Virginia

What Medicare pays in Virginia

Billed charges against Medicare allowed amounts in Virginia, across the 247 procedures Medicare covers most often.

247Procedures
41,048,899Services covered
2.8xBilled vs allowed
#44Rank of 61

Providers here billed the most above the national figure for blood creatinine level. The average was $46.25 against a national $22.73. That is 2.0 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 Virginia

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$246.22$117.512.1x0.90x
Ground mileage, per statute mile$18.53$9.541.9x0.70x
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$1.11$1.091.0x0.64x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$170.80$83.312.1x0.91x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$67.18$22.533.0x0.97x
Therapy procedure using functional activities$73.45$31.292.3x0.99x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$69.16$26.502.6x0.95x
Insertion of needle into vein for collection of blood sample$15.97$8.221.9x0.73x
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$41.23$15.812.6x0.95x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$198.38$75.502.6x0.98x
Therapy procedure using manual technique, each 15 minutes$67.68$20.483.3x1.00x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$29.65$7.593.9x0.80x
Destruction of precancer skin growth, 2-14 growths$22.65$6.313.6x1.03x
Blood test, comprehensive group of blood chemicals$41.60$10.324.0x0.68x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$319.09$115.142.8x0.98x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$190.10$93.662.0x0.90x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$41.42$7.895.2x0.93x
Removal of cataract with insertion of prosthetic lens$542.22$154.243.5x0.53x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$367.07$155.092.4x0.90x
Blood test, lipids (cholesterol and triglycerides)$44.32$13.083.4x0.46x
Pathology examination of tissue using a microscope, intermediate complexity$161.35$48.813.3x0.87x
Administration of influenza virus vaccine$37.38$28.441.3x0.92x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$249.53$123.062.0x0.90x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$347.89$161.132.2x0.85x
Established patient complete exam of visual system$220.65$125.131.8x0.97x
X-ray of chest, 1 view$42.00$8.265.1x0.80x
Hemoglobin a1c level$31.82$9.483.4x0.55x
Chiropractic manipulative treatment, 3-4 spinal regions$53.73$38.241.4x0.88x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$57.10$14.084.1x0.83x
Professional service for preparation and provision of 1 or more antigens$26.02$14.071.8x0.88x
Admn sarscov2 vacc 1 dose$47.98$37.511.3x0.95x
Blood test, thyroid stimulating hormone (tsh)$51.84$16.343.2x0.54x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$573.05$166.823.4x1.01x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$239.05$102.422.3x0.90x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$106.47$61.191.7x0.94x
Emergency department visit with high level of medical decision making$1,148.98$166.356.9x0.93x
Test for allergy using allergenic extract$12.76$3.503.6x0.97x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$142.94$65.572.2x0.93x
Imaging of retina$146.52$39.703.7x1.18x
Screening mammography$209.39$56.533.7x0.84x

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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