22633

Fusion of spine in lower back with partial removal of spine bone and disc

Medicare pricing data for 7,355 providers across 52 states

🤖AI Overview

This procedure has a 6.1x markup — hospitals charge $7,107 but Medicare allows only $1,161. Uninsured patients may face bills 6.1 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 in lower back with partial removal of spine bone and disc (HCPCS code 22633) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,161, but hospitals typically charge $7,107 — a 6.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$232.16

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,161, your out-of-pocket cost would be approximately $232.16. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,161
Average Hospital Charge
$7,107
Markup Ratio
6.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$7,107.24
Medicare Allowed$1,160.79
Medicare Payment$924.89

Hospitals charge 6.1x more than what Medicare allows for this procedure. Medicare actually pays $924.89 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$1,713$5,36723156+47.6%
Puerto Rico$1,586$3,461514+36.6%
New York$1,388$13,0273832,070+19.6%
Hawaii$1,361$3,9981046+17.2%
Massachusetts$1,358$8,0181671,375+17.0%
Pennsylvania$1,348$5,7552611,946+16.2%
Maryland$1,341$5,2261421,409+15.5%
Vermont$1,318$6,531725+13.5%
Illinois$1,292$11,4382452,225+11.3%
California$1,262$6,3985223,670+8.7%
Michigan$1,257$8,3752251,609+8.3%
Rhode Island$1,226$12,26428202+5.6%
Florida$1,208$7,8685764,561+4.1%
Virginia$1,203$6,2391871,820+3.7%
Kentucky$1,194$5,54196571+2.9%
Ohio$1,182$4,8042751,995+1.8%
Alaska$1,176$11,79928280+1.3%
Connecticut$1,167$8,742143595+0.6%
New Jersey$1,160$19,518198960-0.1%
Maine$1,160$3,86234106-0.1%
Texas$1,154$6,0455294,004-0.6%
Utah$1,151$4,40482688-0.8%
West Virginia$1,149$4,10731191-1.0%
Georgia$1,146$7,6042151,533-1.2%
Iowa$1,121$5,49462354-3.4%
Arkansas$1,109$4,13865647-4.5%
Arizona$1,107$5,9932092,148-4.6%
Louisiana$1,101$6,6401311,046-5.1%
Tennessee$1,098$5,0661661,253-5.4%
South Carolina$1,091$5,1811351,287-6.0%
New Mexico$1,089$8,62526165-6.2%
Missouri$1,086$6,6711681,304-6.4%
Colorado$1,086$5,1292032,259-6.5%
Minnesota$1,081$7,1021511,143-6.9%
Kansas$1,067$4,75276738-8.1%
Oklahoma$1,066$5,1151011,097-8.2%
Nevada$1,062$11,01977626-8.5%
North Carolina$1,061$5,5822671,886-8.6%
Mississippi$1,053$7,30643595-9.3%
Montana$1,049$4,82038226-9.6%
Washington$1,043$4,6022111,621-10.1%
Wyoming$1,033$4,78618125-11.1%
Oregon$1,023$5,69586631-11.9%
North Dakota$1,020$3,95021412-12.1%
Indiana$1,011$7,8571751,772-12.9%
Wisconsin$1,009$16,390114650-13.1%
Nebraska$983$4,74371807-15.3%
Delaware$976$7,90022108-16.0%
South Dakota$933$4,76041434-19.7%
New Hampshire$916$6,52246220-21.1%
Alabama$915$4,327108775-21.2%
Idaho$884$11,50256418-23.9%

⚠️ 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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