22585

Fusion of spine bones through front of body with partial removal of disc, each additional disc

Medicare pricing data for 4,955 providers across 50 states

🤖AI Overview

This procedure has a 8.0x markup — hospitals charge $1,644 but Medicare allows only $205.93. Uninsured patients may face bills 8.0 times higher than what insurance negotiates. 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

Fusion of spine bones through front of body with partial removal of disc, each additional disc (HCPCS code 22585) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $205.93, but hospitals typically charge $1,644 — a 8.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$41.19

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $205.93, your out-of-pocket cost would be approximately $41.19. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$205.93
Average Hospital Charge
$1,644
Markup Ratio
8.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,644.34
Medicare Allowed$205.93
Medicare Payment$164.38

Hospitals charge 8.0x more than what Medicare allows for this procedure. Medicare actually pays $164.38 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$274$618735+33.0%
District of Columbia$260$73818105+26.2%
Massachusetts$255$2,42389350+23.8%
Wyoming$251$1,6211056+21.9%
New York$246$2,739192846+19.4%
Rhode Island$241$1,8332573+17.3%
Pennsylvania$238$1,905154599+15.6%
Michigan$236$1,593154474+14.6%
North Dakota$228$1,058918+10.9%
Maryland$227$91099622+10.2%
New Hampshire$227$1,8301750+10.1%
Illinois$226$2,204147522+9.9%
West Virginia$225$1,5931357+9.0%
New Mexico$222$4,64114125+7.7%
California$219$1,8444813,501+6.1%
Florida$218$1,7913962,545+6.0%
Alaska$211$2,1302074+2.7%
Georgia$210$1,374178895+2.1%
New Jersey$209$5,713116407+1.6%
Virginia$208$1,049132824+1.0%
Ohio$208$1,190174994+0.8%
Texas$206$2,0184052,484+0.2%
Connecticut$200$1,93673188-2.7%
Oregon$200$87470278-2.9%
Montana$200$1,12929142-3.0%
Washington$200$712129546-3.1%
Kentucky$199$98563464-3.2%
Missouri$197$1,504120549-4.4%
Arizona$197$1,047122897-4.5%
Iowa$196$1,19732110-5.0%
Hawaii$195$612935-5.1%
Oklahoma$195$74269608-5.4%
North Carolina$192$1,1481781,156-6.6%
Tennessee$191$1,079115594-7.1%
Nevada$189$4,99959333-8.1%
Mississippi$189$1,5683280-8.2%
South Carolina$189$1,02197565-8.2%
Colorado$189$1,1831331,123-8.4%
Louisiana$188$1,598103643-8.9%
Wisconsin$187$3,58072225-9.1%
Indiana$182$1,27598401-11.4%
Utah$182$81844203-11.5%
Kansas$182$88951334-11.6%
Minnesota$181$1,327113627-12.3%
Idaho$173$86750301-16.2%
South Dakota$172$8542297-16.3%
Arkansas$171$93829111-17.1%
Nebraska$162$2,01538203-21.3%
Alabama$152$99699616-26.3%
Delaware$150$2,0921998-27.4%

⚠️ 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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