North Carolina

What Medicare pays in North Carolina

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

248Procedures
54,762,092Services covered
3.2xBilled vs allowed
#23Rank 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 $49.06 against a national $19.23. That is 2.6 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 North Carolina

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$255.11$111.332.3x0.93x
Ground mileage, per statute mile$15.74$9.731.6x0.60x
Insertion of needle into vein for collection of blood sample$23.02$8.602.7x1.06x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$176.00$78.762.2x0.93x
Blood test, comprehensive group of blood chemicals$49.68$10.334.8x0.81x
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$1.28$1.101.2x0.73x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$33.07$7.604.4x0.89x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$63.27$21.802.9x0.92x
Blood test, lipids (cholesterol and triglycerides)$88.47$13.106.8x0.92x
Therapy procedure using functional activities$67.31$29.562.3x0.90x
Hemoglobin a1c level$61.19$9.506.4x1.05x
Blood test, thyroid stimulating hormone (tsh)$96.17$16.455.8x1.00x
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$39.81$15.002.7x0.92x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$65.32$25.752.5x0.90x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$210.31$72.562.9x1.03x
Therapy procedure using manual technique, each 15 minutes$60.70$19.703.1x0.90x
Removal of cataract with insertion of prosthetic lens$365.60$79.684.6x0.36x
Destruction of precancer skin growth, 2-14 growths$22.02$5.833.8x1.00x
Pathology examination of tissue using a microscope, intermediate complexity$156.32$52.143.0x0.84x
Vitamin d-3 level$202.35$28.987.0x1.10x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$314.97$109.492.9x0.97x
Measurement of antibody (ige) to allergic substance, crude allergen extract, each$36.57$5.117.2x1.20x
Creatinine level to test for kidney function or muscle injury$52.66$5.0710.4x1.15x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$212.09$89.932.4x1.01x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$42.65$7.585.6x0.95x
Thyroxine (thyroid chemical), free$82.81$8.839.4x0.95x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$355.09$150.742.4x0.87x
Manual urinalysis test with examination using microscope, automated$30.52$3.109.8x0.96x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$377.84$147.892.6x0.93x
Injection, bupivacaine liposome, 1 mg$4.70$1.393.4x0.96x
X-ray of chest, 1 view$50.47$8.256.1x0.97x
Urine microalbumin (protein) level$64.02$5.6511.3x1.12x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$257.11$117.942.2x0.92x
Administration of influenza virus vaccine$39.49$27.691.4x0.97x
Cyanocobalamin (vitamin b-12) level$92.75$14.776.3x1.05x
Blood test, basic group of blood chemicals (calcium, total)$41.24$8.285.0x0.86x
Bacterial colony count, urine$52.30$7.906.6x1.02x
Emergency department visit with high level of medical decision making$1,126.20$160.687.0x0.91x
Chiropractic manipulative treatment, 3-4 spinal regions$58.06$36.931.6x0.96x
Automated urinalysis test$18.21$2.198.3x1.20x

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.

← All states  ·  All procedures