11046

Removal of muscle and/or tissue, each additional 20.0 sq cm or less

Medicare pricing data for 11,829 providers across 51 states

🤖AI Overview

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

Removal of muscle and/or tissue, each additional 20.0 sq cm or less (HCPCS code 11046) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $60.70, but hospitals typically charge $208.14 — a 3.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$12.14

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $60.70, your out-of-pocket cost would be approximately $12.14. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$60.70
Average Hospital Charge
$208.14
Markup Ratio
3.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$208.14
Medicare Allowed$60.70
Medicare Payment$48.39

Hospitals charge 3.4x more than what Medicare allows for this procedure. Medicare actually pays $48.39 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$71$49725319+16.5%
New York$68$27449117,599+12.6%
California$66$2621,11687,451+8.0%
Connecticut$65$2191253,484+6.3%
Maryland$64$1792617,434+5.0%
Illinois$64$1954526,737+4.7%
District of Columbia$63$191531,972+4.3%
Oregon$62$177912,713+2.3%
Florida$61$1601,16550,965+0.5%
Colorado$60$1521562,336-1.1%
New Jersey$60$3424227,121-1.1%
Delaware$59$16342394-3.0%
Hawaii$58$12541545-3.7%
Massachusetts$58$2212764,979-3.8%
Georgia$58$1813196,194-3.8%
Arizona$58$1602473,318-4.1%
Pennsylvania$58$1985646,836-4.4%
New Mexico$58$169761,458-4.5%
Rhode Island$58$16134286-4.5%
Washington$58$1791984,027-4.7%
Nevada$58$1711071,878-5.1%
Texas$57$16490714,948-6.0%
Mississippi$57$1192039,366-6.5%
Virginia$57$1832954,197-6.6%
Michigan$56$1603203,185-7.8%
Montana$56$15043441-7.9%
West Virginia$56$184771,206-8.5%
Louisiana$55$1362415,906-8.6%
New Hampshire$55$30652449-8.9%
Utah$55$16477926-10.0%
Alabama$54$1261674,501-10.6%
South Carolina$54$1902294,086-11.0%
Ohio$54$1575136,199-11.5%
Oklahoma$53$1571714,039-12.0%
North Carolina$53$2193755,162-12.4%
Missouri$53$1852112,123-12.4%
Wyoming$53$14511161-12.5%
Minnesota$53$2191712,380-13.4%
Idaho$52$13143388-13.6%
Tennessee$52$1702973,860-14.4%
Indiana$52$2152242,820-14.7%
Maine$52$15033298-14.7%
Kentucky$52$1602154,863-14.8%
Wisconsin$51$4012141,553-15.7%
Iowa$51$199741,030-15.9%
South Dakota$50$21640417-17.4%
Vermont$50$23915133-18.0%
Kansas$49$17799946-19.6%
Arkansas$49$1771261,524-19.7%
Nebraska$48$19955927-20.4%
North Dakota$42$40732221-30.3%

⚠️ 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