Code J1434. Medicare covered 1,130,029 of these. Here is what providers billed and what Medicare allowed, state by state.
Providers in Texas billed the most for this, at $10.55. In Alabama the average was $6.00. 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 |
|---|---|---|---|---|
| Texas | $10.55 | $6.68 | 1.6x | 3,454 |
| Oklahoma | $10.22 | $5.95 | 1.7x | 22,070 |
| Florida | $8.99 | $2.85 | 3.1x | 944,251 |
| Nebraska | $8.54 | $3.04 | 2.8x | 60,900 |
| Illinois | $7.76 | $3.02 | 2.6x | 24,450 |
| Arkansas | $6.84 | $3.32 | 2.1x | 42,654 |
| Alabama | $6.00 | $3.11 | 1.9x | 21,000 |
Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.