Guam

What Medicare pays in Guam

Billed charges against Medicare allowed amounts in Guam, across the 179 procedures Medicare covers most often.

179Procedures
180,108Services covered
2.3xBilled vs allowed
#59Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $5,498.28 against a national $1,027.76. That is 5.3 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 Guam

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$177.36$125.561.4x0.65x
Ground mileage, per statute mile$19.43$10.501.9x0.74x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$117.50$88.131.3x0.62x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$46.23$25.051.8x0.67x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$300.32$113.142.7x0.92x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$172.34$77.312.2x0.85x
Ambulance service, basic life support, non-emergency transport, (bls)$772.27$241.443.2x0.69x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$245.24$177.701.4x0.60x
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$26.31$16.131.6x0.61x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$308.67$162.961.9x0.76x
Administration of influenza virus vaccine$39.36$30.831.3x0.97x
Established patient complete exam of visual system$229.43$131.341.7x1.01x
Dialysis services, 4 or more physician visits per month (20 years or older)$367.74$339.041.1x0.48x
Insertion of needle into vein for collection of blood sample$14.58$8.571.7x0.67x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$138.35$107.671.3x0.29x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$40.47$8.165.0x0.90x
Emergency department visit with moderate level of medical decision making$671.85$118.175.7x0.85x
Ambulance service, basic life support, emergency transport (bls-emergency)$196.71$192.491.0x0.16x
Emergency department visit with high level of medical decision making$1,322.04$172.737.7x1.07x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$179.33$107.401.7x0.67x
Dxa bone density measurement of hip, pelvis, spine$47.45$41.781.1x0.30x
Therapy procedure using manual technique, each 15 minutes$48.54$21.492.3x0.72x
Destruction of precancer skin growth, 2-14 growths$23.17$6.793.4x1.05x
Blood test, lipids (cholesterol and triglycerides)$81.81$13.006.3x0.85x
Photography of the retina$181.31$39.654.6x1.52x
Injection of drug or substance under skin or into muscle$23.29$14.651.6x0.42x
Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional$36.18$23.351.5x0.60x
Blood test, comprehensive group of blood chemicals$44.04$10.184.3x0.72x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$76.98$65.261.2x0.68x
X-ray of chest, 2 views$35.84$27.881.3x0.50x
Screening mammography$138.25$99.361.4x0.56x
Critical care, first 30-74 minutes$717.89$206.673.5x0.68x
Hemoglobin a1c level$50.98$9.415.4x0.88x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$354.49$170.692.1x0.62x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$179.90$129.771.4x0.65x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$25.39$9.252.7x0.65x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$367.73$129.432.8x1.00x
Hospital discharge day management, more than 30 minutes$353.55$110.663.2x1.00x
Removal of cataract with insertion of prosthetic lens$5,498.28$852.596.4x5.35x
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes$119.00$48.012.5x0.99x

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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