Code 96365. Medicare covered 1,390,306 of these. Here is what providers billed and what Medicare allowed, state by state.
Providers in Virgin Islands billed the most for this, at $390.46. In Guam the average was $80.50. Same procedure code, same programme.
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.
| State | Billed | Medicare allowed | Gap | Services |
|---|---|---|---|---|
| Virgin Islands | $390.46 | $56.02 | 7.0x | 255 |
| Alaska | $386.12 | $64.65 | 6.0x | 2,915 |
| Wyoming | $367.36 | $59.89 | 6.1x | 3,393 |
| New Hampshire | $360.86 | $61.51 | 5.9x | 2,444 |
| Connecticut | $330.78 | $64.44 | 5.1x | 7,713 |
| Maine | $306.85 | $60.33 | 5.1x | 3,376 |
| West Virginia | $301.89 | $60.18 | 5.0x | 1,117 |
| Minnesota | $288.72 | $60.59 | 4.8x | 19,784 |
| South Dakota | $286.71 | $59.84 | 4.8x | 3,567 |
| Illinois | $273.75 | $60.56 | 4.5x | 56,374 |
| Wisconsin | $271.30 | $56.50 | 4.8x | 12,025 |
| Massachusetts | $264.24 | $65.13 | 4.1x | 12,700 |
| New York | $262.07 | $67.93 | 3.9x | 89,023 |
| Armed Forces Pacific | $251.00 | $73.54 | 3.4x | 112 |
| California | $249.55 | $70.06 | 3.6x | 145,853 |
| Vermont | $248.21 | $64.99 | 3.8x | 650 |
| Nevada | $243.12 | $59.65 | 4.1x | 17,869 |
| Washington | $242.48 | $64.94 | 3.7x | 17,336 |
| District of Columbia | $240.77 | $70.23 | 3.4x | 1,126 |
| New Jersey | $234.89 | $68.45 | 3.4x | 49,804 |
| South Carolina | $234.18 | $53.09 | 4.4x | 28,771 |
| Texas | $232.78 | $57.57 | 4.0x | 149,481 |
| North Dakota | $230.92 | $59.09 | 3.9x | 2,275 |
| Colorado | $230.90 | $62.68 | 3.7x | 34,946 |
| Oregon | $230.16 | $61.30 | 3.8x | 14,027 |
| Delaware | $229.60 | $59.74 | 3.8x | 4,134 |
| Maryland | $228.95 | $67.36 | 3.4x | 31,557 |
| Missouri | $224.37 | $56.44 | 4.0x | 18,456 |
| Georgia | $224.19 | $56.65 | 4.0x | 46,246 |
| Pennsylvania | $221.93 | $61.27 | 3.6x | 36,741 |
| Virginia | $211.39 | $62.16 | 3.4x | 32,703 |
| Rhode Island | $210.98 | $63.31 | 3.3x | 1,361 |
| Michigan | $210.17 | $56.94 | 3.7x | 25,977 |
| Ohio | $208.67 | $55.15 | 3.8x | 26,860 |
| Arkansas | $208.29 | $52.63 | 4.0x | 16,037 |
| Iowa | $206.18 | $56.06 | 3.7x | 10,250 |
| North Carolina | $205.59 | $56.08 | 3.7x | 37,413 |
| New Mexico | $205.21 | $55.99 | 3.7x | 6,971 |
| Kansas | $201.06 | $52.33 | 3.8x | 16,762 |
| Alabama | $198.99 | $53.03 | 3.8x | 31,008 |
| Indiana | $195.55 | $54.91 | 3.6x | 16,018 |
| Tennessee | $195.55 | $53.43 | 3.7x | 36,821 |
| Mississippi | $192.73 | $52.30 | 3.7x | 8,253 |
| Arizona | $184.72 | $57.92 | 3.2x | 34,467 |
| Florida | $179.86 | $59.48 | 3.0x | 206,538 |
| Hawaii | $174.48 | $67.48 | 2.6x | 1,226 |
| Nebraska | $174.05 | $54.83 | 3.2x | 10,261 |
| Kentucky | $172.37 | $52.36 | 3.3x | 10,218 |
| Oklahoma | $167.01 | $52.48 | 3.2x | 16,157 |
| Utah | $162.33 | $54.90 | 3.0x | 11,471 |
| Montana | $157.10 | $60.16 | 2.6x | 2,544 |
| Louisiana | $151.11 | $51.94 | 2.9x | 11,223 |
| Idaho | $150.05 | $53.83 | 2.8x | 3,556 |
| Unknown | $131.29 | $58.29 | 2.3x | 79 |
| Puerto Rico | $85.01 | $60.62 | 1.4x | 1,619 |
| Guam | $80.50 | $65.60 | 1.2x | 411 |
Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.