Washington

What Medicare pays in Washington

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

248Procedures
23,341,917Services covered
3.0xBilled vs allowed
#34Rank of 61

Providers here billed the most above the national figure for identification of organisms by genetic analysis, amplified probe technique. The average was $146.01 against a national $64.75. That is 2.3 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 Washington

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$293.22$118.652.5x1.07x
Ground mileage, per statute mile$28.38$9.642.9x1.07x
Therapy procedure using functional activities$74.71$31.682.4x1.00x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$65.24$23.202.8x0.94x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$199.37$83.722.4x1.06x
Insertion of needle into vein for collection of blood sample$21.74$8.502.6x1.00x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$69.67$27.082.6x0.96x
Therapy procedure using manual technique, each 15 minutes$61.66$20.743.0x0.91x
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$45.57$16.232.8x1.05x
Blood test, comprehensive group of blood chemicals$51.57$10.325.0x0.84x
Chiropractic manipulative treatment, 3-4 spinal regions$66.47$39.381.7x1.09x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$35.61$7.594.7x0.96x
Destruction of precancer skin growth, 2-14 growths$14.68$6.092.4x0.67x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$232.34$77.203.0x1.14x
Pathology examination of tissue using a microscope, intermediate complexity$153.72$52.182.9x0.83x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$417.48$163.182.6x1.03x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$368.61$117.023.2x1.13x
Blood test, lipids (cholesterol and triglycerides)$83.43$13.096.4x0.87x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$36.06$8.074.5x0.81x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$407.83$158.212.6x1.00x
Hemoglobin a1c level$52.93$9.485.6x0.91x
X-ray of chest, 1 view$35.99$8.524.2x0.69x
Blood test, thyroid stimulating hormone (tsh)$84.10$16.435.1x0.88x
Administration of influenza virus vaccine$43.69$28.881.5x1.07x
Admn sarscov2 vacc 1 dose$51.33$38.041.3x1.02x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$327.39$130.172.5x1.18x
Imaging of retina$110.11$40.322.7x0.89x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$263.17$103.902.5x0.99x
Fixed wing air mileage, per statute mile$149.32$14.7110.1x1.08x
Established patient complete exam of visual system$226.81$128.181.8x1.00x
Screening mammography$250.18$70.583.5x1.01x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$220.42$96.362.3x1.05x
Screening 3d breast mammography$136.98$36.273.8x0.99x
Emergency department visit with high level of medical decision making$1,193.10$170.777.0x0.97x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$633.84$170.103.7x1.12x
X-ray of chest, 2 views$62.17$15.494.0x0.87x
Injection, bupivacaine liposome, 1 mg$3.70$1.402.6x0.76x
Destruction of precancer skin growth, 1 growth$149.91$50.932.9x0.96x
Psychotherapy, 1 hour$216.72$127.631.7x1.04x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$318.53$93.333.4x0.67x

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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