Test To Examine How Well The Lungs Exchange Gases
What Medicare pays for 94729, what providers bill, and how the price varies across 53 states, drawn from CMS 2023 claims data.
94729 · the short answer
For test to examine how well the lungs exchange gases, Medicare pays about $27.03 while providers bill $109.43 on average, a 4.0× markup, a below-median markup. State-level Medicare rates range 528% from lowest to highest.
- Medicare pays
- $27.03
- Providers bill
- $109.43
- Markup
- 4.0×
- Markup percentile
- 30th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
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.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
4 more affordable than 30% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Puerto Rico | $41.10 | $64.28 |
| New York | $40.41 | $177.81 |
| New Jersey | $36.88 | $153.55 |
| Maryland | $35.29 | $128.46 |
| Florida | $34.69 | $105.32 |
| Nevada | $33.90 | $134.30 |
| Arizona | $33.18 | $101.40 |
| California | $33.15 | $111.58 |
| Georgia | $33.09 | $145.79 |
| District of Columbia | $30.59 | $123.99 |
| Virginia | $30.08 | $100.97 |
| Minnesota | $29.69 | $176.95 |
| Texas | $29.13 | $112.04 |
| North Carolina | $28.62 | $124.40 |
| Alabama | $28.54 | $86.55 |
| Connecticut | $27.53 | $126.35 |
| Mississippi | $26.02 | $121.48 |
| Delaware | $26.01 | $85.10 |
| Tennessee | $25.95 | $97.31 |
| South Carolina | $25.60 | $107.65 |
| Washington | $25.07 | $104.61 |
| Rhode Island | $23.47 | $109.44 |
| New Mexico | $23.30 | $89.07 |
| Kansas | $22.99 | $108.46 |
| Nebraska | $22.76 | $65.57 |
| Colorado | $21.57 | $101.55 |
| Illinois | $21.00 | $115.09 |
| Kentucky | $20.54 | $71.39 |
| Michigan | $20.23 | $65.49 |
| Arkansas | $19.07 | $73.38 |
| West Virginia | $18.85 | $75.34 |
| Pennsylvania | $18.62 | $76.45 |
| Oregon | $18.16 | $93.42 |
| Alaska | $16.97 | $106.43 |
| Indiana | $16.91 | $65.06 |
| Maine | $16.88 | $111.46 |
| Hawaii | $16.21 | $47.32 |
| Missouri | $16.15 | $75.96 |
| Oklahoma | $15.48 | $51.69 |
| Wisconsin | $15.11 | $195.86 |
| Louisiana | $15.00 | $95.56 |
| Utah | $14.85 | $63.02 |
| Montana | $14.72 | $68.04 |
| Massachusetts | $14.48 | $79.38 |
| Iowa | $14.08 | $77.32 |
| Ohio | $13.67 | $60.33 |
| Wyoming | $10.49 | $57.06 |
| South Dakota | $9.75 | $37.88 |
| Vermont | $9.05 | $43.01 |
| North Dakota | $8.36 | $41.54 |
| New Hampshire | $8.35 | $93.66 |
| Idaho | $7.70 | $45.16 |
| Guam | $6.54 | $26.66 |
What the Data Says About Test To Examine How Well The Lungs Exchange Gases
Across 53 states with reporting providers, CPT code 94729 (Test To Examine How Well The Lungs Exchange Gases) shows a national average Medicare payment of $27.03 against an average billed charge of $109.43. That gap, a 4.0x markup, or 305% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Medicine procedures like this one saw 971.5K services billed to Medicare in 2023 by 16.0K distinct providers, serving 887.4K unique beneficiaries. State-level variation is significant: Guam reports the lowest average payment at $6.54, while Puerto Rico reports the highest at $41.10. A 528% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Medicine category (2.15x), the estimated commercial insurance price lands near $75.85, with self-pay cash discounts commonly bringing the figure closer to $56.55. Within Medicine, Test To Examine How Well The Lungs Exchange Gases ranks #381 of 533 tracked procedures by national average Medicare payment.
What to do with this
If you may have test to examine how well the lungs exchange gases done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare test to examine how well the lungs exchange gases costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Test To Examine How Well The Lungs Exchange Gases cost?
Test To Examine How Well The Lungs Exchange Gases (CPT 94729) shows unusually wide state-to-state pricing: Medicare pays $27.03 on average nationally, but the $6.54-$41.10 range across states spans more than double from cheapest to priciest.
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 Test To Examine How Well The Lungs Exchange Gases cost with insurance?
With commercial insurance, test to examine how well the lungs exchange gases costs an estimated $75.85 on average (range: $53.09-$106.19), a moderate premium over Medicare's $27.03. Without insurance, the estimated cash price is $56.55.
Which state has the lowest cost for Test To Examine How Well The Lungs Exchange Gases?
Guam has by far the lowest average Medicare payment for Test To Examine How Well The Lungs Exchange Gases at $6.54, while Puerto Rico pays more than double at $41.10 - a $34.56 gap.
How many providers perform Test To Examine How Well The Lungs Exchange Gases?
Test To Examine How Well The Lungs Exchange Gases is a widely-performed procedure: 16.0K providers billed Medicare for it in 2023 across 53 states, together handling 971.5K services for 887.4K beneficiaries.
What is the billed-to-Medicare markup for Test To Examine How Well The Lungs Exchange Gases?
Providers bill 4.0x what Medicare pays for Test To Examine How Well The Lungs Exchange Gases - a below-median markup at 305% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.