22634

Fusion of additional segment of spine with partial removal of spine bone and disc

Medicare pricing data for 4,387 providers across 48 states

🤖AI Overview

This procedure has a 6.2x markup — hospitals charge $1,955 but Medicare allows only $314.50. Uninsured patients may face bills 6.2 times higher than what insurance negotiates. Prices vary significantly by location — from $213 in New Hampshire to $531 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

Fusion of additional segment of spine with partial removal of spine bone and disc (HCPCS code 22634) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $314.50, but hospitals typically charge $1,955 — a 6.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$62.90

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $314.50, your out-of-pocket cost would be approximately $62.90. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$314.50
Average Hospital Charge
$1,955
Markup Ratio
6.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,954.87
Medicare Allowed$314.50
Medicare Payment$251.13

Hospitals charge 6.2x more than what Medicare allows for this procedure. Medicare actually pays $251.13 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$531$1,56014144+68.8%
New York$378$3,479215638+20.2%
Massachusetts$364$2,19993489+15.7%
Illinois$351$3,632168999+11.8%
Pennsylvania$351$1,416134738+11.5%
Maryland$344$1,30684535+9.5%
Virginia$339$1,596123766+7.9%
Florida$339$2,3303451,714+7.9%
Michigan$338$2,173136691+7.6%
California$335$1,5863051,894+6.5%
Iowa$332$1,43227104+5.7%
Rhode Island$323$2,3181545+2.7%
Alaska$322$3,98921160+2.5%
Georgia$316$1,979120579+0.5%
Texas$316$1,8572961,528+0.5%
Ohio$315$1,215166787+0.2%
Kentucky$314$1,49555194-0.2%
West Virginia$314$9991676-0.3%
Mississippi$313$3,10929173-0.4%
Connecticut$308$2,85971170-1.9%
New Jersey$308$8,175104309-2.1%
Utah$306$1,21244188-2.7%
Tennessee$304$1,34599468-3.4%
Washington$298$1,203121733-5.2%
Louisiana$298$1,85893637-5.2%
Colorado$296$1,3121591,227-5.8%
Arizona$294$1,616150827-6.6%
Arkansas$293$1,33236172-6.8%
New Mexico$292$2,8541871-7.0%
Missouri$288$2,133104383-8.6%
Nevada$287$2,56959189-8.9%
Montana$286$1,27923142-9.0%
Oregon$286$1,57739124-9.0%
Wyoming$284$1,0791160-9.7%
Oklahoma$284$1,31566452-9.8%
Kansas$283$1,36652279-10.1%
South Carolina$281$1,28680323-10.6%
Minnesota$279$1,58893385-11.3%
North Carolina$278$1,524169716-11.5%
Wisconsin$274$4,55763304-13.0%
Nebraska$270$1,15453368-14.2%
Indiana$263$1,621118720-16.3%
Delaware$257$1,9501141-18.4%
North Dakota$254$90715224-19.2%
Alabama$245$1,37454249-22.1%
South Dakota$233$1,11822125-26.0%
Idaho$223$2,18338112-29.1%
New Hampshire$213$1,9252179-32.4%

⚠️ 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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