93319

3d ultrasound imaging of heart for evaluation of heart structure performed during ultrasound imaging of congenital heart defects

Medicare pricing data for 2,426 providers across 44 states

🤖AI Overview

This procedure has a 8.1x markup — hospitals charge $194.49 but Medicare allows only $24.04. Uninsured patients may face bills 8.1 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

3d ultrasound imaging of heart for evaluation of heart structure performed during ultrasound imaging of congenital heart defects (HCPCS code 93319) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $24.04, but hospitals typically charge $194.49 — a 8.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.81

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $24.04, your out-of-pocket cost would be approximately $4.81. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$24.04
Average Hospital Charge
$194.49
Markup Ratio
8.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$194.49
Medicare Allowed$24.04
Medicare Payment$18.96

Hospitals charge 8.1x more than what Medicare allows for this procedure. Medicare actually pays $18.96 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$31$704213+30.9%
New Jersey$26$14031431+6.9%
New York$26$15670613+6.5%
California$25$2152162,474+4.5%
Maryland$25$11137272+4.4%
Connecticut$25$13738325+4.2%
Massachusetts$25$11678535+4.0%
Florida$25$1821721,312+3.9%
Illinois$25$269109928+2.6%
Pennsylvania$24$1611551,215+1.6%
Washington$24$122105772+0.7%
Rhode Island$24$11719840.0%
Oregon$24$1662287-0.1%
Michigan$24$1501571,249-0.3%
Virginia$24$9093606-0.3%
New Hampshire$24$57716145-0.5%
Nevada$24$11838226-1.2%
Colorado$24$15439239-1.2%
Georgia$24$8929109-1.6%
Hawaii$24$229898-1.7%
West Virginia$24$761240-1.8%
Montana$24$48416215-1.9%
North Carolina$24$1472485-2.0%
District of Columbia$24$31014317-2.0%
Missouri$24$11979859-2.2%
Texas$23$2091401,339-2.4%
Arizona$23$16364934-2.9%
Ohio$23$158871,345-3.2%
Utah$23$9937232-3.3%
South Carolina$23$11629143-3.6%
Minnesota$23$194104533-3.7%
Louisiana$23$13414222-3.9%
Iowa$23$2621045-4.5%
Oklahoma$23$14314223-4.7%
South Dakota$23$201417-4.8%
Alabama$23$11531433-5.1%
Wisconsin$23$74056559-5.2%
Indiana$23$23265370-5.8%
Kentucky$23$20338284-5.8%
Kansas$23$33523214-5.8%
Tennessee$22$22939422-6.4%
Nebraska$22$18141305-6.5%
Arkansas$22$12811169-8.1%
Mississippi$22$128173-8.5%

⚠️ 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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