Code 99497. Medicare covered 2,700,155 of these. Here is what providers billed and what Medicare allowed, state by state.
Providers in Armed Forces Central/South America billed the most for this, at $546.00. In Unknown the average was $124.98. 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 |
|---|---|---|---|---|
| Armed Forces Central/South America | $546.00 | $72.26 | 7.6x | 13 |
| Foreign Country | $513.33 | $71.00 | 7.2x | 93 |
| Puerto Rico | $412.10 | $76.90 | 5.4x | 396 |
| Alaska | $362.84 | $89.95 | 4.0x | 1,381 |
| Minnesota | $252.62 | $69.12 | 3.7x | 11,079 |
| Wisconsin | $252.09 | $68.09 | 3.7x | 14,786 |
| New York | $237.92 | $82.09 | 2.9x | 222,718 |
| Oregon | $237.05 | $70.53 | 3.4x | 12,321 |
| New Jersey | $228.07 | $74.60 | 3.1x | 104,578 |
| Washington | $221.53 | $74.52 | 3.0x | 43,768 |
| Massachusetts | $215.66 | $74.47 | 2.9x | 52,472 |
| Virgin Islands | $215.19 | $77.71 | 2.8x | 149 |
| Wyoming | $206.85 | $68.54 | 3.0x | 1,305 |
| North Dakota | $206.62 | $70.12 | 2.9x | 962 |
| Missouri | $204.42 | $67.69 | 3.0x | 25,337 |
| District of Columbia | $201.40 | $82.63 | 2.4x | 8,681 |
| Texas | $197.28 | $73.28 | 2.7x | 214,915 |
| Iowa | $195.15 | $66.18 | 2.9x | 6,918 |
| California | $194.96 | $79.39 | 2.5x | 379,880 |
| Connecticut | $192.11 | $75.41 | 2.5x | 24,295 |
| Illinois | $191.37 | $75.88 | 2.5x | 99,031 |
| Oklahoma | $191.07 | $68.70 | 2.8x | 25,528 |
| New Mexico | $190.31 | $71.71 | 2.7x | 7,866 |
| Kansas | $187.86 | $65.32 | 2.9x | 13,810 |
| Guam | $187.30 | $78.89 | 2.4x | 134 |
| North Carolina | $185.29 | $69.76 | 2.7x | 81,861 |
| Montana | $184.08 | $63.02 | 2.9x | 5,075 |
| Tennessee | $183.93 | $65.59 | 2.8x | 60,263 |
| Georgia | $182.06 | $73.45 | 2.5x | 84,869 |
| Vermont | $181.61 | $70.62 | 2.6x | 771 |
| Ohio | $178.08 | $66.28 | 2.7x | 63,986 |
| Colorado | $177.34 | $65.83 | 2.7x | 35,872 |
| Florida | $177.01 | $74.94 | 2.4x | 295,616 |
| Maryland | $173.89 | $77.97 | 2.2x | 88,449 |
| Indiana | $171.96 | $68.60 | 2.5x | 40,316 |
| West Virginia | $171.02 | $71.35 | 2.4x | 11,493 |
| Hawaii | $170.59 | $75.26 | 2.3x | 13,759 |
| Delaware | $170.10 | $65.29 | 2.6x | 12,273 |
| Louisiana | $170.05 | $69.89 | 2.4x | 27,924 |
| Virginia | $168.68 | $74.16 | 2.3x | 62,759 |
| Pennsylvania | $167.44 | $71.92 | 2.3x | 77,023 |
| Maine | $167.11 | $70.66 | 2.4x | 3,659 |
| Arizona | $166.20 | $71.87 | 2.3x | 82,917 |
| Idaho | $166.19 | $68.23 | 2.4x | 8,386 |
| Michigan | $163.36 | $69.10 | 2.4x | 70,723 |
| Rhode Island | $160.69 | $74.05 | 2.2x | 7,285 |
| Nebraska | $156.51 | $53.01 | 3.0x | 13,565 |
| New Hampshire | $154.12 | $69.04 | 2.2x | 6,159 |
| Nevada | $151.32 | $70.62 | 2.1x | 61,699 |
| Kentucky | $148.37 | $69.86 | 2.1x | 30,071 |
| Armed Forces Pacific | $148.30 | $64.98 | 2.3x | 111 |
| Utah | $146.74 | $69.92 | 2.1x | 19,759 |
| Mississippi | $143.84 | $71.17 | 2.0x | 30,585 |
| Arkansas | $141.65 | $62.33 | 2.3x | 21,456 |
| Alabama | $134.29 | $70.27 | 1.9x | 35,042 |
| South Carolina | $132.24 | $69.07 | 1.9x | 71,162 |
| South Dakota | $129.99 | $66.66 | 2.0x | 2,592 |
| Unknown | $124.98 | $79.04 | 1.6x | 244 |
Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.