15003

Preparation of skin graft site of trunk, arms, or legs, each additional 100.0 sq cm or 1% body area for infants and children, or less

Medicare pricing data for 1,618 providers across 43 states

🤖AI Overview

This procedure has a 6.7x markup — hospitals charge $265.20 but Medicare allows only $39.80. Uninsured patients may face bills 6.7 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

Preparation of skin graft site of trunk, arms, or legs, each additional 100.0 sq cm or 1% body area for infants and children, or less (HCPCS code 15003) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $39.80, but hospitals typically charge $265.20 — a 6.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$7.96

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $39.80, your out-of-pocket cost would be approximately $7.96. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$39.80
Average Hospital Charge
$265.20
Markup Ratio
6.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$265.20
Medicare Allowed$39.80
Medicare Payment$31.76

Hospitals charge 6.7x more than what Medicare allows for this procedure. Medicare actually pays $31.76 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$51$31576960+27.4%
District of Columbia$51$29114337+27.2%
Illinois$49$24453734+22.7%
Maryland$48$21439478+21.5%
New Jersey$48$50045354+20.2%
Connecticut$48$38314172+19.5%
Massachusetts$47$18542947+18.8%
Montana$45$205631+13.6%
New Mexico$45$1741477+13.5%
Michigan$45$19840469+12.8%
Ohio$44$27860742+11.4%
Louisiana$44$240191,035+11.3%
Pennsylvania$44$166861,665+11.0%
Texas$44$3101242,326+10.1%
Washington$44$15432774+9.6%
Maine$43$1865108+8.9%
Oregon$43$23410403+7.8%
Kentucky$43$178191,115+7.6%
West Virginia$43$1454110+7.1%
Utah$42$15816309+6.4%
North Carolina$42$19836934+6.0%
Minnesota$42$182291,375+5.3%
Iowa$42$33713589+4.6%
Oklahoma$41$12519728+4.1%
Mississippi$41$28018492+3.3%
Virginia$41$621441,172+2.5%
Alabama$40$252221,112+1.6%
South Carolina$40$35819170-0.6%
Wisconsin$39$43830228-1.2%
Nebraska$39$17913798-1.5%
Arizona$39$21350875-1.7%
Colorado$39$19429852-2.5%
Tennessee$38$234381,801-3.9%
California$38$2741495,828-4.0%
Florida$38$2071133,664-4.8%
Arkansas$38$26210422-5.5%
Missouri$37$17241837-7.0%
Kansas$37$18124436-7.1%
Idaho$36$1291277-10.7%
Indiana$33$14722783-15.9%
Georgia$33$384647,150-16.9%
Nevada$30$153191,023-24.6%
South Dakota$28$1171339-30.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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