86334

Immunologic analysis technique on serum (immunofixation)

Code 86334. Medicare covered 934,844 of these. Here is what providers billed and what Medicare allowed, state by state.

$124.33Billed, national avg
$19.86Medicare allowed
6.3xBilled vs allowed
8.3xHighest vs lowest state

Providers in Nevada billed the most for this, at $186.04. In Virgin Islands the average was $22.34. 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$186.04$21.848.5x5,674
Georgia$173.27$20.218.6x22,618
Kansas$165.50$20.088.2x12,238
California$156.83$20.837.5x78,934
New Jersey$155.48$21.547.2x99,746
Foreign Country$145.00$17.358.4x138
Illinois$138.14$18.697.4x33,540
Arizona$137.03$20.646.6x10,051
Colorado$135.93$20.216.7x10,586
New York$134.94$20.386.6x67,786
New Hampshire$133.89$17.087.8x1,290
Maryland$131.75$19.816.7x11,259
Wisconsin$130.22$18.237.1x17,865
Texas$128.77$20.776.2x71,053
Louisiana$127.58$18.007.1x2,657
Florida$126.68$19.736.4x141,785
Oklahoma$119.65$19.616.1x3,997
Pennsylvania$116.93$18.646.3x23,745
Massachusetts$116.10$19.036.1x45,101
Virginia$114.50$20.055.7x21,636
South Dakota$110.17$19.775.6x929
Washington$108.93$20.665.3x10,656
North Carolina$108.51$20.095.4x54,586
Alabama$96.96$20.064.8x19,281
Mississippi$96.91$16.995.7x1,703
Connecticut$96.80$18.145.3x7,127
Michigan$96.66$17.705.5x16,688
West Virginia$85.45$16.885.1x212
Ohio$83.72$18.824.4x41,667
Vermont$83.56$16.875.0x2,649
Delaware$82.71$17.044.9x2,065
Tennessee$82.53$20.424.0x21,934
Minnesota$81.92$18.194.5x7,069
Iowa$81.21$17.394.7x10,528
Indiana$77.14$17.554.4x6,606
Utah$75.23$17.324.3x4,941
North Dakota$72.86$17.384.2x2,363
Hawaii$72.47$19.763.7x2,319
South Carolina$71.52$16.624.3x3,059
Missouri$69.85$17.064.1x5,710
Rhode Island$69.56$18.493.8x3,064
Oregon$67.76$18.953.6x3,870
New Mexico$66.60$21.833.1x1,681
Kentucky$59.63$17.463.4x4,874
Maine$57.75$18.963.0x2,838
District of Columbia$56.40$18.163.1x347
Arkansas$55.00$17.173.2x9,404
Nebraska$53.53$19.202.8x3,548
Montana$48.36$17.162.8x206
Idaho$37.04$16.962.2x856
Puerto Rico$25.69$21.831.2x187
Virgin Islands$22.34$21.551.0x165

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

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