Missouri

What Medicare pays in Missouri

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

249Procedures
22,157,060Services covered
3.1xBilled vs allowed
#31Rank of 61

Providers here billed the most above the national figure for detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique. The average was $124.75 against a national $58.61. 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 Missouri

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$17.98$9.911.8x0.68x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$226.71$107.282.1x0.82x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$162.46$77.132.1x0.86x
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$2.02$1.111.8x1.16x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$67.24$21.463.1x0.97x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$176.32$73.472.4x0.87x
Therapy procedure using functional activities$68.78$29.022.4x0.92x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$66.51$24.932.7x0.92x
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$39.63$15.302.6x0.91x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$287.78$111.312.6x0.88x
Destruction of precancer skin growth, 2-14 growths$23.62$5.624.2x1.07x
Insertion of needle into vein for collection of blood sample$17.51$8.552.0x0.80x
Chiropractic manipulative treatment, 3-4 spinal regions$52.46$36.571.4x0.86x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$37.08$7.684.8x0.83x
X-ray of chest, 1 view$42.73$8.185.2x0.82x
Therapy procedure using manual technique, each 15 minutes$66.29$19.543.4x0.98x
Pathology examination of tissue using a microscope, intermediate complexity$206.18$45.154.6x1.11x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$198.63$91.972.2x0.94x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$344.25$146.842.3x0.84x
Rotary wing air mileage, per statute mile$395.53$38.8410.2x1.11x
Blood test, comprehensive group of blood chemicals$66.63$10.336.4x1.08x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$40.98$7.605.4x1.10x
Administration of influenza virus vaccine$36.10$27.831.3x0.89x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$136.21$63.582.1x0.88x
X-ray of chest, 2 views$52.90$13.443.9x0.74x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$523.74$161.693.2x0.92x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$249.73$104.142.4x0.90x
Emergency department visit with high level of medical decision making$1,106.08$165.266.7x0.90x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$327.26$148.502.2x0.80x
Established patient complete exam of visual system$190.36$117.311.6x0.84x
Screening mammography$168.12$45.483.7x0.68x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$323.82$121.972.7x0.88x
Imaging of retina$116.61$37.793.1x0.94x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$233.13$96.252.4x0.88x
Screening 3d breast mammography$100.10$29.203.4x0.72x
Admn sarscov2 vacc 1 dose$42.69$34.451.2x0.85x
Test for allergy using allergenic extract$13.49$3.204.2x1.02x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$117.48$59.122.0x1.04x
Ct scan head or brain without contrast$220.47$38.115.8x0.89x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$103.44$46.762.2x0.88x

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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