63052

Partial removal of bone of single segment of spine in lower back with release of spinal cord and/or nerves during fusion of spine in lower back

Medicare pricing data for 6,630 providers across 51 states

🤖AI Overview

This procedure has a 8.4x markup — hospitals charge $1,411 but Medicare allows only $167.02. Uninsured patients may face bills 8.4 times higher than what insurance negotiates. 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 bone of single segment of spine in lower back with release of spinal cord and/or nerves during fusion of spine in lower back (HCPCS code 63052) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $167.02, but hospitals typically charge $1,411 — a 8.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$33.40

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $167.02, your out-of-pocket cost would be approximately $33.40. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$167.02
Average Hospital Charge
$1,411
Markup Ratio
8.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,410.93
Medicare Allowed$167.02
Medicare Payment$133.32

Hospitals charge 8.4x more than what Medicare allows for this procedure. Medicare actually pays $133.32 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$237$1,33816124+41.8%
New York$205$2,9243331,634+22.9%
Pennsylvania$200$9722271,659+19.5%
Massachusetts$193$1,8041571,254+15.8%
Rhode Island$193$2,13821132+15.7%
Maryland$188$6461171,137+12.8%
Illinois$186$1,2232251,682+11.7%
Montana$185$76037334+10.5%
Michigan$184$1,1762091,397+10.4%
Hawaii$180$943724+7.9%
California$180$1,5813962,149+7.5%
Maine$178$4952375+6.6%
Florida$177$1,4255223,645+5.9%
Ohio$173$6922441,849+3.3%
Virginia$171$8931711,478+2.5%
Kentucky$169$1,52691628+1.4%
Georgia$169$1,8392061,280+1.3%
Texas$167$1,2454583,199+0.3%
Connecticut$166$1,143119481-0.6%
Alaska$165$1,85728211-0.9%
Wyoming$163$1,26616100-2.3%
Tennessee$163$8821711,057-2.6%
Arkansas$162$1,19860534-3.0%
Utah$161$1,15782551-3.3%
Iowa$161$71256306-3.6%
New Jersey$161$8,624181852-3.7%
West Virginia$160$65228123-4.0%
Arizona$158$7562011,846-5.2%
Louisiana$157$1,072119907-6.3%
South Carolina$156$9951311,279-6.5%
Missouri$155$8991601,290-7.0%
Nevada$153$4,91469539-8.2%
Colorado$153$7721911,650-8.3%
Oklahoma$153$74994913-8.3%
North Carolina$153$1,0012501,665-8.4%
Kansas$151$62177660-9.4%
Mississippi$151$1,98341515-9.9%
Washington$150$7471681,137-10.3%
Indiana$149$1,8361731,580-10.5%
Minnesota$148$1,136134883-11.5%
Vermont$147$1,241725-11.7%
Oregon$146$1,70380571-12.5%
New Hampshire$145$1,27945183-12.9%
North Dakota$144$50421392-13.8%
Wisconsin$142$2,914112581-15.1%
Nebraska$141$66872662-15.6%
New Mexico$141$78123113-15.6%
Alabama$134$686108702-19.7%
South Dakota$132$58540429-20.8%
Delaware$132$2,2831969-21.1%
Idaho$130$2,91353352-21.9%

⚠️ 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