0715T

Shockwave destruction of calcified plaque in coronary artery accessed through skin using catheter

Medicare pricing data for 1,698 providers across 29 states

🤖AI Overview

This procedure has a 6.3x markup — hospitals charge $1,008 but Medicare allows only $160.19. Uninsured patients may face bills 6.3 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Shockwave destruction of calcified plaque in coronary artery accessed through skin using catheter (HCPCS code 0715T) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $160.19, but hospitals typically charge $1,008 — a 6.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$32.04

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $160.19, your out-of-pocket cost would be approximately $32.04. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$160.19
Average Hospital Charge
$1,008
Markup Ratio
6.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,008.26
Medicare Allowed$160.19
Medicare Payment$127.83

Hospitals charge 6.3x more than what Medicare allows for this procedure. Medicare actually pays $127.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$207$7821333+29.0%
South Carolina$193$8301011+20.7%
Virginia$180$1,19032114+12.4%
District of Columbia$173$747835+8.1%
Michigan$170$1,487116331+6.4%
West Virginia$170$1,213714+6.0%
Maryland$168$8092160+5.1%
Missouri$168$70393495+4.9%
Florida$168$8333271,583+4.6%
New Jersey$166$1,24857174+3.6%
Iowa$164$78728187+2.6%
Kansas$163$69636167+1.8%
Wisconsin$162$555522+0.8%
Indiana$160$1,45570268+0.1%
Ohio$159$9091348-0.6%
Colorado$159$1,27660212-0.9%
Illinois$157$1,034960-1.7%
Nebraska$157$79323123-1.8%
Delaware$157$813516-2.2%
New Mexico$156$7761371-2.5%
Louisiana$155$95970303-3.1%
Pennsylvania$155$1,640147693-3.1%
North Carolina$154$7483155-4.1%
Texas$152$1,0673241,197-5.2%
Tennessee$147$1,2471637-8.3%
Mississippi$145$6253088-9.5%
Oklahoma$143$43854236-10.5%
California$143$1,256922-10.8%
Arkansas$142$50840213-11.3%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber