61312

Removal of skull bone for aspiration of blood accumulation in upper brain outside or below brain membrane

Medicare pricing data for 3,746 providers across 50 states

🤖AI Overview

This procedure has a 5.1x markup — hospitals charge $8,066 but Medicare allows only $1,570. Uninsured patients may face bills 5.1 times higher than what insurance negotiates. Prices vary significantly by location — from $1,001 in Delaware to $2,125 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

Removal of skull bone for aspiration of blood accumulation in upper brain outside or below brain membrane (HCPCS code 61312) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,570, but hospitals typically charge $8,066 — a 5.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$313.91

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,570, your out-of-pocket cost would be approximately $313.91. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,570
Average Hospital Charge
$8,066
Markup Ratio
5.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$8,065.72
Medicare Allowed$1,569.53
Medicare Payment$1,251.41

Hospitals charge 5.1x more than what Medicare allows for this procedure. Medicare actually pays $1,251 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$2,125$6,3651026+35.4%
Virginia$1,928$6,13075259+22.8%
Rhode Island$1,906$7,8231637+21.4%
Maryland$1,826$6,23572216+16.4%
Illinois$1,798$9,592131383+14.6%
New York$1,772$12,975218544+12.9%
New Mexico$1,769$5,2441764+12.7%
Massachusetts$1,764$9,57586254+12.4%
Mississippi$1,755$5,5162266+11.8%
West Virginia$1,683$5,4141424+7.3%
Michigan$1,676$10,094124294+6.8%
New Jersey$1,675$26,79088206+6.7%
California$1,674$8,4643281,070+6.7%
Pennsylvania$1,668$7,211166387+6.2%
Vermont$1,657$10,013627+5.6%
New Hampshire$1,638$11,6152265+4.4%
Louisiana$1,619$6,32575195+3.1%
Florida$1,607$9,305323883+2.4%
Indiana$1,600$5,83654106+2.0%
Alaska$1,591$20,172825+1.3%
Hawaii$1,544$4,9191346-1.6%
Arkansas$1,531$6,2272552-2.4%
Kentucky$1,528$6,73150117-2.6%
Oregon$1,525$5,56145102-2.9%
Texas$1,514$6,692285761-3.5%
Ohio$1,513$5,684161410-3.6%
Montana$1,493$4,4902549-4.9%
Missouri$1,492$5,52097211-5.0%
Colorado$1,468$4,82770195-6.4%
South Carolina$1,468$5,35265223-6.5%
Connecticut$1,466$7,35262103-6.6%
Maine$1,460$4,1281320-7.0%
Georgia$1,460$6,707101212-7.0%
Oklahoma$1,457$4,80447200-7.2%
Nebraska$1,438$5,5732760-8.4%
Tennessee$1,421$5,224100236-9.5%
Nevada$1,420$11,98943159-9.6%
Utah$1,408$6,5703093-10.3%
Wisconsin$1,406$15,05272160-10.4%
Kansas$1,390$5,8882975-11.4%
Washington$1,372$5,72984234-12.6%
North Carolina$1,364$5,724113260-13.1%
Arizona$1,359$4,98481294-13.4%
North Dakota$1,342$5,4151522-14.5%
Alabama$1,312$4,29067151-16.4%
Minnesota$1,224$5,70467161-22.0%
Iowa$1,193$5,1962874-24.0%
South Dakota$1,176$4,3401933-25.1%
Idaho$1,015$29,3322148-35.3%
Delaware$1,001$3,8512693-36.2%

⚠️ 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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