G0423

Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session

Medicare pricing data for 147 providers across 20 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

Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session (HCPCS code G0423) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $119.87, but hospitals typically charge $289.76 — a 2.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$23.97

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $119.87, your out-of-pocket cost would be approximately $23.97. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$119.87
Average Hospital Charge
$289.76
Markup Ratio
2.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$289.76
Medicare Allowed$119.87
Medicare Payment$95.32

Hospitals charge 2.4x more than what Medicare allows for this procedure. Medicare actually pays $95.32 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Massachusetts$132$3641396+10.0%
New Jersey$130$602103,791+8.9%
California$128$3512910,376+7.1%
New York$125$278393,098+3.9%
Colorado$123$323234,468+2.4%
Illinois$121$323190+0.9%
Hawaii$121$23421,205+0.8%
Nevada$119$31632,306-0.8%
Georgia$118$6011378-1.3%
Texas$118$31372,338-1.9%
Florida$117$21536,524-2.3%
Arizona$116$2254334-3.3%
Michigan$116$2133316-3.3%
North Carolina$116$34711,316-3.4%
Missouri$116$12482,664-3.4%
Pennsylvania$114$2271556-4.5%
South Carolina$113$22441,982-5.6%
Louisiana$112$14824,596-6.5%
Idaho$111$2501895-7.3%
Arkansas$110$22745,998-8.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber