11730

Simple separation of fingernail or toenail from nail bed, first nail

Medicare pricing data for 22,038 providers across 52 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

Simple separation of fingernail or toenail from nail bed, first nail (HCPCS code 11730) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $109.71, but hospitals typically charge $199.11 — a 1.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$21.94

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $109.71, your out-of-pocket cost would be approximately $21.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$109.71
Average Hospital Charge
$199.11
Markup Ratio
1.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$199.11
Medicare Allowed$109.71
Medicare Payment$81.90

Hospitals charge 1.8x more than what Medicare allows for this procedure. Medicare actually pays $81.90 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$128$2151,49824,008+16.8%
New Jersey$124$20283814,071+12.8%
District of Columbia$123$25436139+12.4%
Maryland$118$1843723,506+7.8%
Hawaii$118$22553213+7.7%
Connecticut$117$2212451,655+7.0%
Alaska$117$43071191+6.5%
Delaware$113$18370770+2.6%
Massachusetts$112$2405155,891+1.8%
Rhode Island$111$21076566+1.5%
Pennsylvania$110$1651,12521,657+0.5%
Michigan$110$16478110,618+0.4%
Colorado$110$2373991,746+0.4%
Florida$109$1841,51824,016-0.3%
California$109$2002,04130,795-0.3%
Washington$109$2325292,334-0.9%
Illinois$108$19695412,052-1.4%
Puerto Rico$107$11234199-2.1%
Arizona$107$2035394,403-2.9%
Oregon$106$2362811,081-3.1%
Wyoming$105$22965147-3.9%
Virginia$105$2015594,098-4.5%
Texas$104$2181,2908,603-4.8%
Montana$104$209103483-4.9%
New Mexico$103$1841371,082-5.7%
Utah$103$2102651,394-6.4%
North Carolina$103$2096373,974-6.5%
Georgia$102$2285383,970-7.1%
Nevada$102$2061461,598-7.3%
South Carolina$101$1823672,934-7.9%
Maine$100$18484454-8.8%
Ohio$99$1838274,728-10.0%
Indiana$98$1984843,061-10.4%
Minnesota$98$3173781,262-10.5%
Tennessee$98$1864473,211-10.8%
Mississippi$97$2761921,412-11.3%
Kentucky$96$1752961,613-12.3%
Louisiana$95$2072852,431-13.0%
Arkansas$95$1692181,207-13.1%
Iowa$95$2622901,289-13.1%
Wisconsin$95$3564331,584-13.3%
Nebraska$95$1941851,341-13.3%
Alabama$94$1742872,152-14.7%
Oklahoma$93$1882561,700-15.5%
Kansas$92$1682561,617-16.1%
Missouri$92$1884382,229-16.2%
New Hampshire$92$25491365-16.5%
Idaho$91$213187691-16.9%
West Virginia$90$20297557-17.9%
North Dakota$83$26179328-24.8%
Vermont$76$16155140-30.4%
South Dakota$74$18277234-32.6%

⚠️ 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

🏥 See Medicare hospital data on OpenMedicare