Puerto Rico

What Medicare pays in Puerto Rico

Billed charges against Medicare allowed amounts in Puerto Rico, across the 228 procedures Medicare covers most often.

228Procedures
1,150,665Services covered
1.7xBilled vs allowed
#61Rank of 61

Providers here billed the most above the national figure for advance care planning, first 30 minutes. The average was $412.10 against a national $187.36. That is 2.2 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 Puerto Rico

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$94.15$84.081.1x0.50x
Insertion of needle into vein for collection of blood sample$7.36$7.071.0x0.34x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$8.46$7.571.1x0.23x
Ground mileage, per statute mile$8.79$8.531.0x0.33x
Blood test, comprehensive group of blood chemicals$11.45$10.291.1x0.19x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$154.63$119.661.3x0.56x
Blood test, lipids (cholesterol and triglycerides)$14.46$13.041.1x0.15x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$125.99$74.351.7x0.62x
Blood test, thyroid stimulating hormone (tsh)$18.05$16.351.1x0.19x
Hemoglobin a1c level$10.77$9.461.1x0.19x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$32.25$22.821.4x0.47x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$190.31$110.171.7x0.58x
Manual urinalysis test with examination using microscope, automated$3.47$3.091.1x0.11x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$22.93$13.921.6x0.33x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$123.69$106.141.2x0.47x
Urine microalbumin (protein) level$6.55$5.641.2x0.11x
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge$10.24$9.801.0x0.65x
Vitamin d-3 level$31.70$28.791.1x0.17x
Application of ultrasound, each 15 minutes$15.55$10.111.5x0.41x
Pathology examination of tissue using a microscope, intermediate complexity$83.10$62.181.3x0.45x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$58.79$51.061.2x0.50x
Established patient problem focused exam of visual system$90.96$85.551.1x0.54x
Creatinine level to test for kidney function or muscle injury$5.70$5.061.1x0.12x
Thyroxine (thyroid chemical), free$9.98$8.791.1x0.11x
X-ray of chest, 1 view$23.84$9.182.6x0.46x
Bacterial urine culture$9.11$7.891.2x0.29x
Cyanocobalamin (vitamin b-12) level$16.23$14.681.1x0.18x
Emergency department visit with high level of medical decision making$1,420.83$176.248.1x1.15x
Blood test, basic group of blood chemicals (calcium, total)$9.18$8.251.1x0.19x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$312.09$166.991.9x0.55x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$36.72$7.754.7x0.82x
Imaging of retina$88.95$39.002.3x0.72x
Psa (prostate specific antigen) measurement, total$19.71$17.921.1x0.19x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$218.09$150.101.5x0.46x
Chiropractic manipulative treatment, 3-4 spinal regions$40.87$37.741.1x0.67x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$203.05$160.021.3x0.50x
Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution$15.71$8.461.9x0.29x
Critical care, first 30-74 minutes$803.74$206.703.9x0.77x
Complete blood cell count (red cells, white blood cell, platelets), automated test$6.88$6.311.1x0.22x
Emergency department visit with low level of medical decision making$117.38$67.431.7x0.29x

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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