92557

Comprehensive hearing and speech recognition test

Code 92557. Medicare covered 1,263,075 of these. Here is what providers billed and what Medicare allowed, state by state.

$122.78Billed, national avg
$35.97Medicare allowed
3.4xBilled vs allowed
5.4xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $201.64. In Northern Mariana Islands the average was $37.41. 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$201.64$34.205.9x15,237
New Hampshire$189.03$34.565.5x6,790
New York$163.90$39.704.1x123,490
Alaska$151.98$42.613.6x1,998
District of Columbia$149.77$39.133.8x2,312
Minnesota$149.26$35.314.2x17,808
Massachusetts$149.24$37.624.0x48,254
New Jersey$136.16$39.013.5x44,888
Oregon$134.87$35.713.8x12,406
California$134.00$39.173.4x103,996
Illinois$131.36$35.743.7x43,080
Wyoming$130.40$35.613.7x2,226
Connecticut$130.22$37.563.5x16,373
Vermont$130.05$34.423.8x2,797
South Dakota$128.17$34.243.7x4,256
Missouri$128.17$34.113.8x21,885
Georgia$126.54$34.653.7x35,309
Maine$123.19$34.463.6x5,085
West Virginia$122.80$33.533.7x4,047
Hawaii$122.48$37.013.3x4,437
Ohio$120.97$33.273.6x39,072
Nebraska$120.65$33.923.6x8,772
Washington$120.42$36.503.3x24,955
Tennessee$120.18$33.283.6x27,230
Iowa$115.67$33.513.5x11,081
Texas$115.23$34.873.3x83,308
Montana$113.13$35.033.2x5,316
Kansas$112.77$33.703.3x14,971
Florida$112.28$35.573.2x103,421
Pennsylvania$111.18$35.253.2x64,613
Maryland$110.48$37.383.0x42,828
Nevada$110.04$34.783.2x6,075
South Carolina$107.62$34.073.2x22,574
North Carolina$106.42$34.373.1x37,551
North Dakota$106.35$34.073.1x2,346
Virginia$103.71$35.892.9x36,125
Colorado$102.52$35.882.9x23,713
Louisiana$101.68$34.133.0x12,930
Rhode Island$101.35$36.132.8x4,352
Indiana$100.57$33.743.0x21,177
Delaware$100.38$35.642.8x6,911
Mississippi$99.83$32.773.0x12,970
Arizona$97.85$34.862.8x33,193
Utah$96.76$34.402.8x7,411
Michigan$93.10$34.462.7x26,558
Kentucky$91.69$33.272.8x12,399
Idaho$89.86$32.742.7x5,977
Arkansas$89.68$32.792.7x10,222
Oklahoma$88.19$33.182.7x14,909
New Mexico$83.00$34.602.4x5,561
Alabama$78.37$32.782.4x16,185
Puerto Rico$66.71$35.511.9x1,128
Guam$41.03$37.771.1x153
Virgin Islands$37.65$35.631.1x348
Northern Mariana Islands$37.41$36.811.0x40

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

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