63046

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

Medicare pricing data for 3,722 providers across 48 states

🤖AI Overview

This procedure has a 8.7x markup — hospitals charge $5,221 but Medicare allows only $596.71. Uninsured patients may face bills 8.7 times higher than what insurance negotiates. Prices vary significantly by location — from $361 in Idaho to $845 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

Partial removal of spine bone with release of middle spinal cord and/or nerves, 1 segment (HCPCS code 63046) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $596.71, but hospitals typically charge $5,221 — a 8.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$119.34

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $596.71, your out-of-pocket cost would be approximately $119.34. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$596.71
Average Hospital Charge
$5,221
Markup Ratio
8.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$5,220.50
Medicare Allowed$596.71
Medicare Payment$475.63

Hospitals charge 8.7x more than what Medicare allows for this procedure. Medicare actually pays $475.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$845$4,1751629+41.7%
Oregon$817$3,4084569+36.9%
Maryland$731$4,05895214+22.5%
South Carolina$726$4,4285687+21.6%
Mississippi$701$4,6062953+17.5%
New Hampshire$673$8,1891727+12.9%
Nevada$661$8,7184876+10.8%
New Jersey$659$12,571103158+10.5%
Arkansas$652$3,5562745+9.2%
Massachusetts$640$5,51168125+7.3%
New York$640$8,554173270+7.3%
California$640$5,970298648+7.2%
Illinois$636$8,002139229+6.6%
Pennsylvania$620$4,313143237+3.9%
Texas$615$4,353303547+3.1%
Georgia$614$4,589113186+3.0%
West Virginia$614$3,2881523+2.9%
Florida$611$5,688274534+2.3%
North Dakota$604$3,4951424+1.2%
Montana$601$4,5971117+0.8%
Hawaii$597$2,6451022+0.1%
Ohio$590$3,653161303-1.1%
Rhode Island$588$6,6401216-1.5%
Louisiana$584$6,01071134-2.1%
Missouri$580$4,15689135-2.9%
Michigan$579$5,380126241-2.9%
Connecticut$576$6,6055270-3.5%
Washington$575$3,34297171-3.6%
Kentucky$572$3,3144486-4.1%
Tennessee$557$3,60984171-6.7%
Virginia$554$3,91298156-7.1%
Wisconsin$553$14,0814556-7.4%
Indiana$544$6,19582134-8.9%
Arizona$541$4,84999164-9.4%
Wyoming$534$4,591915-10.6%
North Carolina$522$3,374134218-12.6%
Utah$518$3,4763344-13.2%
Colorado$518$4,115112196-13.3%
Minnesota$498$4,5406293-16.5%
Alabama$498$3,48566139-16.6%
Kansas$480$3,2324080-19.5%
Iowa$479$4,1942037-19.7%
Oklahoma$466$2,47758102-21.9%
South Dakota$463$3,5041823-22.4%
Nebraska$447$3,6273660-25.1%
Delaware$424$5,1101940-28.9%
Alaska$381$11,0971419-36.2%
Idaho$361$5,5812545-39.6%

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

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💊 Need post-procedure medications? Check costs on OpenPrescriber