What this guide is best for
Direct answer: Use this when the medical bills in your claim look far larger than anything you have seen before.
Best used when: Billed charges commonly run many times the negotiated price for the same imaging or injection.
What the treatment in your claim is worth on paper
Key point: Billed charges commonly run many times the negotiated price for the same imaging or injection.
What a good provider should make clear: Every bill in the claim checked against what that code is normally allowed at.
Common mistake: Assuming the billed total is the amount anyone will actually be paid.
Questions to ask: What was billed, what was allowed, and what is still outstanding on each bill?
What the treatment in your claim is worth on paper
Opening intent: show what the treatment in a claim is billed at against what it is normally allowed at
| Cost question | What matters |
|---|---|
| What are you really comparing? | Use this when the medical bills in your claim look far larger than anything you have seen before. |
| What changes total cost? | Billed charges commonly run many times the negotiated price for the same imaging or injection. |
| Where people get burned | Assuming the billed total is the amount anyone will actually be paid. |
| What to ask before paying | What was billed, what was allowed, and what is still outstanding on each bill? |
Quick answer
The medical bills in an injury claim are usually stated at billed charges. Billed charges are list prices, and list prices in US healthcare run far above what anyone actually pays.
Knowing the size of that gap is the difference between understanding your claim and being surprised by it.
Timing, and why it is urgent
Get copies of every bill early, ideally within the first weeks, while providers still have them readily to hand.
Ask for the itemised statement showing billed, adjusted and outstanding amounts, not the summary. The summary hides the adjustment.
Do not wait for the case to resolve to start assembling this. Reconstructing it later is slow and often incomplete.
Billed against allowed, for common injury treatment
National Medicare figures, office setting, calendar year 2024.
| Code | What it covers | Average submitted charge (office) | Average Medicare allowed |
|---|---|---|---|
| 99284 | Emergency department visit, moderate complexity | $415.07 | $113.03 |
| 72141 | MRI, cervical spine, without contrast | $1,233.04 | $135.87 |
| 72148 | MRI, lumbar spine, without contrast | $1,235.09 | $144.78 |
| 73721 | MRI, leg joint, without contrast | $1,183.52 | $153.71 |
| 97110 | Physical therapy exercise, per 15 minutes | $69.14 | $22.79 |
| 20610 | Large joint aspiration or injection | $281.20 | $66.41 |
| 62323 | Lumbar epidural injection with imaging guidance | $1,068.71 | $234.44 |
| 64483 | Sacral nerve root injection with imaging guidance | $1,379.85 | $271.61 |
A lumbar spine MRI was billed at $1,235.09 and allowed at $144.78. That is roughly 8.5 times.
An epidural injection was billed at $1,068.71 and allowed at $234.44.
These are Medicare's numbers, not yours. But the shape of the gap is the same argument insurers and lienholders will be having about your file.
Documents to collect and keep
Keep the itemised bill from every provider, the explanation of benefits from every insurer, and the record of anything you paid yourself.
Photograph or scan them as they arrive. Keep a dated timeline of treatment, because gaps in treatment get argued about later.
Record mileage and time off work as you go. Reconstructed figures are weaker than contemporaneous ones.
Questions to ask about the bills
- What was billed, what was allowed, and what is still outstanding?
- Is any provider holding a lien on the settlement?
- Was anything billed at list price because no insurer was involved?
- Can the outstanding balance be negotiated before settlement?
Common mistake: treating the billed total as the value of the claim. Nobody in the process does.
Red flags and what not to do
Do not give a recorded statement about your treatment before you have the records in front of you. Be careful with any bill you cannot trace to a provider.
Slow down if anyone asks you to sign a lien document you have not read.
Where these numbers come from, and what they are not
Source: Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners — by Geography and Service, calendar year 2024 claims (file released 21 May 2026).
Method: we pull the published rows for each billing code, keep the average submitted charge and the average Medicare allowed amount, and print them unchanged. Nothing is modelled, averaged across codes, or adjusted.
- The submitted charge is what clinicians billed. It is list price. Almost nobody pays it.
- The allowed amount is what Medicare permitted, including the patient's coinsurance. It is a negotiated price.
- These are Medicare fee-for-service claims. The patients skew 65 and older.
- If you are paying cash or using commercial insurance, neither figure is your price. Use the gap between them as a bargaining range, not a quote.
- CMS hides any cell covering fewer than 11 patients, so some states are missing. We print "not published" there rather than guessing.
Common mistake: reading the allowed amount as "the real price" and expecting a clinic to match it. It is what one payer pays one set of clinicians.
What to do next
Request itemised statements from every provider. Line up billed, allowed and outstanding for each one before discussing numbers with anyone.
Educational only. Not legal advice. No endorsements or rankings.