Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint
What Medicare pays for 64636, what providers bill, and how the price varies across 53 states, drawn from CMS 2023 claims data.
64636 · the short answer
For destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint, Medicare pays about $134.34 while providers bill $967.55 on average, a 7.2× markup, a higher-than-typical markup. State-level Medicare rates range 338% from lowest to highest.
- Medicare pays
- $134.34
- Providers bill
- $967.55
- Markup
- 7.2×
- Markup percentile
- 75th
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: Nervous System Surgery 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
7 Among the most affordable more affordable than 75% 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 |
|---|---|---|
| Guam | $260.06 | $388.87 |
| Alaska | $207.31 | $3,196.68 |
| Connecticut | $202.89 | $1,138.45 |
| Virginia | $202.70 | $876.48 |
| Hawaii | $187.84 | $428.79 |
| Kentucky | $184.20 | $747.30 |
| New York | $181.66 | $1,192.94 |
| Oklahoma | $173.04 | $635.22 |
| Utah | $165.93 | $585.61 |
| North Carolina | $165.88 | $893.80 |
| Arizona | $163.44 | $773.42 |
| Michigan | $160.49 | $780.26 |
| Florida | $160.43 | $1,064.60 |
| South Carolina | $153.23 | $861.59 |
| Alabama | $146.98 | $691.62 |
| Puerto Rico | $144.84 | $189.23 |
| Texas | $138.07 | $957.34 |
| New Jersey | $136.43 | $4,124.52 |
| Nevada | $135.61 | $2,149.80 |
| Massachusetts | $134.23 | $920.48 |
| District of Columbia | $132.91 | $978.18 |
| Illinois | $132.26 | $1,124.74 |
| Delaware | $131.99 | $1,076.92 |
| Colorado | $129.23 | $813.96 |
| New Mexico | $128.45 | $767.62 |
| Oregon | $126.01 | $854.68 |
| New Hampshire | $126.00 | $922.48 |
| Tennessee | $125.36 | $689.78 |
| California | $124.57 | $1,074.88 |
| Maine | $119.91 | $670.99 |
| Washington | $116.86 | $670.23 |
| Pennsylvania | $116.56 | $708.79 |
| Wyoming | $113.96 | $893.64 |
| Rhode Island | $107.39 | $946.26 |
| Arkansas | $104.34 | $1,187.19 |
| Indiana | $103.02 | $930.68 |
| Nebraska | $103.01 | $751.65 |
| Ohio | $99.38 | $540.04 |
| Iowa | $94.86 | $861.47 |
| Vermont | $93.66 | $1,207.58 |
| Maryland | $91.66 | $703.72 |
| Missouri | $89.01 | $645.35 |
| Georgia | $86.53 | $904.66 |
| Mississippi | $84.71 | $800.32 |
| Idaho | $82.77 | $724.94 |
| Louisiana | $81.26 | $955.17 |
| Minnesota | $81.10 | $822.18 |
| North Dakota | $74.02 | $790.99 |
| Kansas | $73.71 | $642.33 |
| Wisconsin | $72.77 | $1,258.16 |
| South Dakota | $71.54 | $357.10 |
| Montana | $69.76 | $531.49 |
| West Virginia | $59.36 | $257.69 |
What the Data Says About Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint
Across 53 states with reporting providers, CPT code 64636 (Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint) shows a national average Medicare payment of $134.34 against an average billed charge of $967.55. That gap, a 7.2x markup, or 620% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.
Nervous System Surgery procedures like this one saw 252.1K services billed to Medicare in 2023 by 9.9K distinct providers, serving 180.5K unique beneficiaries. State-level variation is significant: West Virginia reports the lowest average payment at $59.36, while Guam reports the highest at $260.06. A 338% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Nervous System Surgery category (2.24x), the estimated commercial insurance price lands near $377.61, with self-pay cash discounts commonly bringing the figure closer to $392.51. Within Nervous System Surgery, Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint ranks #350 of 441 tracked procedures by national average Medicare payment.
What to do with this
If you may have destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint 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 destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint 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 Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint cost?
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint (CPT 64636) shows unusually wide state-to-state pricing: Medicare pays $134.34 on average nationally, but the $59.36-$260.06 range across states spans more than double from cheapest to priciest.
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 Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint cost with insurance?
With commercial insurance, destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint costs an estimated $377.61 on average (range: $264.33-$528.65), a moderate premium over Medicare's $134.34. Without insurance, the estimated cash price is $392.51.
Which state has the lowest cost for Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint?
West Virginia has by far the lowest average Medicare payment for Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint at $59.36, while Guam pays more than double at $260.06 - a $200.70 gap.
How many providers perform Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint?
A moderate provider base performs Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint: 9.9K providers nationally, totaling 252.1K Medicare-billed services (180.5K beneficiaries) across 53 states in 2023.
What is the billed-to-Medicare markup for Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint?
Providers bill 7.2x what Medicare pays for Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Each Additional Facet Joint - a higher-than-typical markup at 620% 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.