Illinois

What Medicare pays in Illinois

Billed charges against Medicare allowed amounts in Illinois, across the 249 procedures Medicare covers most often.

249Procedures
62,480,552Services covered
3.3xBilled vs allowed
#19Rank of 61

Providers here billed the most above the national figure for kidney function blood test panel. The average was $93.28 against a national $56.14. 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 Illinois

ProcedureBilled hereAllowedGapvs national billed
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$2.08$1.101.9x1.20x
Ground mileage, per statute mile$30.04$9.443.2x1.14x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$262.15$119.512.2x0.95x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$75.37$22.333.4x1.09x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$179.62$84.382.1x0.95x
Therapy procedure using functional activities$79.48$31.372.5x1.07x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$76.61$26.572.9x1.05x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$198.02$78.012.5x0.97x
Insertion of needle into vein for collection of blood sample$24.36$8.552.9x1.12x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$291.67$118.602.5x0.90x
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$48.34$16.273.0x1.11x
Therapy procedure using manual technique, each 15 minutes$74.09$20.383.6x1.09x
Removal of cataract with insertion of prosthetic lens$426.84$84.405.1x0.42x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$47.91$8.115.9x1.07x
Blood test, comprehensive group of blood chemicals$77.95$10.337.5x1.27x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$43.81$7.605.8x1.18x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$145.05$67.772.1x0.94x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$204.04$97.482.1x0.97x
Chiropractic manipulative treatment, 3-4 spinal regions$56.38$37.821.5x0.93x
Pathology examination of tissue using a microscope, intermediate complexity$219.29$45.174.9x1.18x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$380.15$167.082.3x0.93x
Destruction of precancer skin growth, 2-14 growths$31.00$5.975.2x1.41x
X-ray of chest, 1 view$54.81$8.636.4x1.05x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$534.47$172.423.1x0.94x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$395.83$159.182.5x0.97x
Blood test, lipids (cholesterol and triglycerides)$124.19$13.109.5x1.29x
Emergency department visit with high level of medical decision making$1,125.34$175.826.4x0.91x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$280.64$129.902.2x1.01x
Administration of influenza virus vaccine$39.72$29.801.3x0.97x
Detection test by nucleic acid for organism, amplified probe technique$72.88$34.342.1x1.15x
Established patient complete exam of visual system$218.78$122.291.8x0.96x
Hemoglobin a1c level$63.23$9.496.7x1.09x
Psychotherapy, 1 hour$212.78$123.711.7x1.02x
Blood test, thyroid stimulating hormone (tsh)$112.33$16.456.8x1.17x
Imaging of retina$122.03$38.853.1x0.98x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$256.29$104.622.4x0.96x
Admn sarscov2 vacc 1 dose$47.05$38.041.2x0.93x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$371.16$130.022.9x1.01x
X-ray of chest, 2 views$78.60$14.215.5x1.09x
Removal of fingernails or toenails, 6 or more nails$83.30$42.512.0x0.97x

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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