Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only
What Medicare pays for 0642T, what providers bill, and how the price varies across 2 states, drawn from CMS 2023 claims data.
0642T · the short answer
For noncontact near-infrared spectroscopy study of flap or wound, interpretation and report only, Medicare pays about $9.79 while providers bill $180.14 on average, a 18.4× markup, one of the steepest markups in the catalog. State-level Medicare rates range 27% from lowest to highest.
- Medicare pays
- $9.79
- Providers bill
- $180.14
- Markup
- 18.4×
- Markup percentile
- 99th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Other procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
18 Among the most affordable more affordable than 99% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| New Jersey | $11.56 | $224.24 |
| Missouri | $9.10 | $176.90 |
What the Data Says About Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only
Across 2 states with reporting providers, CPT code 0642T (Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only) shows a national average Medicare payment of $9.79 against an average billed charge of $180.14. That gap, a 18.4x markup, or 1740% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.
Other procedures like this one saw 422 services billed to Medicare in 2023 by 9 distinct providers, serving 228 unique beneficiaries. State-level variation is significant: Missouri reports the lowest average payment at $9.10, while New Jersey reports the highest at $11.56. The 27% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Other category (2.24x), the estimated commercial insurance price lands near $27.86, with self-pay cash discounts commonly bringing the figure closer to $58.87. Within Other, Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only ranks #137 of 151 tracked procedures by national average Medicare payment.
What to do with this
If you may have noncontact near-infrared spectroscopy study of flap or wound, interpretation and report only done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare noncontact near-infrared spectroscopy study of flap or wound, interpretation and report only costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only cost?
Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only (CPT 0642T) is priced fairly consistently nationwide: Medicare pays $9.79 on average, and the $9.10-$11.56 state range stays relatively tight. Providers typically bill $180.14.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only cost with insurance?
With commercial insurance, noncontact near-infrared spectroscopy study of flap or wound, interpretation and report only costs an estimated $27.86 on average (range: $19.50-$39.00), a moderate premium over Medicare's $9.79. Without insurance, the estimated cash price is $58.87.
Which state has the lowest cost for Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only?
Missouri and New Jersey bookend the range for Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only, at $9.10 and $11.56 respectively - a relatively tight $2.46 spread nationwide.
How many providers perform Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only?
Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only is comparatively uncommon: only 9 providers nationally billed Medicare for it in 2023, serving 228 beneficiaries via 422 total services.
What is the billed-to-Medicare markup for Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only?
Providers bill 18.4x what Medicare pays for Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Interpretation And Report Only - one of the steepest markups in the catalog at 1740% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.