97140

Therapy procedure using manual technique, each 15 minutes

Code 97140. Medicare covered 29,275,217 of these. Here is what providers billed and what Medicare allowed, state by state.

$67.80Billed, national avg
$20.62Medicare allowed
3.3xBilled vs allowed
3.3xHighest vs lowest state

Providers in New Jersey billed the most for this, at $98.28. In Puerto Rico the average was $29.58. 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
New Jersey$98.28$21.944.5x2,133,753
Wisconsin$92.91$19.954.7x298,095
Alaska$87.78$26.643.3x73,349
Delaware$79.47$20.163.9x191,686
Minnesota$78.11$20.463.8x220,209
New York$77.89$22.143.5x2,919,929
Armed Forces Pacific$74.91$20.333.7x390
Illinois$74.09$20.383.6x1,041,876
Michigan$72.95$19.983.7x836,651
Rhode Island$72.65$20.723.5x146,216
Wyoming$72.04$20.043.6x234,532
Nevada$70.47$20.143.5x297,948
Indiana$69.36$19.353.6x419,673
Connecticut$68.94$21.253.2x352,025
Virginia$67.68$20.483.3x755,584
North Dakota$67.60$20.803.3x73,858
Colorado$67.41$20.663.3x702,529
Massachusetts$67.39$21.143.2x756,698
Maine$66.96$20.263.3x118,938
District of Columbia$66.81$22.033.0x44,363
Florida$66.48$19.913.3x1,791,379
Missouri$66.29$19.543.4x286,570
New Hampshire$65.80$20.403.2x160,580
Arizona$65.78$19.933.3x934,260
Foreign Country$65.66$20.223.2x469
Oregon$65.63$20.283.2x298,037
Iowa$64.84$19.453.3x306,871
Maryland$64.06$20.963.1x910,000
South Dakota$63.68$20.233.1x96,599
Ohio$63.10$19.263.3x416,245
Texas$62.85$19.773.2x1,037,950
Virgin Islands$62.65$20.473.1x4,593
Kentucky$61.71$19.133.2x297,688
Washington$61.66$20.743.0x613,973
Vermont$61.62$20.573.0x77,874
Nebraska$61.35$19.523.1x235,443
North Carolina$60.70$19.703.1x728,349
Oklahoma$60.60$18.963.2x279,606
California$60.32$21.822.8x3,766,779
Pennsylvania$60.17$20.333.0x1,266,368
Georgia$59.42$19.873.0x581,457
Mississippi$59.14$19.093.1x222,126
Armed Forces Central/South America$59.00$19.843.0x585
South Carolina$58.03$19.443.0x531,792
West Virginia$56.44$18.883.0x111,523
New Mexico$55.95$19.592.9x121,671
Tennessee$55.60$19.302.9x615,803
Kansas$55.45$19.232.9x214,428
Montana$55.30$20.362.7x149,937
Louisiana$54.68$19.392.8x437,921
Utah$54.15$19.692.7x246,586
Arkansas$53.11$18.972.8x186,503
Hawaii$50.67$20.922.4x126,904
Alabama$50.51$18.772.7x359,999
Idaho$49.36$19.352.6x231,344
Guam$48.54$21.492.3x1,452
Unknown$44.64$20.472.2x867
Armed Forces Europe$40.11$20.122.0x616
Puerto Rico$29.58$19.901.5x5,221

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

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