Michigan

What Medicare pays in Michigan

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

248Procedures
29,982,473Services covered
2.8xBilled vs allowed
#50Rank of 61

Providers here billed the most above the national figure for collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha). The average was $44.42 against a national $19.23. 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 Michigan

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$20.48$9.602.1x0.78x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$207.57$111.541.9x0.76x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$147.67$80.551.8x0.78x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$76.08$21.913.5x1.10x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$162.41$76.802.1x0.80x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$86.03$26.183.3x1.18x
Therapy procedure using functional activities$86.16$30.952.8x1.16x
Therapy procedure using manual technique, each 15 minutes$72.95$19.983.7x1.08x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$279.53$115.532.4x0.86x
Chiropractic manipulative treatment, 3-4 spinal regions$55.09$37.581.5x0.91x
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$31.74$15.912.0x0.73x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$40.70$7.915.1x0.91x
Emergency department visit with high level of medical decision making$1,221.64$172.507.1x0.99x
Destruction of precancer skin growth, 2-14 growths$19.86$5.903.4x0.90x
Insertion of needle into vein for collection of blood sample$14.80$8.301.8x0.68x
X-ray of chest, 1 view$42.63$8.435.1x0.82x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$495.82$168.102.9x0.87x
Pathology examination of tissue using a microscope, intermediate complexity$157.60$44.433.5x0.85x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$145.56$65.662.2x0.94x
Psychotherapy, 1 hour$208.34$119.661.7x1.00x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$303.38$151.662.0x0.74x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$233.49$107.532.2x0.84x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$276.82$151.691.8x0.68x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$220.01$94.632.3x1.04x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$294.53$127.362.3x0.80x
Administration of influenza virus vaccine$34.64$28.701.2x0.85x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$24.17$7.583.2x0.65x
Removal of fingernails or toenails, 6 or more nails$74.29$42.031.8x0.87x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$206.35$100.432.1x0.78x
Imaging of retina$99.34$37.412.7x0.80x
Established patient complete exam of visual system$180.80$117.881.5x0.80x
X-ray of chest, 2 views$50.85$13.943.6x0.71x
Blood test, comprehensive group of blood chemicals$34.51$10.323.3x0.56x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$47.06$13.933.4x0.68x
Emergency department visit with moderate level of medical decision making$761.27$117.196.5x0.97x
Admn sarscov2 vacc 1 dose$44.09$36.471.2x0.87x
Critical care, first 30-74 minutes$1,061.42$208.225.1x1.01x
Injection of drug or substance under skin or into muscle$48.68$13.413.6x0.88x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$330.36$94.033.5x0.70x
Test for allergy using allergenic extract$11.85$3.563.3x0.90x

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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