Exploration of spine fusion
Medicare pricing data for 2,777 providers across 45 states
This procedure has a 12.3x markup — hospitals charge $3,802 but Medicare allows only $310.38. Uninsured patients may face bills 12.3 times higher than what insurance negotiates. Prices vary significantly by location — from $191 in South Dakota to $484 in District of Columbia. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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
Exploration of spine fusion (HCPCS code 22830) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $310.38, but hospitals typically charge $3,802 — a 12.3x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $310.38, your out-of-pocket cost would be approximately $62.08. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 12.3x more than what Medicare allows for this procedure. Medicare actually pays $247.57 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $484 | $2,970 | 12 | 100 | +56.1% |
| New York | $389 | $6,281 | 162 | 391 | +25.4% |
| New Hampshire | $383 | $11,633 | 11 | 23 | +23.3% |
| Tennessee | $376 | $2,818 | 46 | 178 | +21.3% |
| Michigan | $375 | $3,293 | 68 | 225 | +20.8% |
| Massachusetts | $353 | $3,839 | 62 | 153 | +13.7% |
| Maryland | $353 | $2,854 | 74 | 368 | +13.7% |
| New Mexico | $351 | $3,409 | 6 | 25 | +13.2% |
| Alaska | $348 | $8,323 | 7 | 18 | +12.2% |
| South Carolina | $343 | $2,380 | 49 | 104 | +10.4% |
| Mississippi | $337 | $3,498 | 16 | 48 | +8.6% |
| New Jersey | $336 | $15,596 | 75 | 174 | +8.3% |
| Illinois | $328 | $7,374 | 87 | 284 | +5.6% |
| North Carolina | $323 | $2,362 | 74 | 212 | +3.9% |
| Virginia | $321 | $3,332 | 57 | 114 | +3.6% |
| Kentucky | $321 | $2,143 | 24 | 48 | +3.4% |
| Florida | $319 | $4,252 | 235 | 873 | +2.7% |
| Texas | $314 | $3,180 | 272 | 987 | +1.3% |
| Pennsylvania | $313 | $2,781 | 88 | 277 | +1.0% |
| California | $308 | $2,861 | 281 | 1,385 | -0.6% |
| Georgia | $301 | $3,804 | 81 | 224 | -2.9% |
| Oregon | $301 | $2,461 | 15 | 26 | -3.1% |
| Ohio | $298 | $2,209 | 103 | 287 | -4.0% |
| Rhode Island | $297 | $6,722 | 10 | 17 | -4.4% |
| Kansas | $296 | $2,091 | 20 | 49 | -4.6% |
| Iowa | $295 | $2,892 | 11 | 15 | -4.9% |
| Minnesota | $293 | $3,673 | 35 | 64 | -5.5% |
| Washington | $287 | $2,268 | 59 | 141 | -7.6% |
| Connecticut | $285 | $4,806 | 50 | 134 | -8.2% |
| Utah | $282 | $1,714 | 27 | 58 | -9.2% |
| Missouri | $280 | $2,809 | 62 | 229 | -9.6% |
| Arizona | $277 | $3,306 | 69 | 208 | -10.6% |
| Louisiana | $276 | $6,081 | 80 | 337 | -11.1% |
| Arkansas | $270 | $2,121 | 33 | 132 | -13.1% |
| Nevada | $268 | $6,653 | 46 | 180 | -13.7% |
| Wisconsin | $268 | $8,267 | 14 | 31 | -13.8% |
| Colorado | $262 | $2,276 | 80 | 296 | -15.5% |
| Oklahoma | $259 | $1,522 | 39 | 153 | -16.5% |
| Idaho | $259 | $2,278 | 28 | 104 | -16.6% |
| Indiana | $255 | $6,782 | 49 | 129 | -17.8% |
| Delaware | $254 | $3,281 | 32 | 140 | -18.2% |
| Montana | $253 | $3,118 | 12 | 28 | -18.5% |
| Alabama | $228 | $1,902 | 49 | 165 | -26.4% |
| Nebraska | $224 | $1,754 | 31 | 122 | -27.7% |
| South Dakota | $191 | $1,435 | 14 | 22 | -38.6% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber