97150

Therapy procedure in a group setting

Code 97150. Medicare covered 2,707,451 of these. Here is what providers billed and what Medicare allowed, state by state.

$51.42Billed, national avg
$13.61Medicare allowed
3.8xBilled vs allowed
6.6xHighest vs lowest state

Providers in New York billed the most for this, at $126.59. In Guam the average was $19.12. 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
New York$126.59$14.918.5x136,506
Massachusetts$116.68$13.758.5x68,211
North Dakota$106.23$13.527.9x202
New Hampshire$87.82$13.636.4x7,885
Montana$85.05$13.506.3x396
Rhode Island$72.87$14.005.2x1,624
Connecticut$65.67$14.004.7x29,756
Wisconsin$62.87$13.264.7x4,325
New Jersey$62.60$14.594.3x215,640
Alaska$61.82$18.293.4x3,767
Nevada$59.01$13.264.5x34,411
Illinois$58.76$13.624.3x30,145
Michigan$57.90$13.564.3x28,477
Indiana$55.64$12.984.3x17,080
Idaho$55.14$12.614.4x9,737
Armed Forces Pacific$55.00$13.574.1x128
Maryland$54.56$13.923.9x147,028
Kentucky$53.25$12.934.1x53,923
Florida$51.93$13.403.9x100,640
Arizona$51.73$13.293.9x128,907
Ohio$50.58$12.913.9x45,528
Washington$49.38$13.563.6x15,283
Nebraska$48.58$13.393.6x1,352
Delaware$47.85$13.513.5x49,770
West Virginia$47.67$13.383.6x3,959
Virginia$47.39$13.673.5x146,724
Iowa$46.64$12.643.7x9,739
South Dakota$46.08$13.553.4x3,199
District of Columbia$45.97$14.693.1x6,128
California$45.36$14.233.2x205,690
Pennsylvania$44.56$13.723.2x326,050
Utah$44.06$13.123.4x2,637
Texas$43.49$13.163.3x228,422
Colorado$42.35$13.773.1x39,480
Virgin Islands$40.65$13.183.1x372
Wyoming$40.36$14.902.7x2,806
Minnesota$38.76$13.892.8x1,013
Maine$36.67$13.402.7x12,122
Oregon$36.40$13.372.7x10,969
Alabama$35.79$12.722.8x26,660
New Mexico$35.75$13.512.6x3,839
Hawaii$34.70$13.442.6x1,771
Louisiana$33.76$12.982.6x23,622
Mississippi$33.13$12.652.6x25,957
Missouri$32.59$13.102.5x32,541
Oklahoma$32.08$12.722.5x57,343
South Carolina$31.89$12.892.5x70,388
North Carolina$30.93$13.092.4x53,899
Georgia$28.25$13.252.1x135,940
Tennessee$26.70$12.842.1x114,125
Arkansas$26.07$12.902.0x11,146
Kansas$25.06$13.071.9x19,750
Armed Forces Europe$20.01$13.131.5x175
Guam$19.12$14.161.4x165

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

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