84165

Protein measurement, serum

Code 84165. Medicare covered 1,369,974 of these. Here is what providers billed and what Medicare allowed, state by state.

$69.97Billed, national avg
$13.50Medicare allowed
5.2xBilled vs allowed
9.4xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $101.14. In Virgin Islands the average was $10.77. 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
Wisconsin$101.14$14.886.8x25,716
New Hampshire$99.47$16.576.0x1,429
New York$91.45$14.076.5x77,124
Nevada$89.58$10.598.5x7,256
West Virginia$85.42$16.815.1x378
Arizona$81.08$11.297.2x40,138
Georgia$80.44$12.676.4x30,418
California$78.97$12.996.1x123,906
Delaware$76.60$16.964.5x3,478
Maryland$76.28$13.715.6x16,875
Massachusetts$76.17$15.954.8x57,678
Foreign Country$75.00$17.354.3x182
Colorado$74.54$13.815.4x18,564
Illinois$74.42$15.714.7x47,971
Kansas$73.92$12.485.9x24,777
Virginia$72.86$13.375.5x25,492
Minnesota$72.13$14.275.1x14,891
Connecticut$70.40$17.634.0x11,187
South Carolina$69.15$16.264.3x5,306
Pennsylvania$68.02$15.514.4x42,318
New Jersey$67.95$11.256.0x120,742
Texas$66.27$12.125.5x108,538
North Carolina$66.16$12.105.5x80,829
South Dakota$65.81$14.094.7x2,766
Missouri$65.70$16.643.9x10,266
Michigan$65.67$15.854.1x32,162
Florida$65.43$13.484.9x179,036
Tennessee$64.24$12.635.1x29,182
Washington$64.13$13.494.8x21,375
Iowa$62.68$15.644.0x17,555
Wyoming$61.21$10.535.8x21
Alabama$59.43$12.354.8x31,076
District of Columbia$58.83$17.383.4x557
Arkansas$58.67$15.093.9x14,226
Louisiana$58.44$14.664.0x3,849
Indiana$58.11$15.503.7x8,806
Mississippi$58.08$16.023.6x3,354
Vermont$58.01$17.083.4x294
Ohio$57.93$13.834.2x59,044
Oregon$57.69$14.514.0x6,040
Rhode Island$56.52$16.243.5x5,769
Oklahoma$53.50$14.003.8x11,508
North Dakota$53.30$16.343.3x5,326
New Mexico$48.66$13.193.7x3,515
Hawaii$47.18$14.133.3x6,846
Kentucky$44.84$15.432.9x7,960
Idaho$40.41$15.962.5x2,519
Utah$40.29$14.872.7x6,625
Montana$40.03$16.972.4x1,830
Nebraska$38.01$14.142.7x7,357
Maine$33.69$15.492.2x5,050
Puerto Rico$11.86$10.381.1x594
Virgin Islands$10.77$10.491.0x250

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

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