93294

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days

Code 93294. Medicare covered 1,898,791 of these. Here is what providers billed and what Medicare allowed, state by state.

$105.62Billed, national avg
$28.57Medicare allowed
3.7xBilled vs allowed
4.5xHighest vs lowest state

Providers in Alaska billed the most for this, at $319.51. In Alabama the average was $71.15. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$319.51$32.599.8x7,086
Wisconsin$307.04$27.2111.3x30,520
New Hampshire$217.03$28.017.7x11,592
Wyoming$189.97$26.357.2x1,272
New York$148.79$30.764.8x93,355
Minnesota$133.71$27.774.8x34,325
Illinois$131.56$29.514.5x72,891
Connecticut$118.06$29.324.0x21,604
North Carolina$117.17$27.674.2x62,148
Georgia$116.29$28.454.1x53,293
Massachusetts$113.23$29.393.9x55,527
Vermont$110.19$28.103.9x1,189
California$108.81$30.303.6x137,437
South Dakota$108.72$27.474.0x9,774
North Dakota$108.41$27.933.9x8,056
New Jersey$106.19$30.913.4x52,360
Montana$104.52$28.363.7x9,388
South Carolina$104.38$27.843.7x52,208
Mississippi$104.30$27.463.8x16,985
Iowa$103.60$26.773.9x27,540
Louisiana$102.64$27.573.7x27,611
Texas$101.14$28.273.6x129,008
Oregon$100.87$28.633.5x20,730
Rhode Island$99.42$29.253.4x3,411
Missouri$97.58$27.603.5x46,903
District of Columbia$97.51$30.333.2x2,095
Colorado$95.22$28.703.3x30,390
Pennsylvania$94.20$28.633.3x91,158
Oklahoma$94.16$27.023.5x29,708
Indiana$93.11$27.203.4x44,972
Ohio$92.97$27.933.3x64,480
Maryland$89.08$29.663.0x29,330
Tennessee$88.97$27.223.3x56,312
Virginia$88.30$28.923.1x65,803
Michigan$87.51$28.593.1x43,444
Washington$87.00$29.123.0x44,982
Kentucky$86.51$27.773.1x28,086
Nevada$85.77$28.133.0x9,477
Kansas$85.17$27.273.1x34,294
Utah$84.98$27.933.0x12,911
Hawaii$84.20$27.143.1x1,532
Arkansas$84.14$26.163.2x28,072
Arizona$83.19$28.023.0x50,836
Nebraska$82.31$26.613.1x20,660
Idaho$81.10$27.263.0x8,011
Florida$80.76$29.152.8x145,929
New Mexico$80.51$27.762.9x7,527
Delaware$80.02$27.362.9x8,251
Maine$79.55$28.562.8x8,722
West Virginia$79.26$28.372.8x13,397
Alabama$71.15$26.932.6x32,189

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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