95861

Needle measurement of electrical activity in arm or leg muscles, 2 extremities

Medicare pricing data for 1,019 providers across 43 states

🤖AI Overview

This procedure has a 20.2x markup — hospitals charge $1,687 but Medicare allows only $83.57. Uninsured patients may face bills 20.2 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

Needle measurement of electrical activity in arm or leg muscles, 2 extremities (HCPCS code 95861) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $83.57, but hospitals typically charge $1,687 — a 20.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$16.71

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $83.57, your out-of-pocket cost would be approximately $16.71. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$83.57
Average Hospital Charge
$1,687
Markup Ratio
20.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,687.23
Medicare Allowed$83.57
Medicare Payment$66.14

Hospitals charge 20.2x more than what Medicare allows for this procedure. Medicare actually pays $66.14 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
West Virginia$120$463211+43.3%
Alaska$105$2,3445143+26.2%
Indiana$94$3131696+12.1%
Oregon$91$1,2851597+8.8%
New York$90$2,238813,261+8.1%
New Jersey$90$2,68431973+8.0%
Florida$90$1,964692,999+7.6%
California$88$1,3651377,056+4.7%
District of Columbia$87$8801235+4.0%
Illinois$85$1,08754716+2.0%
Massachusetts$85$1,2629410+2.0%
Arizona$85$1,539281,800+1.8%
South Carolina$85$1,12916128+1.3%
Washington$84$2,00621748+1.1%
Connecticut$83$1,4763667-0.3%
Texas$83$2,024968,077-0.7%
Michigan$82$97737705-1.9%
Hawaii$82$1,7211146-2.0%
Tennessee$82$819181,122-2.0%
Minnesota$81$1,08730506-2.9%
Colorado$81$1,962353,362-2.9%
Nevada$81$1,222131,599-3.4%
Maryland$80$1,24912834-3.9%
Pennsylvania$80$2,793501,605-3.9%
Virginia$80$2,41591,012-4.4%
Utah$80$3,1576820-4.8%
New Hampshire$79$739641-5.3%
Georgia$79$870251,644-5.6%
Missouri$78$284219-6.2%
North Carolina$78$1,411271,424-7.0%
Nebraska$77$314147-8.0%
New Mexico$77$1,721174-8.0%
Ohio$76$1,826221,499-8.8%
Louisiana$76$275161,966-8.9%
Wisconsin$76$1,5958800-8.9%
Maine$76$391216-9.3%
Kansas$76$1,3146542-9.4%
Arkansas$76$2,4673197-9.6%
Oklahoma$76$5127187-9.6%
Iowa$75$359727-9.7%
Idaho$75$197336-10.1%
Alabama$75$8,112312-10.7%
Mississippi$75$125125-10.9%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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