Connecticut

What Medicare pays in Connecticut

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

247Procedures
13,841,756Services covered
3.0xBilled vs allowed
#38Rank of 61

Providers here billed the most above the national figure for measurement of antibody (ige) to allergic substance, crude allergen extract, each. The average was $63.79 against a national $30.44. That is 2.1 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 Connecticut

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$25.65$9.002.8x0.97x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$278.55$125.722.2x1.01x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$188.42$89.042.1x1.00x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$69.06$23.942.9x1.00x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$139.35$62.972.2x1.23x
Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month$108.43$48.262.2x1.12x
Therapy procedure using functional activities$74.61$34.282.2x1.00x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$71.41$28.932.5x0.98x
Therapy procedure using manual technique, each 15 minutes$68.94$21.253.2x1.02x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$201.68$79.162.5x0.99x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$184.97$97.341.9x0.88x
Pathology examination of tissue using a microscope, intermediate complexity$197.61$53.783.7x1.06x
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$44.35$16.842.6x1.02x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$47.86$8.275.8x1.07x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$315.12$119.702.6x0.97x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$151.16$69.532.2x0.98x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$81.39$14.945.4x1.18x
Injection, bupivacaine liposome, 1 mg$1.91$1.381.4x0.39x
Destruction of precancer skin growth, 2-14 growths$24.33$6.643.7x1.11x
X-ray of chest, 1 view$46.10$8.635.3x0.88x
Flow cytometry technique for dna or cell analysis, each additional marker$89.36$25.073.6x0.80x
Administration of influenza virus vaccine$41.38$31.681.3x1.01x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$404.29$171.212.4x0.99x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$411.26$164.642.5x1.01x
Psychotherapy, 1 hour$189.21$122.331.5x0.90x
Established patient complete exam of visual system$254.58$131.941.9x1.12x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$313.93$134.342.3x1.13x
Management using the results of remote vital sign monitoring per calendar month, first 20 minutes$117.21$49.812.4x1.03x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$273.55$109.312.5x1.03x
Insertion of needle into vein for collection of blood sample$20.68$8.502.4x0.95x
Admn sarscov2 vacc 1 dose$48.74$40.741.2x0.97x
Emergency department visit with high level of medical decision making$1,146.69$174.866.6x0.93x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$559.64$175.073.2x0.98x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$372.73$132.372.8x1.01x
Imaging of retina$185.52$42.654.3x1.50x
Chiropractic manipulative treatment, 1-2 spinal regions$56.80$27.852.0x1.16x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$118.02$55.022.1x1.00x
Critical care, first 30-74 minutes$1,079.94$214.615.0x1.03x
X-ray of chest, 2 views$58.54$14.814.0x0.81x
Removal of cataract with insertion of prosthetic lens$1,141.51$229.125.0x1.11x

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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