92134

Imaging of retina

Code 92134. Medicare covered 8,171,858 of these. Here is what providers billed and what Medicare allowed, state by state.

$123.94Billed, national avg
$39.39Medicare allowed
3.1xBilled vs allowed
3.3xHighest vs lowest state

Providers in Alaska billed the most for this, at $215.79. In Armed Forces Europe the average was $65.02. 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$215.79$46.574.6x15,796
District of Columbia$207.75$43.214.8x12,149
Maryland$199.51$41.594.8x278,683
Hawaii$198.49$42.294.7x35,652
New Jersey$191.85$44.014.4x221,923
Connecticut$185.52$42.654.3x75,857
Virgin Islands$175.88$38.514.6x726
Wisconsin$163.68$34.504.7x115,709
Tennessee$162.35$37.064.4x184,028
New York$152.28$43.693.5x551,408
Virginia$146.52$39.703.7x235,759
Massachusetts$145.26$39.673.7x248,198
Minnesota$144.98$38.983.7x108,030
Northern Mariana Islands$137.06$42.393.2x314
Georgia$135.26$38.273.5x162,966
Armed Forces Pacific$130.00$35.943.6x13
New Hampshire$129.84$38.843.3x31,675
California$128.26$43.403.0x895,096
Guam$125.75$41.593.0x694
Illinois$122.03$38.853.1x338,915
Louisiana$121.14$34.183.5x106,668
Pennsylvania$120.85$39.353.1x397,356
Ohio$119.82$35.983.3x248,708
Delaware$117.45$39.203.0x30,615
Missouri$116.61$37.793.1x151,374
Texas$115.75$38.913.0x521,642
Oregon$115.66$39.212.9x117,080
Nevada$113.72$39.532.9x62,894
Washington$110.11$40.322.7x172,533
Indiana$108.75$37.612.9x157,274
Colorado$108.59$39.822.7x132,792
Kentucky$108.55$36.743.0x99,582
North Dakota$106.73$35.313.0x30,200
North Carolina$106.06$36.722.9x215,866
Iowa$105.72$35.403.0x113,155
Wyoming$104.93$39.022.7x15,044
Arkansas$102.38$34.752.9x72,884
Kansas$102.37$36.892.8x96,503
Michigan$99.34$37.412.7x208,346
Rhode Island$99.18$39.862.5x26,572
Montana$98.30$39.222.5x44,509
Nebraska$96.14$35.012.7x61,415
Florida$94.66$39.142.4x671,030
Vermont$93.54$34.602.7x17,281
Utah$92.80$36.812.5x71,921
West Virginia$91.29$34.552.6x35,614
Armed Forces Central/South America$90.87$37.072.5x110
South Carolina$90.23$37.882.4x149,961
Puerto Rico$88.95$39.002.3x7,755
Foreign Country$88.52$37.852.3x174
Arizona$87.67$39.122.2x201,059
Mississippi$86.76$34.992.5x84,064
Oklahoma$85.40$36.212.4x97,977
Idaho$85.35$37.152.3x42,907
Maine$85.29$37.372.3x30,760
South Dakota$76.57$38.362.0x37,760
New Mexico$74.91$36.892.0x33,393
Alabama$71.32$35.862.0x91,201
Armed Forces Europe$65.02$37.621.7x2,283

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

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