Maryland

What Medicare pays in Maryland

Billed charges against Medicare allowed amounts in Maryland, across the 248 procedures Medicare covers most often.

248Procedures
36,279,766Services covered
2.8xBilled vs allowed
#49Rank of 61

Providers here billed the most above the national figure for identification of organisms by genetic analysis, amplified probe technique. The average was $148.39 against a national $64.75. That is 2.3 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 Maryland

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$278.40$120.182.3x1.01x
Ground mileage, per statute mile$14.86$9.081.6x0.56x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$189.96$88.032.2x1.01x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$64.83$23.192.8x0.94x
Therapy procedure using functional activities$73.81$33.372.2x0.99x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$69.24$27.832.5x0.95x
Therapy procedure using manual technique, each 15 minutes$64.06$20.963.1x0.94x
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$38.46$16.552.3x0.88x
Insertion of needle into vein for collection of blood sample$24.39$8.542.9x1.12x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$35.40$7.594.7x0.95x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$213.08$78.232.7x1.05x
Blood test, comprehensive group of blood chemicals$61.80$10.346.0x1.01x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$200.98$99.772.0x0.95x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$360.99$118.493.0x1.11x
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$1.15$1.101.0x0.66x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$60.79$14.724.1x0.88x
Pathology examination of tissue using a microscope, intermediate complexity$179.72$56.353.2x0.97x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$150.06$70.222.1x0.97x
Destruction of precancer skin growth, 2-14 growths$21.99$6.783.2x1.00x
X-ray of chest, 1 view$35.35$9.873.6x0.68x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$366.56$165.072.2x0.90x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$34.66$8.164.2x0.77x
Detection test by nucleic acid for organism, amplified probe technique$83.82$34.362.4x1.32x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$399.47$166.912.4x0.98x
X-ray of chest, 2 views$52.07$17.802.9x0.72x
Set-up portable x-ray equipment$58.94$24.672.4x1.16x
Blood test, lipids (cholesterol and triglycerides)$103.88$13.107.9x1.08x
Administration of influenza virus vaccine$42.29$31.501.3x1.04x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$271.79$131.032.1x0.98x
Hemoglobin a1c level$52.65$9.495.5x0.91x
Established patient complete exam of visual system$264.14$132.052.0x1.16x
Imaging of retina$199.51$41.594.8x1.61x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$259.30$110.142.4x0.97x
Admn sarscov2 vacc 1 dose$51.67$41.091.3x1.02x
Blood test, thyroid stimulating hormone (tsh)$99.21$16.446.0x1.03x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$630.06$170.843.7x1.11x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$36.98$8.994.1x0.95x
Psychotherapy, 1 hour$188.48$124.321.5x0.90x
Test for allergy using allergenic extract$13.52$3.863.5x1.02x
Emergency department visit with high level of medical decision making$1,242.13$173.847.1x1.01x

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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