95971

Electronic analysis of implanted neurostimulator generator with simple spinal cord or peripheral nerve stimulator programming

Medicare pricing data for 2,867 providers across 45 states

🤖AI Overview

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 neurostimulator generator with simple spinal cord or peripheral nerve stimulator programming (HCPCS code 95971) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $44.01, but hospitals typically charge $175.41 — a 4.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$8.80

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $44.01, your out-of-pocket cost would be approximately $8.80. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$44.01
Average Hospital Charge
$175.41
Markup Ratio
4.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$175.41
Medicare Allowed$44.01
Medicare Payment$33.32

Hospitals charge 4.0x more than what Medicare allows for this procedure. Medicare actually pays $33.32 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$56$736418+27.9%
District of Columbia$51$169630+15.2%
California$50$1922032,174+13.8%
New York$50$280140634+13.4%
Arizona$48$156511,108+10.0%
New Jersey$48$37379394+9.9%
Massachusetts$47$15452187+5.7%
Connecticut$47$17439131+5.7%
Virginia$46$14660236+4.2%
Florida$46$1942731,843+4.2%
Oregon$46$18618117+3.8%
South Dakota$44$160829+1.0%
Washington$44$13858327+1.0%
South Carolina$44$15338380-0.7%
Illinois$44$246100411-1.1%
Texas$43$151192985-1.3%
Colorado$43$15747113-1.8%
Pennsylvania$43$125104583-2.0%
New Hampshire$43$143930-2.1%
Maryland$43$16754227-2.8%
North Carolina$43$16878410-2.9%
Indiana$43$18552681-3.2%
Minnesota$42$17772468-3.8%
Nevada$42$4111381-4.4%
Mississippi$42$11928329-4.6%
Iowa$42$17030150-4.7%
Georgia$42$185105921-4.8%
Michigan$42$157123468-5.2%
Oklahoma$42$10961500-5.7%
Louisiana$41$15635144-6.9%
Utah$41$1322557-7.1%
Tennessee$41$127100622-7.2%
Ohio$41$152193898-7.2%
Alabama$41$9045273-7.3%
Kansas$41$16837154-7.6%
Idaho$41$115716-7.8%
Missouri$40$13761506-10.2%
Kentucky$39$12950483-11.9%
Nebraska$38$13026100-13.0%
Montana$38$100917-13.9%
Hawaii$38$121215-14.3%
Arkansas$37$11837248-16.1%
Delaware$35$11714102-20.6%
Wisconsin$35$33954270-20.8%
West Virginia$33$14316125-23.9%

⚠️ 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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