64494

Injection of lower or sacral spine facet joint using imaging guidance, second level

Medicare pricing data for 11,957 providers across 52 states

🤖AI Overview

This procedure has a 7.2x markup — hospitals charge $690.51 but Medicare allows only $96.10. Uninsured patients may face bills 7.2 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

Injection of lower or sacral spine facet joint using imaging guidance, second level (HCPCS code 64494) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $96.10, but hospitals typically charge $690.51 — a 7.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$19.22

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $96.10, your out-of-pocket cost would be approximately $19.22. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$96.10
Average Hospital Charge
$690.51
Markup Ratio
7.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$690.51
Medicare Allowed$96.10
Medicare Payment$76.10

Hospitals charge 7.2x more than what Medicare allows for this procedure. Medicare actually pays $76.10 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$135$2,37028614+40.4%
Connecticut$115$7091383,362+19.8%
Hawaii$113$25821219+17.9%
New York$113$72974019,515+17.7%
Virginia$112$64021512,535+16.4%
Florida$109$5821,14447,524+13.7%
Utah$107$4071454,100+11.4%
North Carolina$105$59836112,478+9.3%
Arizona$103$48528713,439+7.5%
New Jersey$102$3,5244469,848+6.2%
South Carolina$101$54417312,140+4.7%
Michigan$100$5593997,951+4.3%
Oklahoma$100$4411517,080+3.6%
District of Columbia$99$56326510+2.6%
Kentucky$98$5021556,236+1.5%
Massachusetts$97$78631111,301+0.8%
Illinois$96$75440112,586+0.2%
Delaware$96$999502,054-0.4%
Nevada$96$1,3761243,444-0.4%
California$96$7001,02529,718-0.6%
Texas$94$6431,07629,943-2.0%
New Mexico$93$495712,340-2.8%
Oregon$93$4311283,433-3.2%
Colorado$93$5542035,747-3.2%
Alabama$92$3671546,581-4.3%
Pennsylvania$92$59351314,965-4.7%
Washington$90$3832165,269-6.8%
Nebraska$89$513772,383-6.9%
Iowa$89$646992,819-7.3%
Tennessee$89$4982268,646-7.7%
Rhode Island$88$59432720-8.8%
Puerto Rico$87$9526326-9.1%
Maryland$86$4852539,570-10.3%
Montana$85$407341,078-11.8%
Indiana$84$8392547,041-12.7%
Maine$84$293371,048-12.9%
New Hampshire$83$695612,162-13.2%
Georgia$83$69140212,764-14.0%
Missouri$82$5101916,264-14.2%
Ohio$82$38543412,342-14.8%
Wyoming$81$73117410-15.9%
Louisiana$81$8581895,955-16.0%
Arkansas$80$4551345,965-16.5%
Minnesota$79$6501933,963-18.0%
Vermont$78$53517493-18.9%
Idaho$76$502591,422-20.6%
Mississippi$76$546875,341-20.6%
Wisconsin$76$1,2742125,105-20.9%
South Dakota$74$38234994-22.7%
Kansas$73$6161153,233-24.0%
North Dakota$69$36322586-28.0%
West Virginia$68$276452,047-29.0%

⚠️ 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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