Medicine · 92953

Temporary Pacemaker To Regulate Heart Beat

Medicare Payment (avg)
$0.80
What Medicare actually pays
Billed Charge (avg)
$97.25
What providers submit
Markup
121.7x
12066% above Medicare rate
200
Total Services
195
Beneficiaries
122
Providers
4
States with Data

Price Range Across States

Lowest State Avg
$0.78
Missouri
Highest State Avg
$1.13
New York

What You Might Pay

Est. Commercial Insurance
$2.16
Range: $1.51 – $3.03
Est. Cash / Self-Pay
$27.50
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Medicine procedures average 2.15x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
New York $1.13 $153.27
Florida $0.90 $58.47
California $0.78 $118.55
Missouri $0.78 $27.00

What the Data Says About Temporary Pacemaker To Regulate Heart Beat

Across 4 states with reporting providers, CPT code 92953 (Temporary Pacemaker To Regulate Heart Beat) shows a national average Medicare payment of $0.80 against an average billed charge of $97.25. That gap — a 121.7x markup, or 12066% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Medicine procedures like this one saw 200 services billed to Medicare in 2023 by 122 distinct providers, serving 195 unique beneficiaries. State-level variation is significant: Missouri reports the lowest average payment at $0.78, while New York reports the highest at $1.13. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Medicine category (2.15x), the estimated commercial insurance price lands near $2.16, with self-pay cash discounts commonly bringing the figure closer to $27.50. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Temporary Pacemaker To Regulate Heart Beat cost?

The national average Medicare payment for Temporary Pacemaker To Regulate Heart Beat (CPT 92953) is $0.80, while providers typically bill $97.25. Prices vary significantly by state, ranging from $0.78 to $1.13.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Temporary Pacemaker To Regulate Heart Beat cost with insurance?

With commercial insurance, Temporary Pacemaker To Regulate Heart Beat costs an estimated $2.16 on average (range: $1.51 – $3.03). Without insurance, the estimated cash price is $27.50. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Temporary Pacemaker To Regulate Heart Beat?

Missouri has the lowest average Medicare payment for Temporary Pacemaker To Regulate Heart Beat at $0.78, while New York has the highest at $1.13. This $0.35 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Temporary Pacemaker To Regulate Heart Beat?

Nationally, 122 providers billed Medicare for Temporary Pacemaker To Regulate Heart Beat in 2023, performing 200 total services for 195 beneficiaries across 4 states and territories.

What is the billed-to-Medicare markup for Temporary Pacemaker To Regulate Heart Beat?

Providers bill 121.7x what Medicare pays for Temporary Pacemaker To Regulate Heart Beat — a 12066% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial