Maine

What Medicare pays in Maine

Billed charges against Medicare allowed amounts in Maine, across the 245 procedures Medicare covers most often.

245Procedures
4,209,312Services covered
2.8xBilled vs allowed
#48Rank of 61

Providers here billed the most above the national figure for administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle. The average was $369.04 against a national $196.47. That is 1.9 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 Maine

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$21.56$10.622.0x0.82x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$233.11$96.422.4x0.85x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$163.26$72.232.3x0.87x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$65.33$22.452.9x0.94x
Removal of cataract with insertion of prosthetic lens$122.70$39.403.1x0.12x
Therapy procedure using functional activities$70.33$30.692.3x0.94x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$70.87$26.922.6x0.98x
Therapy procedure using manual technique, each 15 minutes$66.96$20.263.3x0.99x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$197.15$74.172.7x0.97x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$46.28$7.756.0x1.03x
Psychotherapy, 1 hour$176.70$112.651.6x0.85x
Insertion of needle into vein for collection of blood sample$13.40$8.361.6x0.61x
Pathology examination of tissue using a microscope, intermediate complexity$136.44$41.833.3x0.73x
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$35.64$15.562.3x0.82x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$297.15$113.332.6x0.91x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$333.89$136.512.4x0.82x
Destruction of precancer skin growth, 2-14 growths$25.98$5.904.4x1.18x
Chiropractic manipulative treatment, 3-4 spinal regions$56.25$37.441.5x0.93x
Established patient complete exam of visual system$175.68$118.951.5x0.77x
Blood test, comprehensive group of blood chemicals$29.57$10.322.9x0.48x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$261.21$74.933.5x0.94x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$196.64$92.112.1x0.93x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$21.35$7.582.8x0.58x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$345.24$139.932.5x0.85x
Admn sarscov2 vacc 1 dose$48.60$36.511.3x0.96x
Emergency department visit with high level of medical decision making$988.28$167.035.9x0.80x
Administration of influenza virus vaccine$41.76$29.031.4x1.02x
X-ray of chest, 2 views$45.09$11.553.9x0.63x
Imaging of retina$85.29$37.372.3x0.69x
X-ray of chest, 1 view$37.40$8.244.5x0.72x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$529.42$163.013.2x0.93x
Rotary wing air mileage, per statute mile$156.00$39.873.9x0.44x
Screening mammography$152.12$41.753.6x0.61x
Emergency department visit with moderate level of medical decision making$580.34$112.935.1x0.74x
Screening 3d breast mammography$93.79$27.933.4x0.68x
Training for self-care or home management, each 15 minutes$61.33$24.832.5x0.97x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$230.92$91.572.5x0.87x
Hospital discharge day management, more than 30 minutes$284.99$108.642.6x0.81x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$102.09$45.942.2x0.87x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$306.33$71.654.3x0.64x

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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