64634

Destruction of upper or middle spinal facet joint nerves using imaging guidance, each additional facet joint

Medicare pricing data for 7,130 providers across 52 states

🤖AI Overview

This procedure has a 5.8x markup — hospitals charge $976.08 but Medicare allows only $166.88. Uninsured patients may face bills 5.8 times higher than what insurance negotiates. Prices vary significantly by location — from $73 in North Dakota to $350 in Hawaii. Where you get this procedure matters more than almost any other factor. 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

Destruction of upper or middle spinal facet joint nerves using imaging guidance, each additional facet joint (HCPCS code 64634) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $166.88, but hospitals typically charge $976.08 — a 5.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$33.38

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $166.88, your out-of-pocket cost would be approximately $33.38. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$166.88
Average Hospital Charge
$976.08
Markup Ratio
5.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$976.08
Medicare Allowed$166.88
Medicare Payment$132.96

Hospitals charge 5.8x more than what Medicare allows for this procedure. Medicare actually pays $132.96 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$350$567520+109.7%
Connecticut$259$1,17654323+55.2%
Alaska$248$2,4341690+48.8%
Virginia$242$8471401,832+45.2%
New York$229$1,0723642,308+37.1%
Oklahoma$225$689961,887+34.7%
Kentucky$225$734991,151+34.6%
North Carolina$212$8772201,897+27.3%
District of Columbia$209$9121066+25.2%
Arizona$199$7602243,621+19.3%
Alabama$197$62983863+17.9%
Utah$197$6841031,125+17.9%
Florida$195$1,1017449,624+16.6%
South Carolina$192$1,0171101,408+15.0%
Michigan$189$7652271,830+13.3%
Puerto Rico$185$205856+10.7%
New Hampshire$181$94137286+8.3%
Texas$179$1,0467137,844+7.4%
Massachusetts$177$977145960+6.1%
Nevada$165$2,14782734-1.3%
New Jersey$162$3,9682231,274-2.8%
Illinois$159$1,0722401,688-4.7%
Colorado$159$8521361,552-4.7%
Oregon$159$83783653-4.8%
Pennsylvania$154$7272811,942-7.6%
Nebraska$151$84144536-9.7%
New Mexico$150$77050609-10.2%
Delaware$148$98034277-11.2%
California$147$1,1495414,081-12.2%
Tennessee$144$7041451,658-13.7%
Arkansas$141$1,1701021,415-15.7%
Washington$139$662122905-17.0%
Vermont$138$1,34012114-17.5%
Maine$133$57021102-20.2%
Rhode Island$133$1,0051060-20.2%
Indiana$132$9981521,309-21.0%
Ohio$122$5002591,970-27.2%
Missouri$117$6641051,172-30.0%
Maryland$115$7081501,647-31.2%
West Virginia$108$27025346-35.3%
South Dakota$106$34820185-36.6%
Montana$105$51319102-37.2%
Georgia$104$8102583,027-37.4%
Iowa$104$68956420-37.8%
Minnesota$100$7901211,003-39.8%
Louisiana$99$9941271,938-40.5%
Mississippi$96$74056847-42.2%
Idaho$96$59735299-42.7%
Kansas$91$70568636-45.4%
Wisconsin$84$1,210127822-49.7%
Wyoming$75$1,036423-55.0%
North Dakota$73$7741595-56.0%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber