92920

Balloon dilation of single coronary artery or branch

Medicare pricing data for 5,787 providers across 51 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

Balloon dilation of single coronary artery or branch (HCPCS code 92920) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $447.23, but hospitals typically charge $2,042 — a 4.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$89.45

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $447.23, your out-of-pocket cost would be approximately $89.45. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$447.23
Average Hospital Charge
$2,042
Markup Ratio
4.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,041.98
Medicare Allowed$447.23
Medicare Payment$355.61

Hospitals charge 4.6x more than what Medicare allows for this procedure. Medicare actually pays $355.61 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$587$4,3651131+31.2%
Colorado$559$1,79756150+25.1%
Arizona$556$2,724181575+24.4%
Kansas$540$4,66463233+20.6%
Texas$533$3,3755451,557+19.2%
Florida$529$1,8184741,404+18.2%
District of Columbia$508$2,0851964+13.6%
Louisiana$507$2,238136404+13.4%
New York$506$2,3862741,014+13.2%
Oregon$506$1,71151140+13.1%
Nevada$496$1,78746117+10.8%
Michigan$463$1,295211729+3.6%
Illinois$459$2,433242723+2.6%
Montana$450$1,5212663+0.6%
New Jersey$445$2,187173560-0.4%
Missouri$435$1,744149503-2.8%
Pennsylvania$427$1,557237647-4.6%
Mississippi$427$2,48475312-4.6%
California$426$1,6764531,523-4.7%
Connecticut$421$2,77252154-5.9%
Virginia$417$1,370153421-6.7%
West Virginia$417$1,42237150-6.8%
Maine$417$1,9641642-6.9%
Oklahoma$412$1,655104413-7.9%
Georgia$409$1,957163450-8.5%
Massachusetts$407$1,92997331-9.1%
South Carolina$401$2,388106279-10.2%
Arkansas$401$1,20799446-10.4%
Ohio$401$1,566230729-10.4%
Utah$400$1,47135120-10.5%
Washington$398$1,481114408-11.1%
Alabama$392$1,522102337-12.4%
Minnesota$391$2,26285267-12.6%
North Carolina$390$1,668152466-12.8%
Iowa$389$1,70454226-12.9%
Maryland$385$1,32877263-13.9%
North Dakota$381$2,35220107-14.8%
Indiana$376$1,655157466-15.9%
Kentucky$375$1,22697281-16.1%
Rhode Island$372$1,3551149-16.8%
Tennessee$371$1,516134434-17.0%
Nebraska$371$1,60237119-17.2%
Delaware$369$1,1301996-17.6%
New Hampshire$366$4,6162476-18.1%
Hawaii$364$1,077819-18.5%
Wisconsin$361$4,60185222-19.3%
New Mexico$356$1,5741884-20.4%
Idaho$355$1,2402049-20.7%
Vermont$351$2,370934-21.6%
South Dakota$347$1,1341680-22.4%
Wyoming$322$3,376214-27.9%

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

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💊 Need post-procedure medications? Check costs on OpenPrescriber