99307

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes

Code 99307. Medicare covered 1,556,786 of these. Here is what providers billed and what Medicare allowed, state by state.

$94.25Billed, national avg
$38.15Medicare allowed
2.5xBilled vs allowed
4.8xHighest vs lowest state

Providers in Alaska billed the most for this, at $218.02. In Puerto Rico the average was $45.44. 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$218.02$49.404.4x1,170
Armed Forces Europe$138.02$35.153.9x117
Delaware$126.46$34.263.7x4,017
Wyoming$119.31$36.393.3x1,692
New Jersey$113.23$39.952.8x103,111
District of Columbia$113.19$40.112.8x1,795
North Dakota$111.03$36.203.1x1,939
New York$110.12$42.032.6x250,575
Minnesota$108.37$35.423.1x4,457
Oregon$107.57$37.282.9x1,582
Wisconsin$102.62$36.702.8x7,797
Arizona$101.54$36.102.8x7,702
Nebraska$100.71$35.302.9x3,084
California$100.57$40.522.5x169,600
Maryland$100.29$38.442.6x26,722
Colorado$99.20$37.272.7x7,264
West Virginia$95.15$35.042.7x5,846
Northern Mariana Islands$94.74$38.082.5x209
Unknown$94.54$39.972.4x74
New Mexico$94.46$36.432.6x1,453
Pennsylvania$93.87$36.902.5x65,272
Massachusetts$93.80$38.242.5x31,110
Iowa$93.66$35.982.6x8,401
Florida$93.12$38.132.4x168,351
Indiana$92.95$33.682.8x36,267
Virginia$92.68$36.112.6x23,645
Rhode Island$92.57$38.222.4x3,006
Nevada$90.56$38.022.4x16,139
Georgia$89.48$35.622.5x34,163
North Carolina$89.36$34.012.6x22,198
Vermont$88.76$35.392.5x1,249
Illinois$88.61$37.532.4x99,196
Washington$88.45$36.122.4x7,426
Kansas$88.21$34.892.5x7,289
Montana$88.05$39.802.2x2,129
Connecticut$86.54$37.602.3x20,610
Maine$85.27$35.772.4x4,020
Louisiana$85.04$34.822.4x16,721
Oklahoma$82.49$35.052.4x15,730
Ohio$81.84$36.232.3x47,794
Texas$80.43$36.922.2x120,919
Kentucky$80.38$34.492.3x28,398
Michigan$79.51$36.172.2x35,537
South Dakota$78.89$36.942.1x1,173
Tennessee$78.72$34.402.3x26,557
Idaho$77.60$36.242.1x2,195
Utah$76.72$36.272.1x4,879
Hawaii$76.53$41.661.8x10,960
South Carolina$76.21$35.672.1x15,055
New Hampshire$75.32$36.082.1x4,013
Missouri$75.25$35.992.1x24,883
Mississippi$73.65$33.812.2x20,499
Arkansas$73.04$35.802.0x10,793
Alabama$65.90$34.971.9x19,873
Puerto Rico$45.44$39.331.2x122

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

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