95970

Electronic analysis of implanted brain, spinal cord, or peripheral neurostimulator generator

Medicare pricing data for 4,377 providers across 50 states

🤖AI Overview

This procedure has a 8.7x markup — hospitals charge $155.10 but Medicare allows only $17.74. Uninsured patients may face bills 8.7 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

Electronic analysis of implanted brain, spinal cord, or peripheral neurostimulator generator (HCPCS code 95970) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $17.74, but hospitals typically charge $155.10 — a 8.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $17.74, your out-of-pocket cost would be approximately $3.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$17.74
Average Hospital Charge
$155.10
Markup Ratio
8.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$155.10
Medicare Allowed$17.74
Medicare Payment$12.81

Hospitals charge 8.7x more than what Medicare allows for this procedure. Medicare actually pays $12.81 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$22$7092255+24.1%
District of Columbia$21$1541362+16.0%
New York$20$2112111,611+10.2%
New Jersey$19$17758403+9.2%
Maryland$19$21262441+9.1%
California$19$2163382,437+8.1%
Massachusetts$19$17884505+6.0%
Rhode Island$19$100111+5.6%
Florida$19$1092422,061+5.4%
Connecticut$19$21152239+5.1%
Washington$18$116120929+4.0%
Illinois$18$200152913+3.8%
Virginia$18$145102737+2.8%
Nevada$18$13424108+1.4%
Wyoming$18$172728+1.1%
Texas$18$1612742,020+0.5%
Delaware$18$9221131+0.1%
Pennsylvania$18$1311801,083+0.1%
Michigan$18$115182818-0.1%
Vermont$18$31869-0.1%
Colorado$18$185139720-0.4%
Montana$18$7024134-0.5%
New Hampshire$18$14321107-0.8%
Oregon$18$11859328-1.0%
Arizona$17$110921,004-1.4%
Georgia$17$126102454-2.4%
New Mexico$17$1312199-2.5%
West Virginia$17$8832185-2.7%
North Carolina$17$163151973-2.9%
Louisiana$17$18659308-3.2%
South Carolina$17$13871329-3.4%
Minnesota$17$183120604-3.6%
Mississippi$17$11339335-4.6%
Indiana$17$132132882-4.8%
Missouri$17$139127951-5.5%
Ohio$17$1392211,483-5.7%
Maine$17$3620159-6.0%
Kansas$17$13864580-6.1%
Idaho$17$13027176-6.4%
Alabama$17$14057457-6.5%
Kentucky$16$136116741-7.1%
Nebraska$16$12167393-7.3%
Iowa$16$18860446-7.6%
Tennessee$16$143119731-7.7%
North Dakota$16$6120139-7.8%
Utah$16$14343274-8.2%
Wisconsin$16$36286458-8.5%
South Dakota$16$5940286-9.2%
Oklahoma$16$9940329-10.1%
Arkansas$16$12434227-11.1%

⚠️ 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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