Repair Of Nerve With Graft

Medicare Payment (avg)
$587.32
What Medicare actually pays
Billed Charge (avg)
$4,736.06
What providers submit
Markup
8.1x
706% above Medicare rate
1.3K
Total Services
771
Beneficiaries
671
Providers
21
States with Data

Price Range Across States

Lowest State Avg
$325.44
New Jersey
Highest State Avg
$1,193.00
Virginia

What You Might Pay

Est. Commercial Insurance
$1,655.02
Range: $1,158.51 – $2,317.03
Est. Cash / Self-Pay
$1,856.55
Typical self-pay discount

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.

Prices by State

State Medicare Payment Billed Charge
Virginia $1,193.00 $5,420.58
Illinois $881.91 $4,331.64
Kentucky $783.84 $2,729.23
Minnesota $753.24 $4,006.44
Florida $744.36 $4,301.79
California $739.77 $4,337.01
Pennsylvania $717.81 $3,166.05
Nebraska $661.36 $1,966.69
Indiana $660.46 $4,901.88
Georgia $647.68 $3,953.23
Arizona $625.72 $3,671.33
Michigan $613.62 $3,038.42
North Carolina $576.17 $2,543.48
New York $570.70 $6,192.54
Arkansas $538.46 $2,311.06
Ohio $537.69 $2,964.98
South Carolina $490.42 $2,209.90
Connecticut $451.50 $8,617.55
Massachusetts $437.68 $2,764.80
Texas $431.06 $4,190.17
New Jersey $325.44 $8,368.33

What the Data Says About Repair Of Nerve With Graft

Across 21 states with reporting providers, CPT code 64910 (Repair Of Nerve With Graft) shows a national average Medicare payment of $587.32 against an average billed charge of $4,736.06. That gap — a 8.1x markup, or 706% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Nervous System Surgery procedures like this one saw 1.3K services billed to Medicare in 2023 by 671 distinct providers, serving 771 unique beneficiaries. State-level variation is significant: New Jersey reports the lowest average payment at $325.44, while Virginia reports the highest at $1,193.00. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Nervous System Surgery category (2.24x), the estimated commercial insurance price lands near $1,655.02, with self-pay cash discounts commonly bringing the figure closer to $1,856.55. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Repair Of Nerve With Graft cost?

The national average Medicare payment for Repair Of Nerve With Graft (CPT 64910) is $587.32, while providers typically bill $4,736.06. Prices vary significantly by state, ranging from $325.44 to $1,193.00.

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 Repair Of Nerve With Graft cost with insurance?

With commercial insurance, Repair Of Nerve With Graft costs an estimated $1,655.02 on average (range: $1,158.51 – $2,317.03). Without insurance, the estimated cash price is $1,856.55. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Repair Of Nerve With Graft?

New Jersey has the lowest average Medicare payment for Repair Of Nerve With Graft at $325.44, while Virginia has the highest at $1,193.00. This $867.57 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Repair Of Nerve With Graft?

Nationally, 671 providers billed Medicare for Repair Of Nerve With Graft in 2023, performing 1.3K total services for 771 beneficiaries across 21 states and territories.

What is the billed-to-Medicare markup for Repair Of Nerve With Graft?

Providers bill 8.1x what Medicare pays for Repair Of Nerve With Graft — a 706% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial