Pennsylvania

What Medicare pays in Pennsylvania

Billed charges against Medicare allowed amounts in Pennsylvania, across the 247 procedures Medicare covers most often.

247Procedures
55,819,900Services covered
2.8xBilled vs allowed
#51Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $2,459.88 against a national $1,027.76. That is 2.4 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 Pennsylvania

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$239.91$116.362.1x0.87x
Ground mileage, per statute mile$18.33$9.392.0x0.69x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$165.84$82.552.0x0.88x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$62.46$22.492.8x0.90x
Therapy procedure using functional activities$69.43$31.622.2x0.93x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$61.68$26.802.3x0.85x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$174.02$75.202.3x0.86x
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$38.57$15.832.4x0.89x
Therapy procedure using manual technique, each 15 minutes$60.17$20.333.0x0.89x
Detection test by nucleic acid for organism, amplified probe technique$50.29$34.381.5x0.79x
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$0.24$0.161.5x0.14x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$44.31$7.905.6x0.99x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$272.80$113.692.4x0.84x
Insertion of needle into vein for collection of blood sample$23.53$8.502.8x1.08x
Pathology examination of tissue using a microscope, intermediate complexity$159.98$51.303.1x0.86x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$197.89$96.572.0x0.94x
Chiropractic manipulative treatment, 3-4 spinal regions$55.58$37.961.5x0.92x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$333.64$157.812.1x0.82x
Destruction of precancer skin growth, 2-14 growths$25.75$6.014.3x1.17x
Administration of influenza virus vaccine$42.74$30.261.4x1.05x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$364.78$155.352.3x0.89x
Emergency department visit with high level of medical decision making$944.68$169.365.6x0.77x
X-ray of chest, 1 view$40.35$8.624.7x0.77x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$254.77$111.852.3x0.91x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$80.10$14.035.7x1.16x
Blood test, comprehensive group of blood chemicals$71.47$10.346.9x1.16x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$37.96$7.605.0x1.02x
Removal of fingernails or toenails, 6 or more nails$75.61$42.171.8x0.88x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$489.76$165.443.0x0.86x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$149.20$67.892.2x0.97x
Imaging of retina$120.85$39.353.1x0.98x
Established patient complete exam of visual system$196.65$120.871.6x0.87x
Admn sarscov2 vacc 1 dose$54.72$38.981.4x1.08x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$237.74$102.022.3x0.89x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$318.40$124.782.6x0.87x
Psychotherapy, 1 hour$196.38$128.571.5x0.94x
Detection test for candida species (yeast), amplified probe technique$46.75$34.381.4x0.78x
Therapy procedure in a group setting$44.56$13.723.2x0.87x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$103.88$50.982.0x0.88x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$35.40$8.594.1x0.91x

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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