Idaho

What Medicare pays in Idaho

Billed charges against Medicare allowed amounts in Idaho, across the 244 procedures Medicare covers most often.

244Procedures
6,458,819Services covered
2.6xBilled vs allowed
#56Rank of 61

Providers here billed the most above the national figure for admn sarscov2 vacc 1 dose. The average was $87.02 against a national $50.47. That is 1.7 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 Idaho

ProcedureBilled hereAllowedGapvs national billed
Admn sarscov2 vacc 1 dose$87.02$42.792.0x1.72x
Administration of influenza virus vaccine$56.48$32.871.7x1.39x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$226.35$99.462.3x0.82x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$50.84$21.792.3x0.74x
Ground mileage, per statute mile$19.65$10.002.0x0.74x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$161.48$70.772.3x0.86x
Therapy procedure using functional activities$60.56$29.162.1x0.81x
Therapy procedure using manual technique, each 15 minutes$49.36$19.352.6x0.73x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$56.13$25.322.2x0.77x
Destruction of precancer skin growth, 2-14 growths$14.62$5.392.7x0.67x
Chiropractic manipulative treatment, 3-4 spinal regions$54.32$36.631.5x0.89x
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$30.96$14.692.1x0.71x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$199.45$71.492.8x0.98x
Insertion of needle into vein for collection of blood sample$14.90$8.461.8x0.68x
Injection, bupivacaine liposome, 1 mg$2.72$1.382.0x0.56x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$30.29$7.424.1x0.68x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$303.08$136.742.2x0.74x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$30.13$8.143.7x0.78x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$334.56$137.002.4x0.82x
Administration of pneumococcal vaccine$56.90$32.701.7x1.16x
X-ray of chest, 1 view$56.95$8.226.9x1.09x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$354.35$108.133.3x1.09x
Established patient complete exam of visual system$192.16$116.011.7x0.85x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$216.40$89.202.4x0.81x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$224.55$114.502.0x0.81x
Imaging of retina$85.35$37.152.3x0.69x
Pathology examination of tissue using a microscope, intermediate complexity$123.77$52.112.4x0.67x
Destruction of precancer skin growth, 1 growth$135.67$46.772.9x0.87x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$206.26$89.622.3x0.98x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$28.71$7.563.8x0.77x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$100.70$44.142.3x0.86x
Blood test, comprehensive group of blood chemicals$45.32$10.304.4x0.74x
Test for allergy using allergenic extract$13.24$2.954.5x1.00x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$552.24$158.993.5x0.97x
Emergency department visit with high level of medical decision making$1,087.16$157.956.9x0.88x
X-ray of chest, 2 views$72.73$12.755.7x1.01x
Screening mammography$192.31$45.524.2x0.78x
Screening 3d breast mammography$110.62$27.824.0x0.80x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$101.42$52.311.9x0.90x
Psychotherapy, 1 hour$195.10$113.601.7x0.93x

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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