64491

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

Medicare pricing data for 9,246 providers across 52 states

🤖AI Overview

This procedure has a 6.9x markup — hospitals charge $680.29 but Medicare allows only $98.21. Uninsured patients may face bills 6.9 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, second level (HCPCS code 64491) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $98.21, but hospitals typically charge $680.29 — a 6.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$19.64

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $98.21, your out-of-pocket cost would be approximately $19.64. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$98.21
Average Hospital Charge
$680.29
Markup Ratio
6.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$680.29
Medicare Allowed$98.21
Medicare Payment$77.83

Hospitals charge 6.9x more than what Medicare allows for this procedure. Medicare actually pays $77.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$133$269847+35.8%
Alaska$128$1,82521187+29.9%
Connecticut$113$73185974+15.4%
New York$113$7565356,149+14.9%
Florida$111$57794618,413+13.0%
Virginia$109$6591704,020+11.2%
North Carolina$106$5762713,600+8.4%
Utah$106$4141101,426+7.7%
Arizona$105$4602545,506+7.2%
Oklahoma$105$4761242,912+7.0%
New Jersey$105$3,1393323,036+6.8%
District of Columbia$105$68617120+6.6%
Michigan$103$5742862,794+5.0%
Texas$100$71587812,071+1.4%
South Carolina$99$5631423,494+0.9%
Kentucky$98$5061201,896+0.1%
Delaware$98$92945614-0.4%
Nevada$97$1,398881,289-0.8%
California$97$77978610,284-1.0%
Alabama$97$3581111,946-1.3%
Puerto Rico$96$10919101-2.3%
Colorado$96$5921642,582-2.4%
New Mexico$96$47059916-2.6%
Massachusetts$95$7302383,013-2.9%
Pennsylvania$95$5294024,357-2.9%
Illinois$95$7913163,628-3.6%
Rhode Island$94$60317174-3.9%
Oregon$91$432921,243-6.9%
Tennessee$91$4691752,866-6.9%
Nebraska$91$53857721-7.1%
Maryland$89$4972052,932-9.8%
Wyoming$88$61010106-10.1%
Arkansas$87$4561101,746-11.7%
Missouri$87$5211351,929-11.7%
Washington$86$3691451,784-12.8%
Vermont$85$55714189-13.3%
Georgia$85$6633174,638-13.4%
Indiana$85$8661912,280-13.6%
Ohio$84$3603324,067-14.3%
Louisiana$84$9091532,181-14.3%
Iowa$84$59660618-14.4%
New Hampshire$83$63151631-15.8%
Minnesota$80$5861511,633-18.3%
South Dakota$80$35724348-19.0%
Maine$79$28231266-19.1%
Kansas$79$49678987-19.8%
Mississippi$79$483751,666-19.8%
Idaho$78$51646515-20.1%
Montana$78$42527253-20.3%
Wisconsin$78$1,1941601,623-21.0%
West Virginia$73$26537539-25.6%
North Dakota$73$34117185-25.7%

⚠️ 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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