99153

Use of a drug to induce depression of consciousness by physician performing a procedure, each additional 15 minutes

Medicare pricing data for 4,420 providers across 49 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

Use of a drug to induce depression of consciousness by physician performing a procedure, each additional 15 minutes (HCPCS code 99153) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.03, but hospitals typically charge $52.41 — a 4.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.21

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.03, your out-of-pocket cost would be approximately $2.21. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.03
Average Hospital Charge
$52.41
Markup Ratio
4.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$52.41
Medicare Allowed$11.03
Medicare Payment$8.79

Hospitals charge 4.8x more than what Medicare allows for this procedure. Medicare actually pays $8.79 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$13$275359+21.2%
New York$13$5821410,737+18.4%
New Jersey$13$85834,119+17.0%
California$13$4736128,989+13.7%
Maryland$12$26909,271+13.1%
Hawaii$12$327546+10.7%
Connecticut$12$55462,713+10.4%
Alaska$12$9923722+6.3%
Virginia$12$461479,390+5.4%
Rhode Island$11$474109+3.4%
New Hampshire$11$55531+3.3%
Washington$11$60813,216+3.2%
Massachusetts$11$40484,257+2.6%
Pennsylvania$11$40823,164+2.6%
Colorado$11$432006,504+1.9%
Delaware$11$37291,791+1.5%
Illinois$11$2671196,148+0.6%
Florida$11$4142532,298+0.3%
Minnesota$11$45661,441-0.5%
Nevada$11$3227982-0.8%
Montana$11$78528-1.7%
Puerto Rico$11$5644596-3.0%
West Virginia$11$66350-3.2%
Oregon$11$33452,198-3.7%
Michigan$11$5219612,198-4.2%
South Dakota$11$43153,653-4.6%
Arizona$10$3218418,563-5.3%
Ohio$10$45702,268-5.4%
Texas$10$6356128,801-5.5%
Missouri$10$38511,490-5.6%
Georgia$10$561455,637-7.6%
North Carolina$10$321054,494-8.5%
Wisconsin$10$48261,086-9.2%
Idaho$10$4628505-9.3%
South Carolina$10$75672,668-9.7%
New Mexico$10$46441,491-10.0%
Utah$10$34984,216-10.4%
Louisiana$10$551234,049-10.5%
Indiana$10$29472,216-10.8%
Kentucky$10$31271,993-10.8%
North Dakota$10$236536-10.8%
Kansas$10$37251,496-11.1%
Iowa$10$63211,047-11.4%
Nebraska$10$7021499-12.1%
Alabama$10$41682,666-13.0%
Oklahoma$10$43572,937-13.2%
Tennessee$9$351154,766-14.5%
Mississippi$9$79594,811-16.0%
Arkansas$9$23493,552-17.2%

⚠️ 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