The same procedure code settles at a different number in every state. These pages show what providers billed and what Medicare allowed in each one.
American Samoa carries the widest gap between billed and allowed, at 14.7x. Puerto Rico is the tightest at 1.7x. Medicare pays close to the same either way. The billed column is what changes.
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.
Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume, non-drug codes.
A wide gap is not a state overcharging Medicare. Medicare sets its own price and pays it.
It measures how far the sticker sits from the settlement. That matters to anyone without Medicare, because the sticker is where their bill starts.