Musculoskeletal Surgery · 20251
Biopsy Of Upper Or Lower Spine Bone
What Medicare pays for 20251, what providers bill, and how the price varies across 6 states, drawn from CMS 2023 claims data.
- $192.44
- Medicare pays
- $1,985.33
- Providers bill
- 10.3×
- Markup
- #6,364 of 9,297
- Volume rank
The verdict
Biopsy Of Upper Or Lower Spine Bone pairs modest national service volume with one of the steepest markups in the catalog.
- 32nd pct.
- national service volume
- Top 9%
- billed-to-Medicare markup
- 10.3×
- billed vs. Medicare
- $192.44
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Musculoskeletal Surgery, the applied ratio is 2.54x Medicare (RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
10 Among the most affordable more affordable than 91% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$1,985.33
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Florida | $276.78 | $1,922.85 |
| New Mexico | $193.27 | $1,960.00 |
| California | $166.52 | $1,759.83 |
| Texas | $164.21 | $1,310.29 |
| Delaware | $163.54 | $4,056.36 |
| Illinois | $152.53 | $2,702.66 |
What the Data Says About Biopsy Of Upper Or Lower Spine Bone
Across 6 states with reporting providers, CPT code 20251 (Biopsy Of Upper Or Lower Spine Bone) shows a national average Medicare payment of $192.44 against an average billed charge of $1,985.33. That gap, a 10.3x markup, or 932% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.
Musculoskeletal Surgery procedures like this one saw 296 services billed to Medicare in 2023 by 175 distinct providers, serving 214 unique beneficiaries. State-level variation is significant: Illinois reports the lowest average payment at $152.53, while Florida reports the highest at $276.78. A 81% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.54x Medicare; RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline), the estimated commercial insurance price lands near $612.41, with self-pay cash discounts commonly bringing the figure closer to $726.79. Within Musculoskeletal Surgery, Biopsy Of Upper Or Lower Spine Bone ranks #1206 of 1411 tracked procedures by national average Medicare payment.
Where this sits in the registry
Biopsy Of Upper Or Lower Spine Bone (20251) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Musculoskeletal Surgery codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Biopsy Of Upper Or Lower Spine Bone rank among Medicare procedures?
According to CMS Medicare Part B claims, Biopsy Of Upper Or Lower Spine Bone (CPT 20251) ranks #6,364 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #1,206 of 1,411 within Musculoskeletal Surgery by national average Medicare payment. See /methodology#corpus-placement.
How much does Biopsy Of Upper Or Lower Spine Bone cost?
Medicare's national average payment for Biopsy Of Upper Or Lower Spine Bone (CPT 20251) is $192.44, with providers billing $1,985.33 on average; state rates run from $152.53 to $276.78, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Biopsy Of Upper Or Lower Spine Bone cost with insurance?
Commercial insurers pay well above Medicare for biopsy of upper or lower spine bone, an estimated $612.41 on average (range: $428.69-$857.37), versus $192.44 from Medicare. Without insurance, the estimated cash price is $726.79.
Which state has the lowest cost for Biopsy Of Upper Or Lower Spine Bone?
Illinois has the lowest average Medicare payment for Biopsy Of Upper Or Lower Spine Bone at $152.53, while Florida has the highest at $276.78 - a meaningful $124.25 spread.
How many providers perform Biopsy Of Upper Or Lower Spine Bone?
Biopsy Of Upper Or Lower Spine Bone is comparatively uncommon: only 175 providers nationally billed Medicare for it in 2023, serving 214 beneficiaries via 296 total services.
What is the billed-to-Medicare markup for Biopsy Of Upper Or Lower Spine Bone?
Providers bill 10.3x what Medicare pays for Biopsy Of Upper Or Lower Spine Bone - one of the steepest markups in the catalog at 932% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (296 here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($192.44 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.