64493

Injection of lower or sacral spine facet joint using imaging guidance, single level

Medicare pricing data for 14,411 providers across 52 states

🤖AI Overview

This procedure has a 7.7x markup — hospitals charge $1,776 but Medicare allows only $231.71. Uninsured patients may face bills 7.7 times higher than what insurance negotiates. Prices vary significantly by location — from $142 in West Virginia to $296 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

Injection of lower or sacral spine facet joint using imaging guidance, single level (HCPCS code 64493) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $231.71, but hospitals typically charge $1,776 — a 7.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$46.34

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $231.71, your out-of-pocket cost would be approximately $46.34. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$231.71
Average Hospital Charge
$1,776
Markup Ratio
7.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,776.11
Medicare Allowed$231.71
Medicare Payment$180.94

Hospitals charge 7.7x more than what Medicare allows for this procedure. Medicare actually pays $180.94 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$296$3,75938996+27.7%
California$281$2,6181,37160,114+21.3%
Nevada$267$3,1071566,782+15.2%
New Jersey$264$5,39357017,718+13.9%
Maryland$259$1,73135824,046+11.9%
Oregon$259$1,1791677,580+11.7%
Connecticut$255$1,5371664,746+10.0%
Delaware$249$1,817603,945+7.5%
New York$248$1,83482726,833+6.8%
Wyoming$247$2,044351,349+6.5%
Arizona$243$1,57635622,605+4.7%
Georgia$242$1,98254229,522+4.3%
Florida$238$1,6021,35069,231+2.6%
Colorado$237$1,72725911,514+2.1%
Washington$234$1,0522659,402+1.2%
Minnesota$227$1,5902557,581-1.9%
Texas$227$1,9401,28447,792-2.1%
Hawaii$226$54629295-2.3%
Indiana$226$1,96432312,961-2.5%
Tennessee$224$1,47027816,310-3.4%
South Carolina$223$1,14219517,497-3.9%
New Mexico$222$2,597773,635-4.0%
Virginia$221$1,12823514,537-4.4%
Rhode Island$220$1,387401,441-5.0%
Illinois$218$1,77146117,658-6.0%
New Hampshire$218$1,613753,500-6.1%
Pennsylvania$216$1,39759722,686-6.8%
Arkansas$216$1,13116210,863-7.0%
Utah$215$8231555,014-7.1%
Louisiana$214$2,05623211,636-7.4%
Mississippi$214$1,28411411,009-7.5%
Michigan$211$1,21544510,478-9.1%
Montana$209$897532,379-9.6%
Kentucky$209$1,2541728,239-9.7%
Idaho$208$1,007842,859-10.3%
Nebraska$207$1,129893,452-10.7%
North Carolina$203$1,15840414,537-12.2%
Kansas$202$1,6921405,637-12.8%
Alabama$200$1,0061829,565-13.6%
Massachusetts$199$1,29732913,528-14.1%
Oklahoma$199$8331587,885-14.3%
Wisconsin$197$2,7152678,323-14.9%
Ohio$197$1,06949318,520-15.0%
District of Columbia$197$86529600-15.1%
Iowa$197$1,5371103,634-15.1%
North Dakota$186$86328838-19.9%
Missouri$175$1,3292198,037-24.5%
Puerto Rico$169$18126337-27.3%
Maine$160$574381,236-30.8%
South Dakota$153$621371,240-33.8%
Vermont$150$1,16817570-35.1%
West Virginia$142$556482,414-38.5%

⚠️ 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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