64490

Injection of upper or middle spine facet joint using imaging guidance, single level

Medicare pricing data for 11,368 providers across 52 states

🤖AI Overview

This procedure has a 7.4x markup — hospitals charge $1,773 but Medicare allows only $238.93. Uninsured patients may face bills 7.4 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

Injection of upper or middle spine facet joint using imaging guidance, single level (HCPCS code 64490) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $238.93, but hospitals typically charge $1,773 — a 7.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$47.79

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $238.93, your out-of-pocket cost would be approximately $47.79. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$238.93
Average Hospital Charge
$1,773
Markup Ratio
7.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,773.47
Medicare Allowed$238.93
Medicare Payment$186.85

Hospitals charge 7.4x more than what Medicare allows for this procedure. Medicare actually pays $186.85 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$288$2,8041,07920,628+20.7%
Alaska$278$3,10426294+16.2%
Nevada$273$3,2351202,753+14.4%
New Jersey$273$5,0274555,474+14.1%
Oregon$268$1,1741263,026+12.4%
Maryland$266$1,7123016,967+11.2%
Connecticut$261$1,6631141,485+9.0%
Hawaii$258$7061784+8.1%
Delaware$254$1,732551,113+6.3%
Georgia$248$1,96444210,630+4.0%
Arizona$248$1,6233179,340+3.9%
New York$248$1,7486048,303+3.8%
Colorado$244$1,7652124,959+2.2%
Florida$243$1,5941,12827,355+1.8%
Minnesota$243$1,4901953,524+1.6%
Washington$241$1,1541893,391+0.8%
Wyoming$239$1,91021376-0.1%
Texas$238$2,0071,05319,342-0.5%
Rhode Island$232$1,28421272-3.0%
Indiana$229$2,0382524,171-4.0%
Tennessee$228$1,4372195,423-4.4%
South Carolina$227$1,1761605,227-5.1%
Arkansas$224$1,0581353,203-6.2%
Pennsylvania$224$1,2584966,397-6.3%
Illinois$223$1,7613665,281-6.6%
New Mexico$221$1,543661,304-7.5%
Mississippi$220$1,164973,384-7.9%
Louisiana$220$2,0531944,237-8.0%
Michigan$219$1,1903283,797-8.3%
Montana$217$86237598-9.1%
Virginia$217$1,1381784,658-9.1%
Kentucky$217$1,2941272,610-9.3%
Utah$216$8731231,838-9.6%
Idaho$214$1,023631,043-10.3%
Iowa$213$1,82672952-10.8%
Oklahoma$213$9441353,276-10.9%
Kansas$213$1,566991,840-11.0%
District of Columbia$213$96818150-11.0%
New Hampshire$211$1,43161902-11.7%
Wisconsin$210$2,4012102,913-12.1%
North Carolina$209$1,1052934,313-12.4%
Nebraska$209$1,091711,010-12.5%
Massachusetts$206$1,2152553,912-13.8%
Alabama$206$9601342,645-13.8%
Ohio$201$9723835,908-16.0%
North Dakota$193$92223274-19.0%
Puerto Rico$192$22920111-19.8%
Missouri$185$1,3471522,589-22.7%
South Dakota$163$67930449-31.6%
Maine$154$58132318-35.7%
Vermont$151$1,12014228-36.9%
West Virginia$149$53242636-37.8%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber