01938

Anesthesia for injection, drainage or aspiration procedures on spine or spinal cord of lower back accessed through skin using imaging guidance

Medicare pricing data for 9,948 providers across 50 states

🤖AI Overview

This procedure has a 14.0x markup — hospitals charge $1,247 but Medicare allows only $89.11. Uninsured patients may face bills 14.0 times higher than what insurance negotiates. Prices vary significantly by location — from $57 in Rhode Island to $244 in Alaska. Where you get this procedure matters more than almost any other factor. 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

Anesthesia for injection, drainage or aspiration procedures on spine or spinal cord of lower back accessed through skin using imaging guidance (HCPCS code 01938) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $89.11, but hospitals typically charge $1,247 — a 14.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$17.82

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $89.11, your out-of-pocket cost would be approximately $17.82. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$89.11
Average Hospital Charge
$1,247
Markup Ratio
14.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,246.66
Medicare Allowed$89.11
Medicare Payment$69.88

Hospitals charge 14.0x more than what Medicare allows for this procedure. Medicare actually pays $69.88 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$244$2,0231116+173.5%
South Dakota$136$1,9441928+52.8%
Puerto Rico$128$1,3111023+43.1%
Idaho$120$5032382+34.7%
Maryland$114$1,843981,507+27.7%
California$112$1,31288012,900+25.4%
Wyoming$112$798521+25.2%
Washington$108$1,17362468+21.0%
Colorado$105$8771302,041+17.3%
Nebraska$103$1,02233166+16.0%
Oregon$103$1,28944256+15.5%
District of Columbia$103$82012218+15.3%
Maine$102$1,31219157+14.6%
Nevada$102$1,06357997+14.1%
Iowa$100$1,68721837+11.7%
Oklahoma$99$1,03072755+11.0%
New York$99$1,4477057,220+10.6%
Georgia$98$1,8173895,552+10.3%
Arizona$97$1,8441984,398+9.3%
Kentucky$97$2,245821,749+8.6%
Minnesota$97$1,53148326+8.5%
Vermont$97$733438+8.4%
Hawaii$97$2,98010575+8.4%
Illinois$95$9354323,521+6.9%
New Mexico$95$87118215+6.8%
Virginia$94$1,3731421,335+5.3%
Louisiana$93$1,1413023,114+4.0%
Florida$92$1,1131,0069,912+3.8%
South Carolina$92$1,28476246+3.3%
North Carolina$92$1,130105744+3.1%
Missouri$92$1,39777338+2.9%
Kansas$90$1,06045115+1.0%
Massachusetts$90$7462011,323+0.9%
Indiana$90$879121940+0.8%
Arkansas$88$1,74044679-1.1%
Wisconsin$88$1,20172453-1.2%
Tennessee$87$1,0881871,336-2.9%
Mississippi$86$63755410-3.4%
Delaware$85$1,04260463-4.5%
New Jersey$83$1,0545635,535-6.8%
Utah$83$70929143-7.2%
West Virginia$82$8632593-8.3%
New Hampshire$81$67317145-8.7%
Texas$80$1,3951,69620,106-10.2%
Ohio$77$6262101,043-14.0%
Michigan$76$1,2163324,248-14.5%
Connecticut$70$7231841,198-21.7%
Pennsylvania$65$6776337,436-26.8%
Alabama$60$7723025,518-33.1%
Rhode Island$57$42744464-35.9%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber