92567

Test to assess middle ear function

Code 92567. Medicare covered 990,670 of these. Here is what providers billed and what Medicare allowed, state by state.

$51.44Billed, national avg
$15.96Medicare allowed
3.2xBilled vs allowed
5.4xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $85.72. In Guam the average was $15.90. 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$85.72$14.755.8x10,609
New York$72.81$18.114.0x90,475
Wyoming$70.38$15.904.4x2,265
Rhode Island$69.67$16.354.3x3,566
Alaska$69.53$17.933.9x1,886
Massachusetts$64.02$16.753.8x37,035
Connecticut$62.84$16.813.7x13,305
New Hampshire$62.34$14.074.4x5,659
Minnesota$59.98$15.573.9x10,568
New Jersey$59.33$17.793.3x36,457
District of Columbia$59.13$17.923.3x1,910
Georgia$58.71$15.343.8x34,854
Illinois$58.40$15.923.7x31,013
California$55.75$17.863.1x65,044
South Dakota$53.88$14.593.7x3,461
Oregon$53.63$16.053.3x10,160
Vermont$52.26$14.203.7x1,354
Pennsylvania$51.40$15.593.3x47,592
Missouri$50.94$15.003.4x16,963
Washington$50.58$16.253.1x20,673
Ohio$49.25$14.093.5x31,255
Tennessee$48.88$14.533.4x26,347
North Carolina$48.41$15.243.2x32,752
Iowa$46.98$14.743.2x9,612
Texas$46.92$15.453.0x70,641
Maryland$45.69$16.932.7x36,256
Nevada$45.45$15.393.0x4,704
Nebraska$45.03$14.993.0x5,276
Mississippi$44.46$14.293.1x8,671
Virginia$44.32$15.982.8x31,510
North Dakota$44.31$14.243.1x1,632
Indiana$44.03$14.932.9x17,787
Colorado$43.87$16.022.7x17,226
Montana$43.38$15.472.8x3,486
South Carolina$42.84$15.082.8x21,401
West Virginia$42.39$14.552.9x3,156
Kansas$42.32$14.712.9x11,209
Delaware$42.26$16.002.6x6,617
Louisiana$41.87$15.032.8x11,387
Michigan$41.25$14.942.8x19,989
Hawaii$40.99$16.942.4x3,599
Maine$40.94$14.332.9x4,053
Utah$40.67$15.232.7x6,287
Florida$40.66$15.912.6x80,185
Arkansas$39.93$14.212.8x7,408
Kentucky$39.66$14.382.8x10,318
Arizona$39.30$15.502.5x27,534
Oklahoma$38.07$14.732.6x10,076
New Mexico$37.03$15.062.5x4,315
Idaho$36.89$14.102.6x3,906
Alabama$33.84$14.352.4x16,600
Puerto Rico$21.43$15.771.4x35
Northern Mariana Islands$17.54$17.101.0x39
Virgin Islands$16.83$16.051.0x383
Guam$15.90$15.531.0x151

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

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