C9088

Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg

Code C9088. Medicare covered 1,552,138 of these. Here is what providers billed and what Medicare allowed, state by state.

$2.36Billed, national avg
$0.73Medicare allowed
3.2xBilled vs allowed
15.1xHighest vs lowest state

Providers in Nevada billed the most for this, at $10.98. In New Jersey the average was $0.73. 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
Nevada$10.98$0.7215.2x11,200
Arizona$4.97$0.756.7x84,087
Utah$4.39$0.755.8x12,800
Iowa$4.15$0.725.8x615
Missouri$4.00$0.745.4x7,951
Indiana$3.32$0.714.7x13,607
Florida$3.24$0.734.4x234,197
North Dakota$3.23$0.734.4x53,204
Oregon$3.16$0.744.3x39,400
Texas$3.03$0.734.1x89,830
Maryland$3.01$0.744.1x31,200
Alabama$3.00$0.744.0x7,600
Michigan$2.59$0.743.5x153,742
Colorado$2.37$0.673.5x28,000
Illinois$2.18$0.743.0x18,407
New York$1.90$0.722.6x32,402
Ohio$1.85$0.732.5x118,002
Georgia$1.66$0.682.4x62,245
California$1.55$0.722.1x199,398
Nebraska$1.43$0.751.9x6,602
Tennessee$1.35$0.711.9x16,201
Montana$1.14$0.721.6x73,468
North Carolina$0.87$0.691.3x21,276
New Mexico$0.83$0.711.2x35,204
Louisiana$0.81$0.731.1x60,603
South Carolina$0.80$0.691.2x8,806
Mississippi$0.78$0.751.0x118,402
New Jersey$0.73$0.711.0x5,668

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

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