Procedures

What Medicare pays, and what you get billed

The 60 procedures Medicare pays for most often. What providers billed. What Medicare allowed. How far apart they sit.

8,704Procedures tracked
240,266State-level rows
10.3xWidest billed vs allowed
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.

Most billed procedures

ProcedureCodeBilledMedicare allowedGapServices
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more99214$274.90$117.362.3x103,737,268
Ground mileage, per statute mileA0425$26.41$9.462.8x98,923,627
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more99213$188.37$83.792.2x69,283,490
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes97110$69.14$22.793.0x64,224,019
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelledP9603$1.74$1.081.6x49,488,257
Therapy procedure using functional activities97530$74.55$31.542.4x44,653,830
Insertion of needle into vein for collection of blood sample36415$21.81$8.492.6x40,280,537
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes97112$72.64$27.072.7x34,770,833
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes99232$203.39$76.042.7x34,684,276
Therapy procedure using manual technique, each 15 minutes97140$67.80$20.623.3x29,275,217
Blood test, comprehensive group of blood chemicals80053$61.44$10.335.9x27,220,202
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count85025$37.12$7.594.9x26,199,882
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient'sG2211$43.48$15.872.7x24,966,114
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes99233$325.44$115.502.8x22,973,090
Destruction of precancer skin growth, 2-14 growths17003$21.97$6.153.6x19,857,687
Pathology examination of tissue using a microscope, intermediate complexity88305$186.06$50.743.7x18,377,033
Blood test, lipids (cholesterol and triglycerides)80061$96.05$13.097.3x17,334,040
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only93010$44.77$7.955.6x15,486,654
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes99309$210.73$96.782.2x14,872,513
Hemoglobin a1c level83036$58.04$9.496.1x14,591,380
Blood test, thyroid stimulating hormone (tsh)84443$95.89$16.445.8x13,899,335
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more99215$406.90$163.052.5x12,922,225
Chiropractic manipulative treatment, 3-4 spinal regions98941$60.72$38.131.6x12,843,003
Detection test by nucleic acid for organism, amplified probe technique87798$63.45$34.351.8x12,744,756
X-ray of chest, 1 view71045$52.28$8.666.0x12,688,062
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more99204$408.44$156.982.6x12,663,680
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more99308$154.13$68.902.2x11,795,272
Administration of influenza virus vaccineG0008$40.77$29.101.4x11,616,610
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visitG0439$278.53$117.902.4x10,304,868
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report93000$69.02$14.204.9x10,144,071
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes99223$568.30$167.523.4x10,127,121
Established patient complete exam of visual system92014$227.20$124.081.8x9,207,151
Emergency department visit with high level of medical decision making99285$1,232.17$169.607.3x9,078,142
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more99203$265.96$103.442.6x8,656,567
Test for allergy using allergenic extract95004$13.22$3.623.6x8,632,592
Admn sarscov2 vacc 1 dose90480$50.47$38.041.3x8,441,109
Removal of cataract with insertion of prosthetic lens66984$1,027.76$245.774.2x8,319,156
Imaging of retina92134$123.94$39.393.1x8,171,858
Injection of drug or substance under skin or into muscle96372$55.32$13.424.1x6,927,967
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month99490$112.91$59.571.9x6,919,114
Injection, bupivacaine liposome, 1 mgC9290$4.88$1.393.5x6,884,666
Psychotherapy, 1 hour90837$209.11$124.731.7x6,863,646
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function93306$475.05$113.004.2x6,792,070
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more99212$117.55$51.972.3x6,770,558
X-ray of chest, 2 views71046$71.87$16.494.4x6,714,671
Vitamin d-3 level82306$184.26$28.966.4x6,420,195
Manual urinalysis test with examination using microscope, automated81001$31.94$3.1010.3x6,352,561
Destruction of precancer skin growth, 1 growth17000$155.48$49.833.1x6,300,981
Screening mammography77067$247.97$65.203.8x6,050,448
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes99222$368.00$126.032.9x6,018,660
Professional service for preparation and provision of 1 or more antigens95165$29.45$13.842.1x5,866,952
Screening 3d breast mammography77063$138.33$34.094.1x5,805,552
Critical care, first 30-74 minutes99291$1,050.22$208.015.0x5,801,848
Automated urinalysis test81003$15.18$2.196.9x5,688,971
Creatinine level to test for kidney function or muscle injury82570$45.67$5.069.0x5,536,830
Thyroxine (thyroid chemical), free84439$87.19$8.829.9x5,454,734
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careG0283$38.88$8.764.4x5,441,343
Hospital discharge day management, more than 30 minutes99239$353.47$110.403.2x5,422,288
Removal of fingernails or toenails, 6 or more nails11721$85.46$42.802.0x5,354,601
Blood test, basic group of blood chemicals (calcium, total)80048$47.96$8.275.8x5,135,813

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. National figures, weighted by service volume, non-drug codes.

How to read this

Two columns matter. Billed is the ask. Allowed is the settlement.

A 10x gap does not mean anyone paid 10x. It means the billed figure was never real. Medicare set the price and the provider took it.

Anyone without Medicare negotiates from that first column instead. That is the whole problem with it.