20985

Computer-assisted surgery for muscle and bone procedure

Medicare pricing data for 3,274 providers across 51 states

🤖AI Overview

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

Computer-assisted surgery for muscle and bone procedure (HCPCS code 20985) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $136.06, but hospitals typically charge $679.23 — a 5.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$27.21

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $136.06, your out-of-pocket cost would be approximately $27.21. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$136.06
Average Hospital Charge
$679.23
Markup Ratio
5.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$679.23
Medicare Allowed$136.06
Medicare Payment$108.52

Hospitals charge 5.0x more than what Medicare allows for this procedure. Medicare actually pays $108.52 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$171$1,4102006,720+25.3%
District of Columbia$164$3898163+20.4%
Maryland$154$416531,197+13.5%
New Jersey$152$1,271883,209+11.5%
Illinois$151$8811303,339+10.8%
Connecticut$151$590681,379+10.8%
Rhode Island$148$50613532+8.7%
Massachusetts$147$905591,673+7.8%
Virginia$147$564791,959+7.7%
Florida$146$6462554,604+7.1%
Delaware$145$2963202+6.4%
Pennsylvania$144$663731,438+5.9%
New Hampshire$144$45524746+5.7%
Georgia$140$631651,160+2.8%
Ohio$139$411911,240+2.0%
Louisiana$139$60252813+2.0%
Michigan$137$428971,607+0.5%
Texas$137$6552414,342+0.4%
South Carolina$136$400581,977+0.2%
Vermont$135$91510303-0.6%
Missouri$135$47732494-0.7%
Oklahoma$135$460482,264-0.8%
Kentucky$134$368521,245-1.7%
Alabama$134$36442779-1.7%
Hawaii$134$4199282-1.8%
Maine$133$323659-2.6%
South Dakota$133$5183140-2.6%
West Virginia$132$41419293-2.9%
Colorado$132$567912,566-3.1%
New Mexico$132$44915317-3.2%
Mississippi$132$1,235371,864-3.3%
Wisconsin$130$811521,043-4.6%
Idaho$129$453541,418-5.4%
Minnesota$127$984701,008-6.7%
California$126$5563269,205-7.6%
Washington$125$37438829-8.3%
Tennessee$124$45151887-8.6%
Iowa$124$41329810-8.6%
North Dakota$123$3994108-9.9%
Nebraska$122$44115510-10.4%
Alaska$122$58019581-10.7%
Arkansas$121$35324533-11.2%
Oregon$120$378511,071-11.5%
Wyoming$119$9251673-12.3%
North Carolina$118$529991,706-13.3%
Arizona$114$3941243,098-16.1%
Indiana$113$697931,889-17.1%
Kansas$110$362561,609-19.1%
Montana$109$87314536-19.8%
Utah$102$39032513-25.3%
Nevada$97$412441,519-29.0%

⚠️ 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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