Outpatient heart rehabilitation, qualified health care professional services
Medicare pricing data for 155 providers across 17 states
This procedure has a 6.0x markup — hospitals charge $87.09 but Medicare allows only $14.57. Uninsured patients may face bills 6.0 times higher than what insurance negotiates. Prices vary significantly by location — from $8 in Tennessee to $19 in Texas. Where you get this procedure matters more than almost any other factor. 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
Outpatient heart rehabilitation, qualified health care professional services (HCPCS code 93797) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $14.57, but hospitals typically charge $87.09 — a 6.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $14.57, your out-of-pocket cost would be approximately $2.91. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 6.0x more than what Medicare allows for this procedure. Medicare actually pays $11.05 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Texas | $19 | $40 | 4 | 1,929 | +29.8% |
| California | $18 | $91 | 5 | 116 | +25.1% |
| Rhode Island | $17 | $40 | 7 | 136 | +18.5% |
| Colorado | $17 | $43 | 18 | 145 | +16.8% |
| New York | $17 | $108 | 14 | 1,456 | +16.0% |
| Washington | $17 | $42 | 3 | 1,097 | +15.9% |
| Florida | $17 | $48 | 7 | 46 | +13.8% |
| Minnesota | $16 | $147 | 15 | 415 | +12.5% |
| Arizona | $16 | $154 | 16 | 2,012 | +12.3% |
| Wisconsin | $16 | $306 | 10 | 79 | +10.1% |
| New Mexico | $16 | $17 | 1 | 951 | +8.0% |
| Louisiana | $15 | $46 | 2 | 73 | +6.3% |
| South Carolina | $15 | $50 | 4 | 369 | +6.2% |
| New Jersey | $14 | $314 | 3 | 383 | -6.7% |
| North Carolina | $10 | $72 | 18 | 3,594 | -34.4% |
| Massachusetts | $8 | $81 | 2 | 450 | -42.3% |
| Tennessee | $8 | $81 | 1 | 77 | -43.0% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber