Unknown

What Medicare pays in Unknown

Billed charges against Medicare allowed amounts in Unknown, across the 91 procedures Medicare covers most often.

91Procedures
35,805Services covered
2.0xBilled vs allowed
#60Rank of 61

Providers here billed the most above the national figure for continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report. The average was $400.00 against a national $107.04. That is 3.7 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 Unknown

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$204.00$128.521.6x0.74x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$142.21$86.481.6x0.75x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$46.95$21.642.2x0.68x
Insertion of needle into vein for collection of blood sample$17.38$8.582.0x0.80x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$111.59$64.641.7x0.72x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$48.94$28.311.7x0.67x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$20.51$7.602.7x0.55x
Therapy procedure using functional activities$52.27$26.462.0x0.70x
Removal of fingernails or toenails, 6 or more nails$95.00$42.792.2x1.11x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$15.16$9.011.7x0.39x
Training for self-care or home management, each 15 minutes$45.12$22.702.0x0.72x
Therapy procedure using manual technique, each 15 minutes$44.64$20.472.2x0.66x
Removal of noncancer thickened skin growth, 2-4 growths$125.00$81.901.5x0.93x
Application of ultrasound, each 15 minutes$15.09$10.641.4x0.40x
Ultrasound of both sides of head and neck blood flow$232.60$201.251.2x0.56x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$216.03$98.892.2x1.03x
Ultrasound study of arm or leg veins with compression and maneuvers$222.10$166.141.3x0.63x
Psychotherapy, 1 hour$244.11$110.822.2x1.17x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$167.14$115.001.5x0.63x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$30.05$15.471.9x0.44x
Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less$61.68$26.612.3x0.51x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$237.95$172.181.4x0.58x
X-ray of chest, 1 view$38.00$8.454.5x0.73x
Ct scan head or brain without contrast$180.00$39.474.6x0.73x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$217.66$131.961.6x0.78x
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$35.75$16.572.2x0.82x
Ct scan of abdomen and pelvis with contrast$407.78$163.862.5x0.66x
Ct scan of chest with contrast$327.57$65.805.0x0.75x
Administration of chemotherapy into vein, 1 hour or less$277.04$120.832.3x0.58x
Dxa bone density measurement of hip, pelvis, spine$60.00$9.426.4x0.38x
Therapy procedure for walking training, each 15 minutes$35.00$21.891.6x0.62x
Injection of drug or substance under skin or into muscle$40.74$13.723.0x0.74x
Advance care planning, first 30 minutes$124.98$79.041.6x0.67x
Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes$199.32$154.881.3x0.60x
Complete ultrasound scan behind abdominal cavity$160.00$112.051.4x0.65x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$309.41$148.262.1x0.76x
Blood creatinine level$13.37$5.022.7x0.59x
Nuclear medicine study from skull base to mid-thigh with ct scan$2,961.87$1,394.832.1x1.39x
Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes$239.92$120.092.0x0.83x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$320.00$189.981.7x0.67x

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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