California

What Medicare pays in California

Billed charges against Medicare allowed amounts in California, across the 249 procedures Medicare covers most often.

249Procedures
146,067,740Services covered
3.3xBilled vs allowed
#20Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $4,163.66 against a national $1,027.76. That is 4.1 times as much.

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.

The 40 most common procedures in California

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$323.15$130.242.5x1.18x
Ground mileage, per statute mile$55.44$9.146.1x2.10x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$207.98$92.922.2x1.10x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$60.32$24.542.5x0.87x
Therapy procedure using functional activities$66.11$34.151.9x0.89x
Insertion of needle into vein for collection of blood sample$25.22$8.562.9x1.16x
Therapy procedure using manual technique, each 15 minutes$60.32$21.822.8x0.89x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$62.43$28.992.2x0.86x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$350.90$120.812.9x1.08x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$218.76$79.752.7x1.08x
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled$1.50$1.121.3x0.86x
Blood test, comprehensive group of blood chemicals$65.96$10.346.4x1.07x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$39.24$7.605.2x1.06x
Destruction of precancer skin growth, 2-14 growths$19.15$7.302.6x0.87x
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's$54.47$17.063.2x1.25x
Detection test by nucleic acid for organism, amplified probe technique$50.25$34.381.5x0.79x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$483.38$180.692.7x1.19x
Pathology examination of tissue using a microscope, intermediate complexity$183.72$55.603.3x0.99x
Blood test, lipids (cholesterol and triglycerides)$107.13$13.118.2x1.12x
Hemoglobin a1c level$63.00$9.496.6x1.09x
Blood test, thyroid stimulating hormone (tsh)$102.72$16.456.2x1.07x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$217.95$106.252.1x1.03x
X-ray of chest, 1 view$60.48$9.216.6x1.16x
Test for allergy using allergenic extract$11.45$3.972.9x0.87x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$466.54$171.062.7x1.14x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$50.55$8.416.0x1.13x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$153.71$73.282.1x1.00x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$614.22$176.573.5x1.08x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$70.73$15.344.6x1.02x
Administration of influenza virus vaccine$41.89$31.681.3x1.03x
Chiropractic manipulative treatment, 3-4 spinal regions$62.72$41.301.5x1.03x
Imaging of retina$128.26$43.403.0x1.03x
Established patient complete exam of visual system$248.95$138.401.8x1.10x
Emergency department visit with high level of medical decision making$1,149.33$175.086.6x0.93x
Critical care, first 30-74 minutes$1,017.00$215.974.7x0.97x
Manual urinalysis test with examination using microscope, automated$34.51$3.1111.1x1.08x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$32.25$9.203.5x0.83x
Psychotherapy, 1 hour$223.86$141.671.6x1.07x
Admn sarscov2 vacc 1 dose$52.77$41.491.3x1.05x
Vitamin d-3 level$193.67$28.996.7x1.05x

The last column compares this state against the national average for the same code. Above 1.00 means providers here billed more.

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

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