01942

Anesthesia for nerve modulation procedure spinal cord or repair of bone of spine of lower back accessed through skin using imaging guidance

Medicare pricing data for 21,347 providers across 52 states

🤖AI Overview

This procedure has a 11.2x markup — hospitals charge $1,752 but Medicare allows only $156.32. Uninsured patients may face bills 11.2 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

Anesthesia for nerve modulation procedure spinal cord or repair of bone of spine of lower back accessed through skin using imaging guidance (HCPCS code 01942) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $156.32, but hospitals typically charge $1,752 — a 11.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$31.26

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $156.32, your out-of-pocket cost would be approximately $31.26. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$156.32
Average Hospital Charge
$1,752
Markup Ratio
11.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,752.44
Medicare Allowed$156.32
Medicare Payment$123.20

Hospitals charge 11.2x more than what Medicare allows for this procedure. Medicare actually pays $123.20 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$221$1,1771846+41.2%
Puerto Rico$221$2,5241545+41.2%
Idaho$217$1,41273146+39.1%
Utah$215$1,685124227+37.5%
California$208$1,8641,2302,613+33.2%
Montana$206$1,14753101+31.9%
Wyoming$202$1,4201421+29.0%
Washington$201$1,522321598+28.4%
Nevada$195$1,87589213+24.9%
New Mexico$193$1,78566127+23.6%
Oregon$192$1,865129254+23.1%
Maryland$182$1,780285857+16.2%
New York$178$2,6951,0202,002+14.1%
Iowa$178$1,467113240+13.7%
Illinois$170$1,8949892,098+8.8%
Arizona$170$2,565281873+8.5%
Delaware$169$1,56978236+8.4%
Florida$169$2,1211,9245,127+8.3%
Oklahoma$169$1,245251927+8.0%
Colorado$169$1,623277481+7.8%
Indiana$167$1,4424861,047+6.9%
District of Columbia$167$1,5624783+6.8%
Arkansas$167$2,423175469+6.6%
Wisconsin$166$1,924329593+6.2%
Hawaii$166$2,82230120+5.9%
Nebraska$162$1,116143451+3.9%
Minnesota$162$1,422228469+3.7%
Louisiana$161$1,510352890+3.2%
Kansas$158$1,156294891+0.8%
New Jersey$156$1,8264191,434+0.1%
Tennessee$156$1,4865821,346-0.4%
Massachusetts$155$1,4386351,281-0.8%
New Hampshire$154$1,853122207-1.4%
Missouri$153$1,2845131,068-2.3%
Maine$150$1,94478143-3.9%
Texas$148$2,0142,1705,802-5.1%
Kentucky$146$1,421392997-6.4%
North Dakota$146$1,02086169-6.9%
Connecticut$145$1,631250397-7.2%
Virginia$140$1,5865461,045-10.6%
Ohio$137$1,3318781,770-12.1%
Georgia$137$1,7831,0632,873-12.4%
Mississippi$136$684158603-12.8%
Rhode Island$135$1,22359115-13.5%
Michigan$134$2,0399011,886-14.4%
Pennsylvania$130$1,3891,1072,807-16.8%
Vermont$129$1,1211835-17.2%
North Carolina$124$1,6067701,648-21.0%
West Virginia$122$1,251147382-21.9%
South Carolina$122$1,690459902-21.9%
South Dakota$118$1,11194154-24.8%
Alabama$114$1,198417989-27.2%

⚠️ 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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