92604

Analysis and reprogramming of inner ear implant (7 years or older)

Medicare pricing data for 1,397 providers across 49 states

🤖AI Overview

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

Analysis and reprogramming of inner ear implant (7 years or older) (HCPCS code 92604) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $88.65, but hospitals typically charge $253.10 — a 2.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$17.73

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $88.65, your out-of-pocket cost would be approximately $17.73. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$88.65
Average Hospital Charge
$253.10
Markup Ratio
2.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$253.10
Medicare Allowed$88.65
Medicare Payment$63.83

Hospitals charge 2.9x more than what Medicare allows for this procedure. Medicare actually pays $63.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$105$2309135+18.6%
New Jersey$101$3848124+13.7%
California$100$295821,666+12.4%
New York$100$384551,184+12.3%
Maryland$98$26227733+10.8%
Connecticut$98$29020248+10.6%
Washington$95$25035592+6.6%
Hawaii$94$272333+6.1%
Alaska$92$1194129+4.0%
Colorado$92$20646781+3.2%
Montana$91$2358234+2.8%
Virginia$91$28530796+2.7%
Delaware$91$192328+2.6%
Nevada$91$28811196+2.5%
Wyoming$91$251373+2.1%
Illinois$90$29646795+2.0%
North Dakota$90$210655+2.0%
Florida$90$2161042,714+1.0%
Texas$89$2321012,250+0.8%
Georgia$89$25633675+0.7%
Oregon$89$25527514+0.5%
Missouri$89$243351,182+0.3%
Arizona$88$219471,267-0.4%
North Carolina$88$20536598-0.7%
South Dakota$88$25314163-1.1%
Michigan$88$19052823-1.3%
Utah$87$22321335-2.3%
Massachusetts$86$30532341-2.8%
Indiana$86$19734514-2.9%
South Carolina$86$23219640-3.0%
Iowa$86$23111303-3.4%
Oklahoma$86$173411,080-3.5%
Nebraska$86$22315556-3.5%
Louisiana$86$20415114-3.5%
New Mexico$85$22211218-4.0%
Kentucky$85$76524575-4.5%
West Virginia$85$162799-4.6%
Kansas$85$3496191-4.6%
Alabama$85$15729522-4.7%
Arkansas$83$22111183-6.0%
Mississippi$83$2055229-6.1%
Wisconsin$83$35620303-6.2%
Tennessee$83$30436490-6.8%
Minnesota$81$24037744-9.2%
Pennsylvania$80$17166850-9.8%
Ohio$79$263621,098-10.6%
New Hampshire$76$2216226-14.1%
Maine$75$1779132-15.0%
Idaho$72$16513270-18.8%

⚠️ 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

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