Delaware

What Medicare pays in Delaware

Billed charges against Medicare allowed amounts in Delaware, across the 239 procedures Medicare covers most often.

239Procedures
6,853,399Services covered
2.7xBilled vs allowed
#52Rank of 61

Providers here billed the most above the national figure for intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session. The average was $5,486.56 against a national $1,749.75. That is 3.1 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 Delaware

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$233.58$116.622.0x0.85x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$73.35$22.113.3x1.06x
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$2.28$1.112.1x1.31x
Therapy procedure using functional activities$79.14$31.462.5x1.06x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$164.65$83.102.0x0.87x
Ground mileage, per statute mile$23.82$10.172.3x0.90x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$74.95$26.132.9x1.03x
Therapy procedure using manual technique, each 15 minutes$79.47$20.163.9x1.17x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$175.64$75.182.3x0.86x
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$33.19$15.732.1x0.76x
Chiropractic manipulative treatment, 3-4 spinal regions$73.04$38.551.9x1.20x
Destruction of precancer skin growth, 2-14 growths$20.99$6.203.4x0.96x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$259.39$114.302.3x0.80x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$50.19$13.693.7x0.73x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$213.49$93.662.3x1.01x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$243.88$116.802.1x0.88x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$358.52$162.132.2x0.88x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$39.72$8.664.6x1.02x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$53.11$7.826.8x1.19x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$373.78$154.642.4x0.92x
Administration of influenza virus vaccine$37.67$30.411.2x0.92x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$94.57$59.621.6x0.84x
Detection test by nucleic acid for organism, amplified probe technique$50.98$34.341.5x0.80x
Test for allergy using allergenic extract$10.10$3.522.9x0.76x
Therapy procedure in a group setting$47.85$13.513.5x0.93x
Assessment of emotional or behavioral problems$52.93$4.3012.3x2.32x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$241.70$102.512.4x0.91x
Emergency department visit with high level of medical decision making$1,120.57$169.326.6x0.91x
Therapy procedure for walking training, each 15 minutes$59.04$21.862.7x1.04x
Pathology examination of tissue using a microscope, intermediate complexity$157.40$49.113.2x0.85x
Admn sarscov2 vacc 1 dose$50.27$38.941.3x1.00x
X-ray of chest, 1 view$38.27$8.334.6x0.73x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$477.32$166.312.9x0.84x
Psychotherapy, 1 hour$196.57$117.921.7x0.94x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$104.39$51.792.0x0.89x
Established patient complete exam of visual system$167.35$123.921.4x0.74x
Ambulance service, basic life support, emergency transport (bls-emergency)$1,117.08$436.042.6x0.89x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$354.21$122.992.9x0.96x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$574.19$132.054.3x1.21x
Screening mammography$205.27$76.492.7x0.83x

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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