11720

Removal of fingernails or toenails, 1-5 nails

Medicare pricing data for 14,750 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 1.9 million services annually. Even small pricing inefficiencies here affect millions of patients. 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 fingernails or toenails, 1-5 nails (HCPCS code 11720) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $32.47, but hospitals typically charge $58.41 — a 1.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.49

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $32.47, your out-of-pocket cost would be approximately $6.49. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$32.47
Average Hospital Charge
$58.41
Markup Ratio
1.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$58.41
Medicare Allowed$32.47
Medicare Payment$23.83

Hospitals charge 1.8x more than what Medicare allows for this procedure. Medicare actually pays $23.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$38$65283,911+16.1%
New York$36$631,388174,227+11.1%
New Jersey$36$61874149,796+10.7%
Maryland$35$58336101,759+8.4%
Connecticut$35$5917724,355+7.3%
Massachusetts$34$6834257,710+5.5%
California$34$631,461235,026+3.7%
Rhode Island$33$677316,383+2.6%
Delaware$33$555614,000+0.9%
Wyoming$32$39111,1890.0%
Virginia$32$6133236,261-0.1%
Washington$32$5627018,308-0.6%
Nevada$32$49909,743-0.7%
Puerto Rico$32$3311205-0.9%
Montana$32$61552,440-1.7%
Pennsylvania$32$541,039193,885-2.2%
Florida$32$511,006108,643-2.6%
Arizona$31$5233424,280-3.4%
New Hampshire$31$58504,109-3.9%
Illinois$31$58724135,540-4.1%
Oregon$31$6915010,332-4.2%
Michigan$31$5257342,690-4.3%
Colorado$31$6515611,470-4.5%
Texas$31$5873354,206-5.6%
Vermont$31$54162,488-5.8%
Maine$31$57503,437-6.0%
Ohio$30$4979394,011-6.2%
Hawaii$30$53321,855-6.3%
Utah$30$561309,789-6.3%
Georgia$30$7033223,304-6.5%
Minnesota$30$6719711,071-6.7%
South Carolina$30$5219119,259-7.0%
Alaska$30$7915370-7.4%
North Carolina$30$5735456,293-7.7%
Wisconsin$30$7123329,441-8.0%
Indiana$30$5524532,611-8.3%
West Virginia$30$618512,012-8.6%
Tennessee$29$5624018,306-9.4%
Kentucky$29$4317918,839-9.5%
Alabama$29$4912412,650-9.5%
Kansas$29$508915,614-10.1%
Missouri$29$5627238,969-10.6%
New Mexico$29$60722,058-10.6%
Arkansas$29$51686,388-10.7%
Mississippi$29$97583,237-10.8%
Iowa$29$7117815,181-11.2%
Nebraska$29$52937,588-12.0%
Louisiana$28$671385,296-12.5%
Oklahoma$27$521375,098-17.6%
Idaho$27$62706,387-17.6%
South Dakota$23$45323,500-29.0%
North Dakota$23$6047485-29.7%

⚠️ 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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