G6015

Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session

Code G6015. Medicare covered 1,078,295 of these. Here is what providers billed and what Medicare allowed, state by state.

$1,749.75Billed, national avg
$350.35Medicare allowed
5.0xBilled vs allowed
12.9xHighest vs lowest state

Providers in Vermont billed the most for this, at $5,607.22. In Puerto Rico the average was $434.86. 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
Vermont$5,607.22$376.4514.9x1,109
Delaware$5,486.56$366.9615.0x886
Alaska$4,894.60$372.4113.1x6,970
Wisconsin$3,620.44$345.4810.5x6,555
Wyoming$3,279.40$366.948.9x2,764
Minnesota$3,143.45$359.188.8x14,177
Arkansas$3,132.64$299.2810.5x20,540
Virginia$3,077.04$349.018.8x14,080
New Mexico$2,806.37$317.678.8x2,332
Massachusetts$2,446.17$372.756.6x6,735
Maryland$2,337.16$373.956.2x29,488
Mississippi$2,293.88$298.927.7x3,882
Ohio$2,260.22$339.866.7x25,156
Tennessee$2,007.70$314.056.4x14,824
Oregon$1,923.87$361.035.3x6,336
Missouri$1,900.89$319.785.9x8,936
Illinois$1,847.61$346.255.3x31,538
New Jersey$1,836.76$391.264.7x31,228
Texas$1,829.71$337.375.4x137,707
Michigan$1,813.31$324.745.6x23,043
Connecticut$1,768.78$380.564.6x3,222
Nevada$1,733.11$348.635.0x18,367
Georgia$1,724.48$317.575.4x18,194
Arizona$1,712.89$339.195.0x63,015
California$1,706.74$411.864.1x107,895
North Dakota$1,700.92$370.564.6x5,011
Indiana$1,653.23$316.195.2x17,383
West Virginia$1,618.41$311.635.2x2,528
Iowa$1,578.43$335.894.7x380
Pennsylvania$1,565.83$352.794.4x23,384
Alabama$1,545.29$314.024.9x25,691
Hawaii$1,541.77$390.294.0x4,942
Louisiana$1,534.36$313.184.9x23,823
New York$1,505.05$398.943.8x58,141
District of Columbia$1,492.32$348.194.3x3,770
Colorado$1,483.29$362.014.1x10,419
North Carolina$1,472.18$326.834.5x19,299
Washington$1,384.57$358.373.9x21,925
New Hampshire$1,364.54$360.283.8x1,607
Utah$1,364.07$329.774.1x1,497
Florida$1,352.24$341.754.0x187,942
Kentucky$1,344.73$309.914.3x5,735
Idaho$1,314.21$322.084.1x5,266
Rhode Island$1,296.43$354.783.7x5,411
Nebraska$1,162.57$318.893.6x6,131
Kansas$1,127.69$320.893.5x16,661
South Carolina$1,107.96$325.683.4x21,652
Oklahoma$1,077.64$304.563.5x6,310
Maine$1,023.00$299.743.4x1,033
Guam$928.93$398.092.3x944
Puerto Rico$434.86$350.001.2x2,431

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

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