G0008

Administration of influenza virus vaccine

Code G0008. Medicare covered 11,616,610 of these. Here is what providers billed and what Medicare allowed, state by state.

$40.77Billed, national avg
$29.10Medicare allowed
1.4xBilled vs allowed
2.3xHighest vs lowest state

Providers in Armed Forces Europe billed the most for this, at $68.09. In Vermont the average was $29.28. 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
Armed Forces Europe$68.09$34.652.0x192
Foreign Country$64.44$32.932.0x61
Idaho$56.48$32.871.7x576,010
Unknown$50.00$33.211.5x80
Massachusetts$49.53$31.381.6x394,329
Florida$49.42$28.171.8x946,246
Arkansas$48.83$26.401.8x115,948
New York$47.46$32.031.5x639,259
Virgin Islands$45.93$26.761.7x783
New Jersey$45.37$32.201.4x404,020
Alaska$44.74$31.081.4x20,383
Washington$43.69$28.881.5x195,750
District of Columbia$43.19$32.701.3x17,164
Pennsylvania$42.74$30.261.4x558,647
Kentucky$42.47$25.861.6x138,620
Maryland$42.29$31.501.3x310,748
California$41.89$31.681.3x960,480
Maine$41.76$29.031.4x35,517
Connecticut$41.38$31.681.3x132,474
Wisconsin$40.32$27.281.5x223,861
Armed Forces Pacific$39.79$30.021.3x174
Illinois$39.72$29.801.3x423,365
North Carolina$39.49$27.691.4x363,369
Guam$39.36$30.831.3x2,718
North Dakota$38.97$29.651.3x31,049
West Virginia$38.47$26.261.5x41,101
Louisiana$38.28$28.171.4x98,595
Rhode Island$37.92$30.591.2x36,659
Georgia$37.74$26.811.4x274,889
Delaware$37.67$30.411.2x59,428
Virginia$37.38$28.441.3x379,622
Oklahoma$36.62$27.501.3x128,125
Minnesota$36.11$27.931.3x181,834
Missouri$36.10$27.831.3x197,929
South Dakota$35.98$27.271.3x39,082
Texas$35.41$28.011.3x619,847
New Hampshire$35.19$30.021.2x76,710
Montana$35.08$27.761.3x39,831
Nebraska$35.03$26.981.3x96,874
Michigan$34.64$28.701.2x246,899
Arizona$34.50$27.631.2x197,588
Oregon$34.48$26.581.3x95,322
Iowa$34.46$26.351.3x181,696
Indiana$34.20$27.651.2x262,111
Nevada$34.09$27.291.2x69,228
Alabama$33.70$26.891.3x116,771
Hawaii$33.63$30.381.1x41,344
Tennessee$33.62$26.511.3x250,419
Ohio$33.61$27.091.2x399,626
New Mexico$33.37$26.591.3x50,676
Colorado$33.37$28.161.2x314,044
South Carolina$33.24$27.121.2x244,608
Wyoming$32.71$25.431.3x24,548
Puerto Rico$32.28$29.721.1x4,403
Kansas$32.04$24.981.3x145,719
Mississippi$31.46$25.591.2x105,334
Northern Mariana Islands$31.26$30.631.0x106
Utah$30.61$24.881.2x73,603
Vermont$29.28$24.531.2x30,754

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

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