Utah

What Medicare pays in Utah

Billed charges against Medicare allowed amounts in Utah, across the 248 procedures Medicare covers most often.

248Procedures
7,967,710Services covered
2.9xBilled vs allowed
#40Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $2,649.38 against a national $1,027.76. That is 2.6 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 Utah

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$251.01$111.992.2x0.91x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$54.05$22.062.4x0.78x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$170.54$80.202.1x0.91x
Ground mileage, per statute mile$42.40$9.554.4x1.61x
Therapy procedure using functional activities$62.58$29.832.1x0.84x
Therapy procedure using manual technique, each 15 minutes$54.15$19.692.7x0.80x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$59.12$26.302.2x0.81x
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$39.78$14.932.7x0.91x
Destruction of precancer skin growth, 2-14 growths$16.29$5.812.8x0.74x
Insertion of needle into vein for collection of blood sample$14.40$8.311.7x0.66x
Injection, bupivacaine liposome, 1 mg$3.79$1.402.7x0.78x
Pathology examination of tissue using a microscope, intermediate complexity$177.12$48.063.7x0.95x
Blood test, comprehensive group of blood chemicals$32.93$10.323.2x0.54x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$20.43$7.582.7x0.55x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$343.48$148.472.3x0.84x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$28.98$8.393.5x0.75x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$210.29$72.932.9x1.03x
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$1.16$1.101.0x0.66x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$281.07$119.912.3x1.01x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$358.52$148.562.4x0.88x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$198.54$92.722.1x0.94x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$38.36$7.754.9x0.86x
Hemoglobin a1c level$24.59$9.462.6x0.42x
Administration of influenza virus vaccine$30.61$24.881.2x0.75x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$315.22$110.412.9x0.97x
Chiropractic manipulative treatment, 3-4 spinal regions$70.95$37.391.9x1.17x
Imaging of retina$92.80$36.812.5x0.75x
Established patient complete exam of visual system$212.91$113.731.9x0.94x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$230.67$98.822.3x0.87x
Destruction of precancer skin growth, 1 growth$135.68$49.012.8x0.87x
Blood test, lipids (cholesterol and triglycerides)$41.02$13.083.1x0.43x
Admn sarscov2 vacc 1 dose$40.89$32.131.3x0.81x
X-ray of chest, 1 view$33.77$8.424.0x0.65x
Injection of drug or substance under skin or into muscle$43.01$12.823.4x0.78x
Emergency department visit with high level of medical decision making$1,105.77$167.036.6x0.90x
Blood test, thyroid stimulating hormone (tsh)$45.06$16.432.7x0.47x
Test for allergy using allergenic extract$10.79$3.273.3x0.82x
Psychotherapy, 1 hour$214.10$116.901.8x1.02x
Removal of fingernails or toenails, 6 or more nails$87.67$41.412.1x1.03x
Injection of drug into eye$463.09$121.983.8x0.79x

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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