64636

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint

Medicare pricing data for 9,867 providers across 52 states

🤖AI Overview

This procedure has a 5.7x markup — hospitals charge $967.55 but Medicare allows only $168.58. Uninsured patients may face bills 5.7 times higher than what insurance negotiates. Prices vary significantly by location — from $75 in West Virginia to $261 in Alaska. 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 lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint (HCPCS code 64636) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $168.58, but hospitals typically charge $967.55 — a 5.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$33.72

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $168.58, your out-of-pocket cost would be approximately $33.72. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$168.58
Average Hospital Charge
$967.55
Markup Ratio
5.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$967.55
Medicare Allowed$168.58
Medicare Payment$134.34

Hospitals charge 5.7x more than what Medicare allows for this procedure. Medicare actually pays $134.34 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$261$3,19723249+54.5%
Connecticut$255$1,138911,370+51.1%
Virginia$254$8761797,703+50.6%
Hawaii$235$4291482+39.6%
Kentucky$231$7471304,617+37.1%
New York$228$1,1935859,524+35.2%
Oklahoma$217$6351316,006+28.8%
Utah$208$5861263,741+23.5%
North Carolina$208$8943148,604+23.3%
Arizona$206$77326710,643+21.9%
Michigan$201$7803366,214+19.4%
Florida$201$1,06593130,070+19.3%
South Carolina$193$8621486,318+14.3%
Alabama$184$6921233,927+9.4%
Puerto Rico$182$18916214+7.8%
Texas$173$95792823,623+2.7%
New Jersey$171$4,1253525,091+1.5%
Nevada$170$2,1501022,181+0.8%
Massachusetts$168$9202354,666-0.1%
District of Columbia$167$97820254-1.2%
Illinois$166$1,1253427,351-1.5%
Delaware$165$1,077461,279-1.9%
Colorado$162$8141713,862-3.9%
New Mexico$161$768621,896-4.3%
New Hampshire$158$922551,359-6.3%
Oregon$158$8551012,038-6.4%
Tennessee$157$6901886,183-6.8%
California$156$1,07579614,592-7.3%
Maine$150$67131616-11.0%
Washington$147$6701682,801-13.0%
Pennsylvania$147$7094148,416-13.1%
Wyoming$143$89412164-15.3%
Rhode Island$135$94621264-20.1%
Arkansas$131$1,1871185,530-22.4%
Indiana$129$9312154,983-23.3%
Nebraska$129$752682,121-23.4%
Ohio$125$5403867,727-25.9%
Iowa$119$861902,157-29.2%
Vermont$118$1,20814335-29.9%
Maryland$115$7042116,973-31.7%
Missouri$112$6451564,187-33.7%
Georgia$109$9053369,690-35.5%
Mississippi$106$800783,541-36.9%
Idaho$104$725501,106-38.4%
Louisiana$102$9551686,033-39.4%
Minnesota$102$8221442,830-39.7%
North Dakota$93$79118407-44.9%
Kansas$93$642892,245-45.0%
Wisconsin$91$1,2581733,304-45.8%
South Dakota$90$35727663-46.8%
Montana$88$53130568-47.9%
West Virginia$75$258361,714-55.3%

⚠️ 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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