99152

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes

Code 99152. Medicare covered 1,412,693 of these. Here is what providers billed and what Medicare allowed, state by state.

$112.43Billed, national avg
$15.76Medicare allowed
7.1xBilled vs allowed
6.4xHighest vs lowest state

Providers in Alaska billed the most for this, at $329.73. In Idaho the average was $51.22. 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$329.73$23.1514.2x3,197
Virgin Islands$270.00$11.7623.0x75
Wyoming$214.27$13.4715.9x783
Wisconsin$201.44$11.8417.0x27,372
Vermont$172.44$12.7413.5x1,987
Kansas$152.15$12.8411.8x16,349
California$149.70$17.598.5x135,619
Connecticut$146.89$18.827.8x11,814
New York$140.64$18.727.5x62,318
West Virginia$139.65$11.8811.8x5,153
North Dakota$136.08$11.4811.9x5,877
Iowa$133.81$11.7111.4x15,837
Georgia$133.21$15.098.8x41,088
North Carolina$126.56$13.879.1x40,663
Louisiana$125.39$14.098.9x23,701
New Hampshire$122.33$11.7610.4x7,117
New Mexico$120.96$17.187.0x6,885
Nebraska$120.29$14.158.5x10,471
South Carolina$117.54$14.098.3x27,025
New Jersey$116.79$14.398.1x28,569
Texas$114.74$17.206.7x119,954
Minnesota$114.34$12.289.3x28,640
Illinois$112.85$15.057.5x68,337
Guam$109.59$31.573.5x398
Arizona$108.29$21.055.1x35,305
Utah$107.97$24.394.4x12,755
Oregon$107.32$15.726.8x13,191
Florida$105.34$18.185.8x107,886
Rhode Island$105.00$12.858.2x4,264
Nevada$101.55$14.317.1x10,925
Indiana$99.64$11.848.4x36,252
Missouri$98.31$13.327.4x32,369
Oklahoma$94.72$15.666.0x32,600
Colorado$94.62$16.885.6x18,835
Virginia$94.42$16.935.6x45,389
Michigan$94.30$18.485.1x44,108
District of Columbia$93.75$14.536.5x2,568
Kentucky$92.04$14.246.5x20,449
Maryland$90.61$22.454.0x20,415
Arkansas$89.79$14.266.3x20,165
Massachusetts$88.82$14.766.0x32,876
Mississippi$86.34$13.876.2x21,747
Ohio$85.70$12.157.1x48,104
Puerto Rico$83.64$23.643.5x692
Tennessee$83.56$14.485.8x28,109
Delaware$82.69$18.624.4x4,399
Pennsylvania$81.31$12.516.5x52,092
Montana$79.41$11.816.7x6,228
South Dakota$77.74$15.744.9x9,216
Alabama$74.88$14.545.1x16,090
Washington$72.98$14.555.0x31,465
Hawaii$71.14$17.914.0x2,364
Maine$65.25$11.675.6x4,256
Idaho$51.22$11.934.3x8,339

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

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