63045

Partial removal of spine bone with release of upper spinal cord and/or nerves, 1 segment

Medicare pricing data for 5,727 providers across 51 states

🤖AI Overview

This procedure has a 9.5x markup — hospitals charge $5,294 but Medicare allows only $560.08. Uninsured patients may face bills 9.5 times higher than what insurance negotiates. Prices vary significantly by location — from $386 in Delaware to $799 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

Partial removal of spine bone with release of upper spinal cord and/or nerves, 1 segment (HCPCS code 63045) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $560.08, but hospitals typically charge $5,294 — a 9.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$112.02

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $560.08, your out-of-pocket cost would be approximately $112.02. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$560.08
Average Hospital Charge
$5,294
Markup Ratio
9.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$5,294.28
Medicare Allowed$560.08
Medicare Payment$446.54

Hospitals charge 9.5x more than what Medicare allows for this procedure. Medicare actually pays $446.54 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$799$3,8822593+42.6%
Vermont$654$5,759411+16.7%
New Mexico$648$5,3362344+15.8%
Maryland$648$4,725135531+15.7%
Maine$645$2,4122644+15.2%
New York$643$8,225290761+14.7%
Washington$643$3,532175473+14.7%
Mississippi$642$4,6362894+14.6%
Minnesota$624$5,23797202+11.4%
Oregon$615$3,15599272+9.8%
California$612$6,3244631,453+9.3%
Massachusetts$605$6,025129484+7.9%
North Carolina$594$3,642186485+6.0%
Arizona$593$4,249144415+5.8%
Illinois$590$7,639174490+5.3%
Arkansas$584$3,71747164+4.3%
Missouri$582$4,523131390+3.9%
Kentucky$581$3,31568167+3.8%
West Virginia$579$3,8662265+3.4%
Ohio$572$3,558195625+2.1%
Pennsylvania$572$4,534247694+2.1%
Louisiana$568$4,985107252+1.4%
Montana$561$5,6443388+0.2%
New Hampshire$561$6,3653055+0.2%
Florida$561$6,2714081,129+0.2%
New Jersey$560$11,934150345-0.0%
Texas$553$4,2714501,382-1.3%
Wyoming$549$6,5771436-1.9%
Oklahoma$549$2,74674229-2.1%
Virginia$547$3,805142406-2.4%
Utah$542$3,3024499-3.3%
Georgia$534$4,386162438-4.6%
Michigan$526$5,852169415-6.1%
Nevada$509$9,71168222-9.2%
Indiana$499$4,899128319-10.9%
Rhode Island$498$7,8102055-11.1%
Connecticut$492$6,01593210-12.2%
Nebraska$485$3,49944133-13.5%
Alaska$477$10,7683092-14.9%
South Carolina$474$3,735104360-15.5%
Colorado$466$3,586157496-16.9%
Tennessee$465$3,144132364-17.0%
Alabama$461$3,32691240-17.7%
North Dakota$459$2,6581353-18.0%
Iowa$457$3,81041115-18.4%
Kansas$452$3,17967300-19.3%
Wisconsin$438$13,941108281-21.7%
Hawaii$429$2,6061282-23.4%
South Dakota$404$3,3152856-27.9%
Idaho$387$8,24947120-30.9%
Delaware$386$4,66828122-31.1%

⚠️ 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