G0009

Administration of pneumococcal vaccine

Code G0009. Medicare covered 1,730,774 of these. Here is what providers billed and what Medicare allowed, state by state.

$49.09Billed, national avg
$29.96Medicare allowed
1.6xBilled vs allowed
2.6xHighest vs lowest state

Providers in Massachusetts billed the most for this, at $67.85. In Virgin Islands the average was $26.48. 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
Massachusetts$67.85$32.242.1x52,526
Foreign Country$67.62$32.002.1x24
Florida$63.21$30.542.1x172,894
Washington$60.20$30.891.9x29,921
Maine$59.03$29.022.0x3,712
New York$58.21$33.381.7x89,693
Armed Forces Europe$57.59$35.261.6x110
Alaska$57.09$33.601.7x2,873
Idaho$56.90$32.701.7x50,966
California$53.93$32.891.6x155,808
North Dakota$53.48$30.501.8x3,188
New Jersey$52.27$33.021.6x64,777
Iowa$52.01$28.561.8x20,934
Arkansas$51.70$26.382.0x16,436
Delaware$50.08$30.641.6x8,657
Unknown$50.00$32.961.5x14
Connecticut$49.80$32.511.5x18,431
Rhode Island$49.54$31.441.6x5,848
Kentucky$49.53$27.251.8x20,107
West Virginia$49.25$26.431.9x5,457
Oregon$49.04$29.221.7x14,747
Maryland$48.90$32.011.5x47,370
New Hampshire$48.19$30.321.6x9,074
District of Columbia$48.04$34.471.4x3,601
North Carolina$47.28$28.481.7x53,986
Georgia$47.03$28.711.6x44,723
South Carolina$46.76$28.201.7x38,007
Wisconsin$46.58$27.581.7x26,622
Illinois$45.03$30.301.5x69,847
Pennsylvania$44.75$30.321.5x76,273
Virginia$44.26$29.831.5x59,227
Missouri$43.59$28.581.5x26,514
Minnesota$43.05$28.281.5x19,689
Texas$42.43$28.071.5x103,216
Nebraska$42.41$27.911.5x14,967
Colorado$42.33$29.151.5x43,065
New Mexico$42.22$26.951.6x8,202
Montana$42.21$28.091.5x4,435
Arizona$42.11$28.031.5x35,503
Kansas$42.07$26.241.6x23,013
Louisiana$40.98$27.941.5x15,332
Ohio$40.37$28.311.4x57,319
South Dakota$39.39$25.051.6x3,909
Indiana$39.24$28.251.4x44,697
Utah$39.00$26.621.5x11,861
Tennessee$38.81$27.491.4x39,891
Armed Forces Pacific$37.96$28.701.3x25
Guam$37.87$31.951.2x536
Alabama$37.11$27.261.4x17,713
Michigan$36.99$28.651.3x37,034
Oklahoma$36.99$27.381.4x19,165
Hawaii$36.57$30.031.2x6,121
Mississippi$36.13$25.691.4x14,113
Wyoming$35.96$27.121.3x4,481
Nevada$35.58$26.971.3x10,238
Vermont$34.77$27.141.3x2,913
Puerto Rico$29.98$26.991.1x781
Virgin Islands$26.48$24.141.1x105

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

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