South Dakota

What Medicare pays in South Dakota

Billed charges against Medicare allowed amounts in South Dakota, across the 238 procedures Medicare covers most often.

238Procedures
4,082,258Services covered
2.7xBilled vs allowed
#53Rank of 61

Providers here billed the most above the national figure for identification of organisms by genetic analysis, amplified probe technique. The average was $202.66 against a national $64.75. That is 3.1 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 South Dakota

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$18.40$9.941.9x0.70x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$193.64$98.922.0x0.70x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$65.11$22.852.8x0.94x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$146.84$71.102.1x0.78x
Chiropractic manipulative treatment, 3-4 spinal regions$52.06$37.981.4x0.86x
Therapy procedure using functional activities$70.97$31.302.3x0.95x
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$27.68$15.001.8x0.64x
Therapy procedure using manual technique, each 15 minutes$63.68$20.233.1x0.94x
Fixed wing air mileage, per statute mile$143.55$14.799.7x1.03x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$175.85$72.392.4x0.86x
Insertion of needle into vein for collection of blood sample$16.44$7.882.1x0.75x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$67.61$26.822.5x0.93x
Destruction of precancer skin growth, 2-14 growths$19.89$4.404.5x0.91x
Pathology examination of tissue using a microscope, intermediate complexity$124.36$36.133.4x0.67x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$32.09$7.574.2x0.72x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$35.41$7.594.7x0.95x
Blood test, comprehensive group of blood chemicals$50.76$10.334.9x0.83x
Established patient complete exam of visual system$179.05$120.391.5x0.79x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$270.15$137.802.0x0.66x
Administration of influenza virus vaccine$35.98$27.271.3x0.88x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$268.02$140.411.9x0.66x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$244.50$110.262.2x0.75x
Imaging of retina$76.57$38.362.0x0.62x
Blood test, lipids (cholesterol and triglycerides)$62.58$13.084.8x0.65x
Chiropractic manipulative treatment, 1-2 spinal regions$42.01$26.321.6x0.86x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$200.71$87.982.3x0.75x
Admn sarscov2 vacc 1 dose$44.06$33.311.3x0.87x
Screening mammography$179.84$59.683.0x0.73x
Destruction of precancer skin growth, 1 growth$142.70$44.363.2x0.92x
X-ray of chest, 2 views$44.22$13.423.3x0.62x
Screening 3d breast mammography$83.00$31.242.7x0.60x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$280.00$68.204.1x0.59x
X-ray of chest, 1 view$25.72$8.083.2x0.49x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$213.11$120.291.8x0.77x
Hemoglobin a1c level$42.61$9.484.5x0.73x
Psychotherapy, 1 hour$207.12$116.541.8x0.99x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$34.76$8.294.2x0.89x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$101.29$45.322.2x0.86x
Blood test, basic group of blood chemicals (calcium, total)$48.99$8.265.9x1.02x
Removal of cataract with insertion of prosthetic lens$1,830.42$511.753.6x1.78x

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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