Rhode Island

What Medicare pays in Rhode Island

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

244Procedures
4,188,254Services covered
3.1xBilled vs allowed
#27Rank of 61

Providers here billed the most above the national figure for testing for presence of drug, by chemistry analyzers. The average was $342.43 against a national $211.28. That is 1.6 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 Rhode Island

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$274.58$114.182.4x1.00x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$70.93$23.143.1x1.03x
Ground mileage, per statute mile$37.39$8.674.3x1.42x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$191.50$83.732.3x1.02x
Therapy procedure using functional activities$77.57$33.202.3x1.04x
Therapy procedure using manual technique, each 15 minutes$72.65$20.723.5x1.07x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$76.07$27.152.8x1.05x
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$1.00$0.971.0x0.58x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$206.09$76.892.7x1.01x
Removal of cataract with insertion of prosthetic lens$171.94$47.623.6x0.17x
Destruction of precancer skin growth, 2-14 growths$19.95$6.203.2x0.91x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$41.03$7.945.2x0.92x
Insertion of needle into vein for collection of blood sample$14.88$8.641.7x0.68x
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$39.65$16.062.5x0.91x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$311.40$116.212.7x0.96x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$185.38$94.612.0x0.88x
Emergency department visit with high level of medical decision making$1,090.82$171.126.4x0.89x
Injection, bupivacaine liposome, 1 mg$1.36$1.341.0x0.28x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$276.85$97.962.8x0.99x
X-ray of chest, 1 view$45.18$8.845.1x0.86x
X-ray of chest, 2 views$58.56$16.173.6x0.81x
Administration of influenza virus vaccine$37.92$30.591.2x0.93x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$32.84$7.604.3x0.88x
Established patient complete exam of visual system$213.00$124.831.7x0.94x
Screening mammography$283.68$76.033.7x1.14x
Screening 3d breast mammography$173.48$37.524.6x1.25x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$396.31$157.382.5x0.97x
Pathology examination of tissue using a microscope, intermediate complexity$195.78$40.184.9x1.05x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$551.29$170.103.2x0.97x
Chiropractic manipulative treatment, 3-4 spinal regions$69.88$39.071.8x1.15x
Admn sarscov2 vacc 1 dose$44.28$40.231.1x0.88x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$390.46$153.462.5x0.96x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$265.63$103.882.6x1.00x
Blood test, comprehensive group of blood chemicals$55.90$10.345.4x0.91x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$51.58$14.123.7x0.75x
Psychotherapy, 1 hour$209.80$122.171.7x1.00x
Imaging of retina$99.18$39.862.5x0.80x
Hemoglobin a1c level$35.71$9.493.8x0.62x
Destruction of precancer skin growth, 1 growth$161.03$50.073.2x1.04x
Blood test, lipids (cholesterol and triglycerides)$45.41$13.103.5x0.47x

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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