Vermont

What Medicare pays in Vermont

Billed charges against Medicare allowed amounts in Vermont, across the 219 procedures Medicare covers most often.

219Procedures
2,302,282Services covered
2.6xBilled vs allowed
#57Rank of 61

Providers here billed the most above the national figure for intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session. The average was $5,607.22 against a national $1,749.75. That is 3.2 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 Vermont

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$23.63$10.952.2x0.89x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$185.58$101.091.8x0.68x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$119.02$70.821.7x0.63x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$59.15$23.192.6x0.86x
Therapy procedure using manual technique, each 15 minutes$61.62$20.573.0x0.91x
Psychotherapy, 1 hour$159.24$116.941.4x0.76x
Therapy procedure using functional activities$61.01$29.812.0x0.82x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$60.17$27.162.2x0.83x
Chiropractic manipulative treatment, 3-4 spinal regions$55.22$38.071.5x0.91x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$63.46$7.658.3x1.42x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$246.07$73.153.4x1.21x
Admn sarscov2 vacc 1 dose$40.37$35.411.1x0.80x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$263.96$144.031.8x0.65x
Pathology examination of tissue using a microscope, intermediate complexity$161.19$37.124.3x0.87x
Administration of influenza virus vaccine$29.28$24.531.2x0.72x
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$37.29$15.382.4x0.86x
Established patient complete exam of visual system$214.54$121.991.8x0.94x
Insertion of needle into vein for collection of blood sample$19.09$8.582.2x0.88x
Destruction of precancer skin growth, 2-14 growths$13.00$5.072.6x0.59x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$322.01$111.822.9x0.99x
Psychotherapy, 45 minutes$165.44$80.722.0x0.93x
Screening mammography$171.52$34.954.9x0.69x
Screening 3d breast mammography$120.89$27.154.5x0.87x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$263.43$120.262.2x0.95x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$166.32$85.232.0x0.63x
Emergency department visit with high level of medical decision making$661.99$162.544.1x0.54x
Imaging of retina$93.54$34.602.7x0.75x
X-ray of chest, 1 view$50.76$8.206.2x0.97x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$283.09$136.242.1x0.69x
Therapy procedure using water pool to exercises, each 15 minutes$58.15$28.012.1x0.79x
X-ray of chest, 2 views$67.76$11.775.8x0.94x
Emergency department visit with moderate level of medical decision making$462.32$110.974.2x0.59x
Hemoglobin a1c level$42.21$9.494.4x0.73x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$76.28$42.621.8x0.65x
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)$1,156.32$521.252.2x0.71x
Ambulance service, basic life support, emergency transport (bls-emergency)$923.86$438.792.1x0.74x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$539.41$161.823.3x0.95x
Removal of cataract with insertion of prosthetic lens$954.96$284.543.4x0.93x
Destruction of precancer skin growth, 1 growth$119.32$49.242.4x0.77x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$385.83$70.515.5x0.81x

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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