New Jersey

What Medicare pays in New Jersey

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

248Procedures
79,243,880Services covered
3.5xBilled vs allowed
#12Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $5,102.88 against a national $1,027.76. That is 5.0 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 New Jersey

ProcedureBilled hereAllowedGapvs national billed
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$98.99$24.414.1x1.43x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$315.95$131.122.4x1.15x
Insertion of needle into vein for collection of blood sample$26.39$8.353.2x1.21x
Blood test, comprehensive group of blood chemicals$63.59$10.336.2x1.03x
Therapy procedure using functional activities$86.20$34.712.5x1.16x
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
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$215.10$93.322.3x1.14x
Ground mileage, per statute mile$22.37$8.152.7x0.85x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$38.64$7.605.1x1.04x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$94.84$29.303.2x1.31x
Therapy procedure using manual technique, each 15 minutes$98.28$21.944.5x1.45x
Blood test, lipids (cholesterol and triglycerides)$114.10$13.118.7x1.19x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$227.53$81.202.8x1.12x
Blood test, thyroid stimulating hormone (tsh)$116.40$16.457.1x1.21x
Hemoglobin a1c level$72.50$9.517.6x1.25x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$365.62$121.973.0x1.12x
Manual urinalysis test with examination using microscope, automated$38.16$3.1112.3x1.19x
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$43.99$17.212.6x1.01x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$207.08$105.482.0x0.98x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$161.37$73.792.2x1.05x
Vitamin d-3 level$241.05$28.998.3x1.31x
Thyroxine (thyroid chemical), free$110.76$8.8312.5x1.27x
Detection test by nucleic acid for organism, amplified probe technique$123.46$34.363.6x1.95x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$70.11$15.424.5x1.02x
Chiropractic manipulative treatment, 3-4 spinal regions$77.88$41.481.9x1.28x
Creatinine level to test for kidney function or muscle injury$57.06$5.0711.2x1.25x
Therapy procedure for walking training, each 15 minutes$63.88$23.232.7x1.13x
Bacterial colony count, urine$52.48$7.906.6x1.03x
Blood test, basic group of blood chemicals (calcium, total)$45.28$8.245.5x0.94x
Urine microalbumin (protein) level$68.29$5.6512.1x1.19x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$42.61$8.505.0x0.95x
Pathology examination of tissue using a microscope, intermediate complexity$203.76$50.854.0x1.10x
Iron level$36.08$6.335.7x1.10x
Destruction of precancer skin growth, 2-14 growths$24.50$6.923.5x1.12x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$609.77$178.103.4x1.07x
Cyanocobalamin (vitamin b-12) level$102.36$14.776.9x1.16x
Ferritin (blood protein) level$90.21$13.356.8x1.15x
Magnesium level$42.53$6.556.5x1.11x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$60.37$9.486.4x1.55x
Psa (prostate specific antigen) measurement, total$118.30$18.006.6x1.15x

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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