Iowa

What Medicare pays in Iowa

Billed charges against Medicare allowed amounts in Iowa, across the 246 procedures Medicare covers most often.

246Procedures
12,553,188Services covered
3.0xBilled vs allowed
#36Rank of 61

Providers here billed the most above the national figure for assessment of emotional or behavioral problems. The average was $51.21 against a national $22.83. 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 Iowa

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$236.76$105.112.3x0.86x
Ground mileage, per statute mile$19.61$10.281.9x0.74x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$167.60$75.402.2x0.89x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$66.70$21.493.1x0.96x
Chiropractic manipulative treatment, 3-4 spinal regions$51.16$36.821.4x0.84x
Therapy procedure using functional activities$70.68$29.942.4x0.95x
Insertion of needle into vein for collection of blood sample$14.71$8.551.7x0.67x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$69.32$25.652.7x0.95x
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$34.57$14.812.3x0.80x
Therapy procedure using manual technique, each 15 minutes$64.84$19.453.3x0.96x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$205.80$70.792.9x1.01x
Destruction of precancer skin growth, 2-14 growths$35.55$5.386.6x1.62x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$31.13$7.584.1x0.84x
Administration of influenza virus vaccine$34.46$26.351.3x0.85x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$43.43$7.465.8x0.97x
Pathology examination of tissue using a microscope, intermediate complexity$198.04$42.604.6x1.06x
Admn sarscov2 vacc 1 dose$42.82$36.121.2x0.85x
Blood test, comprehensive group of blood chemicals$50.05$10.314.9x0.81x
Established patient complete exam of visual system$230.13$115.192.0x1.01x
Chiropractic manipulative treatment, 1-2 spinal regions$43.05$25.491.7x0.88x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$266.16$115.192.3x0.96x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$317.67$108.522.9x0.98x
Imaging of retina$105.72$35.403.0x0.85x
Injection, bupivacaine liposome, 1 mg$3.86$1.392.8x0.79x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$365.05$141.422.6x0.89x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$120.66$56.182.1x1.07x
Removal of fingernails or toenails, 6 or more nails$104.36$38.932.7x1.22x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$363.00$141.862.6x0.89x
X-ray of chest, 2 views$54.89$13.913.9x0.76x
Hemoglobin a1c level$40.12$9.464.2x0.69x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$240.31$93.742.6x0.90x
Screening mammography$222.49$61.003.6x0.90x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$191.12$88.372.2x0.91x
Screening 3d breast mammography$103.25$31.233.3x0.75x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$106.25$47.302.2x0.90x
X-ray of chest, 1 view$39.33$8.094.9x0.75x
Blood test, lipids (cholesterol and triglycerides)$54.53$13.074.2x0.57x
Emergency department visit with high level of medical decision making$968.05$155.716.2x0.79x
Test for allergy using allergenic extract$13.30$3.054.4x1.01x
Destruction of precancer skin growth, 1 growth$189.10$45.954.1x1.22x

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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