84460

Liver enzyme (sgpt), level

Code 84460. Medicare covered 1,154,341 of these. Here is what providers billed and what Medicare allowed, state by state.

$48.05Billed, national avg
$5.15Medicare allowed
9.3xBilled vs allowed
16.3xHighest vs lowest state

Providers in Florida billed the most for this, at $93.53. In Puerto Rico the average was $5.73. 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
Florida$93.53$5.1818.1x343,521
California$48.99$5.189.5x210,903
Guam$40.50$5.197.8x20
Wisconsin$40.32$5.167.8x17,197
North Dakota$37.02$5.147.2x586
Colorado$32.07$5.176.2x8,593
West Virginia$28.74$5.195.5x50
Arizona$27.93$4.935.7x18,346
Kansas$27.88$5.185.4x9,395
Wyoming$27.52$5.135.4x85
Minnesota$26.60$5.175.1x34,920
Indiana$26.52$5.165.1x23,601
Washington$26.44$5.135.2x6,562
Pennsylvania$26.23$5.175.1x15,812
Illinois$26.04$5.145.1x19,664
South Dakota$25.69$5.165.0x1,211
North Carolina$25.16$5.174.9x35,978
Alabama$24.76$5.174.8x13,151
Missouri$23.78$5.174.6x3,714
Oregon$23.11$5.084.6x952
Georgia$22.90$5.184.4x10,828
Kentucky$22.31$5.134.3x2,015
Nevada$22.22$5.184.3x1,742
Vermont$22.05$5.174.3x133
Tennessee$21.94$5.164.3x10,440
Nebraska$21.50$5.134.2x3,027
Connecticut$21.43$5.184.1x1,236
Ohio$21.29$5.174.1x33,200
Massachusetts$21.26$5.154.1x47,621
Rhode Island$20.99$5.184.1x4,138
Oklahoma$20.82$4.704.4x3,018
South Carolina$20.48$5.184.0x7,604
Mississippi$20.41$5.154.0x9,197
Montana$20.31$5.193.9x155
New Hampshire$20.19$5.183.9x3,338
Hawaii$19.94$5.153.9x15,137
Louisiana$19.51$5.153.8x6,838
Maryland$19.06$5.173.7x5,279
Arkansas$17.51$5.173.4x5,547
New York$17.13$5.163.3x23,243
New Jersey$17.09$5.013.4x89,637
Iowa$17.02$5.163.3x18,872
Idaho$16.66$5.193.2x74
New Mexico$16.35$5.143.2x1,108
Texas$16.19$5.183.1x53,414
Virginia$15.82$5.173.1x10,309
Michigan$15.52$5.173.0x19,735
Maine$14.49$5.082.9x632
District of Columbia$12.14$5.192.3x51
Utah$11.77$5.142.3x379
Delaware$10.36$5.192.0x201
Puerto Rico$5.73$5.131.1x1,894

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

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