93295

Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days

Medicare pricing data for 9,700 providers across 51 states

🤖AI Overview

This procedure has a 5.1x markup — hospitals charge $184.95 but Medicare allows only $36.09. Uninsured patients may face bills 5.1 times higher than what insurance negotiates. 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, or multiple lead implantable defibrillator system, remote up to 90 days (HCPCS code 93295) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $36.09, but hospitals typically charge $184.95 — a 5.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$7.22

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $36.09, your out-of-pocket cost would be approximately $7.22. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$36.09
Average Hospital Charge
$184.95
Markup Ratio
5.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$184.95
Medicare Allowed$36.09
Medicare Payment$25.73

Hospitals charge 5.1x more than what Medicare allows for this procedure. Medicare actually pays $25.73 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$43$535111,904+18.0%
New York$39$31862037,621+8.9%
New Jersey$39$15626321,213+7.4%
California$38$18191842,452+6.5%
District of Columbia$38$167251,572+6.1%
Maryland$38$15916313,094+4.4%
Massachusetts$37$21726720,259+3.5%
Illinois$37$21929130,524+2.3%
Washington$37$13820413,933+1.9%
Rhode Island$37$150351,349+1.7%
Connecticut$36$2271417,269+1.0%
Florida$36$13092948,512+0.9%
Colorado$36$1431398,636+0.9%
Hawaii$36$11824733+0.9%
Virginia$36$15422325,423+0.8%
Montana$36$128443,453+0.3%
Pennsylvania$36$17245740,114+0.2%
Oregon$36$1621207,259-0.3%
Nevada$36$139552,740-0.6%
Texas$36$17070146,557-1.0%
New Hampshire$36$362513,475-1.1%
North Dakota$36$219202,200-1.4%
Minnesota$36$2039811,830-1.6%
Georgia$36$19823121,108-1.6%
Maine$35$165402,722-1.9%
Michigan$35$15032618,169-1.9%
Arizona$35$12825515,514-2.0%
Vermont$35$190161,265-2.1%
Ohio$35$17233828,749-2.1%
Missouri$35$19925118,211-2.4%
West Virginia$35$136476,024-2.4%
North Carolina$35$21021024,305-2.5%
South Carolina$35$18720317,814-2.7%
Utah$35$162483,146-2.7%
South Dakota$35$202203,033-2.7%
New Mexico$35$119342,653-2.8%
Louisiana$35$16524411,440-2.9%
Delaware$35$172383,878-3.4%
Wisconsin$35$48414411,503-3.5%
Kansas$35$15816611,779-3.7%
Oklahoma$35$16916211,532-4.0%
Indiana$35$17515018,104-4.2%
Kentucky$34$13216111,800-4.7%
Alabama$34$11216611,561-4.7%
Nebraska$34$121626,970-4.9%
Iowa$34$1901048,870-5.0%
Idaho$34$145532,919-5.2%
Mississippi$34$200886,912-5.2%
Wyoming$34$28610610-5.5%
Tennessee$34$17721720,460-5.6%
Arkansas$33$1421149,499-9.0%

⚠️ 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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