22552

Fusion of upper spine bone with removal of disc and release of spinal cord or nerve, each additional disc

Medicare pricing data for 7,656 providers across 51 states

🤖AI Overview

This procedure has a 7.2x markup — hospitals charge $1,855 but Medicare allows only $257.74. Uninsured patients may face bills 7.2 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

Fusion of upper spine bone with removal of disc and release of spinal cord or nerve, each additional disc (HCPCS code 22552) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $257.74, but hospitals typically charge $1,855 — a 7.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$51.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $257.74, your out-of-pocket cost would be approximately $51.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$257.74
Average Hospital Charge
$1,855
Markup Ratio
7.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,855.33
Medicare Allowed$257.74
Medicare Payment$205.80

Hospitals charge 7.2x more than what Medicare allows for this procedure. Medicare actually pays $205.80 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$371$1,49322153+43.9%
Puerto Rico$339$7911155+31.6%
Rhode Island$331$2,7131854+28.4%
New York$311$4,3613391,575+20.7%
Massachusetts$306$2,404141680+18.9%
Hawaii$298$842726+15.6%
Illinois$294$3,2592481,470+14.0%
Pennsylvania$291$1,9752661,071+13.0%
Maryland$288$1,4221611,357+11.9%
Michigan$283$2,2292491,185+9.6%
Alaska$282$3,39237371+9.3%
Kentucky$279$1,238103534+8.2%
California$277$1,7965573,082+7.6%
Florida$273$2,0795974,463+5.8%
Virginia$271$1,5162001,471+5.0%
New Mexico$268$1,6492793+4.2%
Ohio$268$1,1772921,618+3.9%
Texas$259$1,4396054,811+0.6%
Mississippi$259$2,11957398+0.4%
Missouri$256$1,7621791,060-0.7%
Georgia$254$1,9222441,662-1.6%
New Hampshire$253$2,12443184-1.9%
New Jersey$253$6,291184793-2.0%
Tennessee$250$1,2051911,186-3.2%
South Carolina$249$1,1791441,008-3.4%
Arkansas$248$74360487-3.7%
Connecticut$248$2,056112337-3.9%
Washington$245$991183882-5.0%
Arizona$242$1,2772021,445-6.0%
Nevada$241$4,59078343-6.7%
North Carolina$237$1,2982952,031-8.2%
Oregon$235$1,15795497-8.7%
Colorado$235$1,1852091,302-8.9%
Oklahoma$234$1,1301111,050-9.0%
Maine$234$8542768-9.3%
Louisiana$233$1,9691541,601-9.7%
Utah$231$1,15586429-10.4%
Wisconsin$230$3,939107423-10.7%
Montana$230$95138232-10.8%
Indiana$227$1,712170854-12.0%
Nebraska$222$1,27070312-13.7%
West Virginia$221$1,06535152-14.3%
Wyoming$220$2,0361696-14.8%
Iowa$218$1,29572350-15.5%
Alabama$215$1,310154945-16.4%
Kansas$215$90581679-16.5%
North Dakota$212$84721204-17.8%
Delaware$210$2,16833308-18.6%
Minnesota$205$1,407141645-20.4%
Idaho$197$2,45673426-23.4%
South Dakota$193$83743280-25.0%

⚠️ 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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