93459

Insertion of tube in left lower heart chamber, coronary artery and bypass graft for diagnosis with review by radiologist

Medicare pricing data for 8,524 providers across 52 states

🤖AI Overview

This procedure has a 5.9x markup — hospitals charge $1,692 but Medicare allows only $287.92. Uninsured patients may face bills 5.9 times higher than what insurance negotiates. 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

Insertion of tube in left lower heart chamber, coronary artery and bypass graft for diagnosis with review by radiologist (HCPCS code 93459) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $287.92, but hospitals typically charge $1,692 — a 5.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$57.58

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $287.92, your out-of-pocket cost would be approximately $57.58. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$287.92
Average Hospital Charge
$1,692
Markup Ratio
5.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,692.17
Medicare Allowed$287.92
Medicare Payment$227.37

Hospitals charge 5.9x more than what Medicare allows for this procedure. Medicare actually pays $227.37 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Arizona$394$3,0562221,271+36.7%
Alaska$361$8,6911277+25.5%
Kansas$358$5,43380923+24.3%
Oregon$344$1,40583377+19.4%
Florida$335$1,2017755,553+16.3%
Nevada$330$2,06381362+14.8%
Louisiana$320$2,3702161,498+11.2%
Texas$320$2,9068995,117+11.2%
District of Columbia$313$1,2251556+8.8%
New York$303$1,5143892,408+5.3%
Delaware$293$90623244+1.6%
New Jersey$287$1,5812301,155-0.4%
Oklahoma$286$1,1321581,467-0.7%
Colorado$285$96083319-1.0%
Massachusetts$285$1,289117550-1.1%
Illinois$282$1,7523251,998-1.9%
Maryland$281$1,30490761-2.3%
Michigan$280$1,3423101,572-2.6%
Nebraska$278$1,05658451-3.6%
Connecticut$277$1,79973328-3.7%
Missouri$277$1,5572241,642-3.9%
Mississippi$276$2,2051041,160-4.1%
Pennsylvania$275$1,5632911,590-4.4%
Virginia$274$1,0061961,167-4.7%
New Hampshire$274$3,55830202-4.9%
California$274$1,3286853,173-4.9%
Wyoming$274$5,979835-4.9%
Alabama$272$1,2951851,335-5.4%
Vermont$269$1,6101134-6.5%
Ohio$268$1,0433432,296-7.0%
Georgia$267$1,8332612,065-7.4%
Kentucky$266$8681431,202-7.6%
Arkansas$264$1,0621521,928-8.4%
Washington$262$924161878-9.1%
Hawaii$259$8321779-10.1%
North Carolina$258$1,4142431,693-10.5%
Montana$257$1,29429243-10.9%
West Virginia$255$1,90055487-11.5%
Puerto Rico$254$9751532-11.7%
Tennessee$251$8852562,052-12.8%
Maine$251$1,0642073-12.9%
South Carolina$250$2,1041611,424-13.0%
Rhode Island$250$1,1852187-13.2%
South Dakota$249$1,03720200-13.5%
Idaho$249$92732134-13.6%
New Mexico$248$1,35228212-13.7%
Indiana$247$1,4662081,642-14.3%
Wisconsin$244$3,892118685-15.2%
North Dakota$242$1,32622214-15.8%
Minnesota$241$1,86686361-16.2%
Utah$235$1,12850279-18.4%
Iowa$232$1,15968563-19.4%

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

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