96372

Injection of drug or substance under skin or into muscle

Code 96372. Medicare covered 6,927,967 of these. Here is what providers billed and what Medicare allowed, state by state.

$55.32Billed, national avg
$13.42Medicare allowed
4.1xBilled vs allowed
4.1xHighest vs lowest state

Providers in Alaska billed the most for this, at $95.65. In Guam the average was $23.29. 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
Alaska$95.65$16.086.0x13,040
Wisconsin$94.74$13.027.3x43,269
New York$87.76$15.405.7x307,007
Virgin Islands$85.22$13.696.2x1,698
New Hampshire$83.27$13.736.1x13,860
Maine$76.93$13.605.7x6,714
Connecticut$74.64$14.745.1x43,559
Massachusetts$71.62$14.534.9x83,885
Illinois$70.09$13.775.1x195,248
New Jersey$69.30$15.394.5x186,689
South Dakota$68.92$13.195.2x12,854
North Dakota$68.35$13.415.1x13,388
Minnesota$68.00$13.635.0x47,066
Vermont$63.80$13.674.7x2,892
Maryland$62.36$14.654.3x139,932
Nevada$62.16$13.424.6x56,567
Washington$61.48$14.004.4x60,320
Wyoming$60.69$13.094.6x12,490
Colorado$59.65$13.734.3x61,574
Foreign Country$59.42$11.465.2x798
Missouri$58.93$12.744.6x80,788
Hawaii$58.20$14.594.0x16,174
Kansas$58.11$12.634.6x74,700
District of Columbia$57.88$15.533.7x6,274
California$57.78$15.363.8x733,868
Iowa$57.57$12.664.5x48,232
Oregon$57.54$13.564.2x37,399
Pennsylvania$56.71$13.674.1x202,622
Georgia$55.12$12.724.3x300,708
Rhode Island$55.08$13.924.0x7,671
Delaware$54.50$13.784.0x21,940
North Carolina$53.94$12.774.2x245,529
Virginia$53.70$13.773.9x184,914
Nebraska$53.20$12.714.2x62,540
Texas$52.54$12.964.1x607,846
Florida$51.74$13.573.8x691,182
West Virginia$51.65$12.354.2x24,149
South Carolina$50.96$12.634.0x177,765
Michigan$48.68$13.413.6x172,238
Ohio$48.61$12.853.8x130,072
New Mexico$48.06$12.593.8x29,347
Tennessee$47.96$12.203.9x324,923
Arkansas$47.45$12.133.9x134,282
Oklahoma$47.30$12.033.9x161,785
Kentucky$46.89$12.313.8x105,942
Arizona$46.84$13.173.6x172,894
Idaho$46.57$12.193.8x19,293
Montana$46.01$13.273.5x8,125
Indiana$45.59$12.763.6x122,541
Louisiana$45.49$12.303.7x156,729
Armed Forces Europe$43.83$12.623.5x84
Mississippi$43.10$11.763.7x211,426
Utah$43.01$12.823.4x49,058
Armed Forces Pacific$42.13$12.363.4x232
Unknown$40.74$13.723.0x244
Armed Forces Central/South America$40.02$12.153.3x14
Alabama$38.86$12.063.2x297,792
Puerto Rico$33.47$14.002.4x2,329
Guam$23.29$14.651.6x1,289

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

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