Wisconsin

What Medicare pays in Wisconsin

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

247Procedures
18,118,516Services covered
4.9xBilled vs allowed
#4Rank of 61

Providers here billed the most above the national figure for detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique. The average was $180.42 against a national $58.61. 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 Wisconsin

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$28.20$10.012.8x1.07x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$345.01$107.003.2x1.26x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$232.77$75.093.1x1.24x
Insertion of needle into vein for collection of blood sample$27.37$8.583.2x1.25x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$94.85$22.384.2x1.37x
Removal of cataract with insertion of prosthetic lens$358.21$45.587.9x0.35x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$270.56$71.343.8x1.33x
Pathology examination of tissue using a microscope, intermediate complexity$398.44$48.258.3x2.14x
Chiropractic manipulative treatment, 3-4 spinal regions$68.68$37.401.8x1.13x
Therapy procedure using functional activities$84.28$30.212.8x1.13x
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$50.78$14.953.4x1.17x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$89.39$26.233.4x1.23x
Therapy procedure using manual technique, each 15 minutes$92.91$19.954.7x1.37x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$98.92$7.5713.1x2.21x
Blood test, comprehensive group of blood chemicals$103.30$10.2610.1x1.68x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$67.71$7.559.0x1.82x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$479.53$143.943.3x1.18x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$414.08$108.113.8x1.27x
Administration of influenza virus vaccine$40.32$27.281.5x0.99x
Destruction of precancer skin growth, 2-14 growths$52.51$5.2110.1x2.39x
Blood test, lipids (cholesterol and triglycerides)$120.53$13.019.3x1.25x
Admn sarscov2 vacc 1 dose$51.48$35.331.5x1.02x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$453.11$118.503.8x1.63x
X-ray of chest, 1 view$72.22$8.039.0x1.38x
Hemoglobin a1c level$72.30$9.427.7x1.25x
Chiropractic manipulative treatment, 1-2 spinal regions$54.39$25.842.1x1.11x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$519.45$142.043.7x1.27x
Emergency department visit with high level of medical decision making$1,177.14$158.947.4x0.96x
Established patient complete exam of visual system$238.34$111.682.1x1.05x
Blood test, thyroid stimulating hormone (tsh)$120.47$16.377.4x1.26x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$352.65$92.913.8x1.33x
Blood test, basic group of blood chemicals (calcium, total)$92.05$8.2211.2x1.92x
Screening mammography$317.86$55.505.7x1.28x
X-ray of chest, 2 views$124.83$14.628.5x1.74x
Screening 3d breast mammography$159.45$30.305.3x1.15x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$729.52$158.044.6x1.28x
Imaging of retina$163.68$34.504.7x1.32x
Blood test, clotting time$45.26$4.1810.8x1.65x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$145.44$44.413.3x1.24x
Injection, bupivacaine liposome, 1 mg$3.79$1.402.7x0.78x

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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