C9290

Injection, bupivacaine liposome, 1 mg

Code C9290. Medicare covered 6,884,666 of these. Here is what providers billed and what Medicare allowed, state by state.

$4.88Billed, national avg
$1.39Medicare allowed
3.5xBilled vs allowed
9.9xHighest vs lowest state

Providers in Oregon billed the most for this, at $13.41. In Rhode Island the average was $1.36. 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
Oregon$13.41$1.389.7x126,075
Delaware$9.56$1.416.8x26,334
Wyoming$8.98$1.396.4x27,400
Mississippi$8.66$1.406.2x52,269
Texas$7.55$1.385.5x603,564
Missouri$6.68$1.414.7x90,203
Arkansas$6.22$1.414.4x31,179
West Virginia$6.19$1.404.4x34,983
Indiana$6.17$1.394.5x171,394
Ohio$5.98$1.404.3x274,132
Kentucky$5.93$1.404.2x4,266
Arizona$5.72$1.404.1x180,921
Maryland$5.71$1.384.1x143,806
Louisiana$5.61$1.404.0x71,739
Florida$5.29$1.403.8x1,077,066
Michigan$5.10$1.403.6x60,693
Pennsylvania$4.80$1.393.5x131,528
Alaska$4.78$1.383.5x112,381
North Carolina$4.70$1.393.4x407,843
Minnesota$4.66$1.393.4x173,097
California$4.47$1.403.2x581,804
Illinois$4.41$1.383.2x165,317
Kansas$4.00$1.382.9x37,215
Tennessee$4.00$1.402.9x220,292
New Hampshire$3.92$1.412.8x129,545
New York$3.90$1.382.8x37,548
Iowa$3.86$1.392.8x107,867
Utah$3.79$1.402.7x147,231
Wisconsin$3.79$1.402.7x96,527
North Dakota$3.74$1.412.6x46,683
Washington$3.70$1.402.6x129,942
Nevada$3.50$1.382.5x46,178
Georgia$3.37$1.382.4x184,589
Nebraska$3.30$1.412.3x40,035
Virginia$3.26$1.402.3x136,152
Colorado$3.13$1.382.3x146,338
Montana$2.89$1.392.1x129,874
Idaho$2.72$1.382.0x69,474
Oklahoma$2.57$1.391.8x17,823
Maine$2.39$1.411.7x5,720
Massachusetts$2.29$1.401.6x7,980
Alabama$2.12$1.371.6x35,882
Connecticut$1.91$1.381.4x172,971
New Jersey$1.78$1.361.3x232,608
South Carolina$1.62$1.311.2x107,096
District of Columbia$1.56$1.411.1x5,187
Rhode Island$1.36$1.341.0x44,185

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

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