64611

Injection of chemical for paralysis of salivary glands on both sides of mouth

Medicare pricing data for 1,241 providers across 42 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 chemical for paralysis of salivary glands on both sides of mouth (HCPCS code 64611) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $120.41, but hospitals typically charge $419.06 — a 3.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$24.08

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $120.41, your out-of-pocket cost would be approximately $24.08. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$120.41
Average Hospital Charge
$419.06
Markup Ratio
3.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$419.06
Medicare Allowed$120.41
Medicare Payment$92.77

Hospitals charge 3.5x more than what Medicare allows for this procedure. Medicare actually pays $92.77 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$142$80531164+18.2%
New York$141$771109999+16.9%
Connecticut$132$52529271+9.8%
Illinois$131$50255420+8.4%
Maryland$129$31316188+7.4%
Florida$128$384107982+6.3%
Massachusetts$128$4722487+6.0%
District of Columbia$126$36315218+4.8%
California$124$3511481,868+3.1%
Michigan$123$31025185+2.2%
Virginia$120$38325215-0.7%
Oregon$119$37727158-1.1%
Missouri$118$41533176-1.8%
South Carolina$117$33323183-3.0%
Montana$117$2681281-3.1%
Alabama$116$209448-3.7%
Texas$115$36188731-4.7%
Washington$114$31127170-5.0%
Arizona$114$33738356-5.5%
Georgia$114$46334229-5.6%
Nevada$112$36411100-7.2%
North Carolina$112$34437187-7.2%
Pennsylvania$111$36246187-7.8%
Nebraska$109$266836-9.2%
Rhode Island$109$314432-9.5%
Delaware$108$260344-10.3%
Colorado$108$35433219-10.6%
New Hampshire$107$631637-10.9%
Iowa$107$318622-10.9%
Indiana$105$33631159-12.9%
Tennessee$105$28520131-13.2%
Kansas$103$35413158-14.1%
Wisconsin$102$7241592-15.3%
Louisiana$101$304937-16.0%
South Dakota$101$151561-16.4%
Idaho$99$209428-18.0%
Ohio$98$34439214-18.5%
Minnesota$98$42333164-18.9%
Utah$94$2871176-22.0%
Kentucky$92$283864-23.8%
Oklahoma$84$2928252-29.9%
Arkansas$71$329438-40.7%

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

Related from TheDataProject.ai

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