33430

Replacement of mitral valve on heart-lung machine

Medicare pricing data for 2,834 providers across 48 states

🤖AI Overview

Prices vary significantly by location — from $1,323 in Iowa to $2,978 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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

Replacement of mitral valve on heart-lung machine (HCPCS code 33430) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,845, but hospitals typically charge $8,439 — a 4.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$368.95

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,845, your out-of-pocket cost would be approximately $368.95. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,845
Average Hospital Charge
$8,439
Markup Ratio
4.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$8,438.52
Medicare Allowed$1,844.74
Medicare Payment$1,472.70

Hospitals charge 4.6x more than what Medicare allows for this procedure. Medicare actually pays $1,473 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$2,978$7,498522+61.4%
Hawaii$2,489$7,736524+34.9%
Maryland$2,257$7,0983087+22.3%
New York$2,192$12,599162550+18.8%
Massachusetts$2,127$8,83471233+15.3%
Oklahoma$2,123$6,9942391+15.1%
Georgia$2,066$10,96154140+12.0%
Missouri$2,053$8,35871194+11.3%
Pennsylvania$2,034$7,579166606+10.3%
Rhode Island$2,031$9,446731+10.1%
Tennessee$2,027$6,52957192+9.9%
Illinois$2,016$12,592101314+9.3%
New Jersey$1,990$10,47659227+7.9%
Kansas$1,975$5,6822384+7.1%
Colorado$1,975$7,80940114+7.0%
Ohio$1,968$9,792115404+6.7%
Virginia$1,961$8,00768246+6.3%
Florida$1,939$7,577246820+5.1%
South Dakota$1,920$6,838833+4.1%
Kentucky$1,891$5,47240123+2.5%
Minnesota$1,852$11,24152180+0.4%
Arkansas$1,849$5,20821124+0.2%
Connecticut$1,824$9,42440126-1.1%
Texas$1,819$7,542165552-1.4%
North Dakota$1,814$10,7701434-1.6%
Louisiana$1,792$7,25652152-2.9%
Mississippi$1,780$7,8031856-3.5%
Nevada$1,751$6,6152598-5.1%
New Hampshire$1,743$10,6562688-5.5%
Utah$1,736$5,5612575-5.9%
Michigan$1,726$7,61793251-6.4%
South Carolina$1,716$5,73553159-7.0%
California$1,692$6,9552881,026-8.3%
Arizona$1,641$6,77961361-11.1%
Alabama$1,631$7,16152228-11.6%
North Carolina$1,608$8,16788309-12.8%
Washington$1,576$5,83868186-14.6%
Nebraska$1,550$6,3742591-16.0%
Indiana$1,544$7,91171216-16.3%
Montana$1,532$8,6961753-16.9%
Wisconsin$1,519$24,45371202-17.7%
Delaware$1,510$8,0451229-18.1%
West Virginia$1,500$5,3321542-18.7%
Idaho$1,468$5,5261345-20.4%
Maine$1,464$4,5141426-20.7%
Oregon$1,419$5,43759185-23.1%
Vermont$1,402$12,356721-24.0%
Iowa$1,323$6,0912878-28.3%

⚠️ 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

🏥 See Medicare hospital data on OpenMedicare