62252

Reprogramming of cerebrospinal fluid shunt

Medicare pricing data for 1,332 providers across 44 states

🤖AI Overview

This procedure has a 5.1x markup — hospitals charge $384.19 but Medicare allows only $75.58. Uninsured patients may face bills 5.1 times higher than what insurance negotiates. Prices vary significantly by location — from $34 in Iowa to $94 in New York. 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

Reprogramming of cerebrospinal fluid shunt (HCPCS code 62252) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $75.58, but hospitals typically charge $384.19 — a 5.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$15.12

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $75.58, your out-of-pocket cost would be approximately $15.12. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$75.58
Average Hospital Charge
$384.19
Markup Ratio
5.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$384.19
Medicare Allowed$75.58
Medicare Payment$57.86

Hospitals charge 5.1x more than what Medicare allows for this procedure. Medicare actually pays $57.86 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$94$83482516+23.9%
District of Columbia$93$213522+23.6%
New Jersey$93$86135116+23.4%
Maryland$90$23413136+18.8%
California$82$3641261,030+8.9%
Pennsylvania$80$22338129+6.4%
Washington$80$2733083+6.2%
Illinois$80$48447150+5.6%
Florida$79$377129614+5.2%
Alaska$79$1,238920+4.1%
Connecticut$79$42620115+4.1%
Nevada$79$3131064+4.1%
Delaware$78$570946+3.1%
Georgia$76$34644162+1.1%
Texas$75$320106627-1.1%
Michigan$75$4213589-1.4%
Kansas$74$215620-1.8%
Missouri$74$54828126-2.4%
Oklahoma$73$2091629-3.3%
Colorado$73$2361740-3.3%
North Carolina$71$29339137-5.8%
Idaho$71$3441125-5.9%
Arizona$71$23834268-6.2%
Kentucky$71$2202856-6.4%
Wisconsin$70$6532651-7.0%
Tennessee$68$25742117-9.4%
Louisiana$68$3712583-9.6%
Alabama$68$1372466-10.3%
South Carolina$68$26734127-10.3%
Indiana$67$28730129-11.4%
Mississippi$66$202626-13.0%
Arkansas$65$217951-13.6%
Minnesota$65$45836161-13.9%
Ohio$64$29233139-14.9%
Nebraska$60$2451127-20.0%
Oregon$53$18234105-29.6%
Virginia$50$27230285-33.4%
Massachusetts$50$25521121-34.2%
Montana$48$117919-35.9%
New Hampshire$40$239727-47.6%
Wyoming$38$225450-50.2%
North Dakota$37$124820-50.5%
South Dakota$35$1521017-53.8%
Iowa$34$2611577-54.7%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber