93294

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days

Medicare pricing data for 11,767 providers across 51 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 1.7 million services annually. Even small pricing inefficiencies here affect millions of patients. 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

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days (HCPCS code 93294) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $29.45, but hospitals typically charge $104.00 — a 3.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.89

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $29.45, your out-of-pocket cost would be approximately $5.89. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$29.45
Average Hospital Charge
$104.00
Markup Ratio
3.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$104.00
Medicare Allowed$29.45
Medicare Payment$21.00

Hospitals charge 3.5x more than what Medicare allows for this procedure. Medicare actually pays $21.00 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$34$330185,840+17.0%
New York$32$14474682,681+9.0%
New Jersey$32$10836948,386+7.7%
California$31$1051,106124,781+6.4%
Maryland$31$8917424,009+4.7%
District of Columbia$31$84272,124+4.4%
Massachusetts$31$11331651,082+3.6%
Illinois$30$12937569,373+2.9%
Connecticut$30$11617819,362+2.3%
Rhode Island$30$95372,524+1.8%
Florida$30$791,029131,965+1.5%
Washington$30$8428343,560+1.4%
Virginia$30$8627060,970+1.1%
Colorado$30$8415026,433+0.7%
Montana$30$1134810,099+0.3%
Pennsylvania$30$9350887,344+0.2%
Nevada$29$81788,198-0.2%
Hawaii$29$81241,610-0.4%
Oregon$29$10014719,620-0.7%
Michigan$29$8739740,420-1.0%
Vermont$29$102141,087-1.1%
Texas$29$100959118,651-1.2%
New Hampshire$29$2056110,677-1.3%
Georgia$29$11627949,516-1.5%
Ohio$29$9239257,773-1.9%
North Dakota$29$112246,600-2.0%
Arizona$29$8631143,056-2.1%
Maine$29$85668,031-2.1%
New Mexico$29$81386,915-2.1%
West Virginia$29$805212,994-2.2%
Minnesota$29$12712333,526-2.4%
North Carolina$29$11729458,207-2.6%
Louisiana$29$9827126,173-2.7%
Utah$29$87709,936-2.7%
Missouri$29$9829944,610-2.9%
South Carolina$29$10126544,364-2.9%
Delaware$29$81427,180-3.0%
South Dakota$28$109309,538-3.4%
Oklahoma$28$9519229,517-3.9%
Kansas$28$8717430,832-4.1%
Alabama$28$7118830,240-4.2%
Indiana$28$9417641,307-4.3%
Wisconsin$28$29919028,850-4.4%
Wyoming$28$156111,673-4.4%
Kentucky$28$8118927,670-4.6%
Mississippi$28$10210417,420-4.8%
Iowa$28$10011724,539-5.3%
Nebraska$28$846920,762-5.4%
Tennessee$28$9128148,962-5.6%
Idaho$28$84598,416-5.7%
Arkansas$27$8314126,133-9.3%

⚠️ 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