82570

Creatinine level to test for kidney function or muscle injury

Code 82570. Medicare covered 5,536,830 of these. Here is what providers billed and what Medicare allowed, state by state.

$45.67Billed, national avg
$5.06Medicare allowed
9.0xBilled vs allowed
11.3xHighest vs lowest state

Providers in Nevada billed the most for this, at $60.93. In Virgin Islands the average was $5.37. 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
Nevada$60.93$5.0712.0x45,779
Kansas$59.07$5.0811.6x155,831
New Jersey$57.06$5.0711.2x559,150
Colorado$56.38$5.0611.1x31,562
North Carolina$52.66$5.0710.4x476,712
Texas$52.37$5.0710.3x567,649
Wisconsin$51.63$5.0010.3x69,891
Florida$50.01$5.089.9x580,141
New York$49.42$5.079.7x138,354
Maryland$48.65$5.079.6x90,763
California$48.48$5.089.6x645,107
Massachusetts$47.94$5.089.4x126,465
Georgia$47.81$5.069.5x155,732
Illinois$47.50$5.079.4x187,592
West Virginia$46.16$5.059.1x1,934
Alabama$46.04$5.069.1x163,084
Pennsylvania$43.38$5.078.6x78,563
Alaska$42.98$5.038.5x3,326
Ohio$42.75$5.078.4x176,800
Guam$40.49$5.008.1x284
Washington$39.99$5.067.9x90,358
Oklahoma$38.37$5.067.6x57,934
South Carolina$33.99$5.036.8x63,262
Arizona$33.38$5.076.6x316,353
Rhode Island$29.27$5.045.8x8,311
Louisiana$27.58$5.065.5x29,496
Tennessee$26.98$5.045.4x191,526
Vermont$26.83$5.085.3x243
Minnesota$26.17$3.976.6x41,927
North Dakota$26.16$4.995.2x4,927
Oregon$25.78$5.065.1x41,895
District of Columbia$24.87$4.745.2x414
South Dakota$24.62$5.074.9x8,695
Iowa$24.45$5.064.8x25,392
Mississippi$24.42$5.044.8x32,036
New Mexico$24.36$5.064.8x20,193
Missouri$24.32$5.064.8x29,262
Hawaii$23.95$5.064.7x45,772
Montana$23.29$5.064.6x2,911
New Hampshire$22.51$5.074.4x2,884
Kentucky$22.00$5.034.4x16,812
Connecticut$21.54$5.074.2x11,746
Idaho$21.00$5.064.2x5,583
Wyoming$20.18$5.064.0x1,248
Virginia$20.14$5.064.0x73,132
Indiana$20.06$5.064.0x38,880
Nebraska$19.49$5.063.9x20,619
Arkansas$18.84$5.043.7x19,484
Michigan$18.22$5.053.6x32,466
Utah$13.73$5.062.7x24,927
Maine$13.38$5.042.7x3,990
Delaware$13.03$5.052.6x7,164
Armed Forces Europe$6.69$1.315.1x35
Puerto Rico$5.70$5.061.1x11,260
Virgin Islands$5.37$5.081.1x904

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

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