93296

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

Code 93296. Medicare covered 1,982,430 of these. Here is what providers billed and what Medicare allowed, state by state.

$92.82Billed, national avg
$21.59Medicare allowed
4.3xBilled vs allowed
9.8xHighest vs lowest state

Providers in Alaska billed the most for this, at $335.86. In South Dakota the average was $34.26. 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$335.86$22.5714.9x8,210
Wyoming$306.48$20.8314.7x956
Wisconsin$239.32$19.9812.0x12,017
Maine$137.78$24.145.7x941
Connecticut$119.41$23.115.2x19,778
Massachusetts$118.28$23.615.0x39,572
New York$114.97$24.954.6x365,336
Illinois$110.94$20.775.3x59,567
New Hampshire$110.35$22.135.0x1,907
Minnesota$110.18$21.315.2x40,653
North Carolina$108.45$19.505.6x64,495
Georgia$104.57$19.805.3x45,177
New Jersey$100.90$23.784.2x53,540
District of Columbia$98.71$24.374.1x1,601
Pennsylvania$98.62$20.704.8x90,341
Texas$97.77$20.614.7x153,664
North Dakota$97.08$23.054.2x324
Delaware$96.56$20.834.6x8,940
Indiana$87.59$19.314.5x47,083
Iowa$87.18$18.944.6x15,263
Mississippi$87.08$18.064.8x17,923
Missouri$86.63$19.274.5x46,562
South Carolina$85.76$19.374.4x52,519
Louisiana$84.41$18.584.5x21,137
Rhode Island$84.30$22.383.8x1,885
California$84.23$25.513.3x124,032
Virginia$83.56$22.153.8x29,625
Maryland$81.87$22.843.6x34,965
Kansas$81.22$18.874.3x33,382
Vermont$79.58$21.323.7x1,048
Utah$79.02$19.634.0x13,367
Oregon$78.34$21.613.6x9,909
Washington$76.98$22.313.5x36,337
Hawaii$76.72$23.573.3x564
Arizona$75.98$20.423.7x46,586
New Mexico$75.67$19.303.9x1,415
Tennessee$71.86$18.843.8x56,055
Oklahoma$71.75$18.713.8x17,709
Alabama$71.04$18.193.9x32,116
Colorado$69.25$23.612.9x39,522
Arkansas$65.56$17.843.7x15,962
Florida$65.44$20.453.2x149,435
Nevada$63.10$20.913.0x6,530
Michigan$59.70$20.262.9x20,916
Idaho$58.78$19.153.1x2,521
West Virginia$58.55$19.363.0x7,721
Ohio$58.53$19.233.0x76,688
Nebraska$58.40$18.853.1x22,879
Kentucky$56.55$19.003.0x28,593
Montana$54.57$21.112.6x4,194
South Dakota$34.26$20.471.7x948

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

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