22216

Incision or removal of spine bone segment, each additional segment

Medicare pricing data for 2,024 providers across 42 states

🤖AI Overview

This procedure has a 6.1x markup — hospitals charge $1,509 but Medicare allows only $248.09. Uninsured patients may face bills 6.1 times higher than what insurance negotiates. Prices vary significantly by location — from $84 in New Hampshire to $391 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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

Incision or removal of spine bone segment, each additional segment (HCPCS code 22216) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $248.09, but hospitals typically charge $1,509 — a 6.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$49.62

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $248.09, your out-of-pocket cost would be approximately $49.62. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$248.09
Average Hospital Charge
$1,509
Markup Ratio
6.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,509.31
Medicare Allowed$248.09
Medicare Payment$198.02

Hospitals charge 6.1x more than what Medicare allows for this procedure. Medicare actually pays $198.02 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$391$1,132987+57.6%
Illinois$317$2,94572700+27.7%
Maryland$300$1,27553541+21.1%
Kentucky$299$1,0112067+20.5%
Pennsylvania$293$1,63166358+18.0%
Florida$291$1,9051581,106+17.1%
New York$287$3,5191191,006+15.8%
New Mexico$273$1,080977+9.9%
Louisiana$267$1,63734209+7.8%
Michigan$266$1,17745338+7.4%
Massachusetts$266$1,60447533+7.0%
Missouri$257$1,39937276+3.5%
Arizona$249$1,26176887+0.4%
North Carolina$248$1,023585270.0%
Ohio$248$1,24977588-0.2%
Minnesota$245$1,71935340-1.1%
Wisconsin$244$4,91918130-1.5%
Alaska$243$3,33618103-1.9%
Rhode Island$242$3,6581182-2.4%
Washington$242$86558275-2.4%
Utah$242$9881151-2.6%
Tennessee$242$98447498-2.6%
Iowa$241$1,3591039-2.7%
Connecticut$241$1,53528120-3.0%
California$240$1,1852514,349-3.2%
Texas$233$1,2651631,718-6.0%
South Carolina$233$1,32319101-6.1%
Virginia$225$1,25653478-9.2%
Colorado$222$1,19984811-10.6%
New Jersey$213$3,0972993-14.3%
Alabama$205$90726169-17.4%
Oregon$205$88622129-17.5%
Arkansas$199$1,0401346-19.8%
Idaho$195$1,57222123-21.4%
Georgia$195$80845327-21.4%
Nebraska$189$1,03722146-23.7%
Indiana$185$1,22649295-25.6%
Oklahoma$182$75740266-26.8%
Kansas$180$1,3051874-27.3%
Delaware$126$1,436836-49.1%
Nevada$110$7741367-55.5%
New Hampshire$84$1,057318-66.0%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber