
New Mexico$57.91$17.943.2x8,206
Idaho$54.74$17.943.1x3,393
Rhode Island$51.59$18.012.9x3,655
Maine$51.48$17.992.9x3,573
Michigan$51.10$17.982.8x28,727
Vermont$49.03$17.912.7x135
Utah$46.91$17.972.6x13,351
Delaware$44.40$18.022.5x243
Hawaii$43.59$17.922.4x17,871
Puerto Rico$19.71$17.921.1x7,400
Virgin Islands$18.69$17.921.0x1,295

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

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