15004

Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less

Medicare pricing data for 6,199 providers across 49 states

🤖AI Overview

Prices vary significantly by location — from $200 in Idaho to $407 in Hawaii. Where you get this procedure matters more than almost any other factor. 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 face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less (HCPCS code 15004) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $298.41, but hospitals typically charge $1,177 — a 3.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$59.68

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $298.41, your out-of-pocket cost would be approximately $59.68. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$298.41
Average Hospital Charge
$1,177
Markup Ratio
3.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,177.10
Medicare Allowed$298.41
Medicare Payment$237.15

Hospitals charge 3.9x more than what Medicare allows for this procedure. Medicare actually pays $237.15 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$407$1,323420+36.4%
New York$395$1,5172822,213+32.3%
District of Columbia$350$1,04024209+17.3%
California$341$1,2766794,818+14.1%
Illinois$339$1,2262471,492+13.6%
Louisiana$328$807116651+9.8%
Florida$327$1,0116065,064+9.7%
New Jersey$318$2,6781771,176+6.6%
Virginia$318$1,5042321,738+6.4%
Texas$313$1,0515403,185+4.9%
New Mexico$310$1,02928113+3.7%
Alabama$305$75864449+2.1%
Colorado$299$90795428+0.3%
Kentucky$295$77765387-1.0%
Pennsylvania$291$917261951-2.6%
South Carolina$284$94086386-4.7%
Connecticut$284$1,24941165-4.7%
Massachusetts$282$1,012103507-5.6%
North Carolina$279$943195680-6.3%
Mississippi$276$1,05848260-7.6%
Arkansas$273$71733164-8.7%
Oklahoma$272$72382611-8.8%
Michigan$272$890176455-8.9%
Washington$269$945145707-9.9%
Maryland$268$1,2791601,151-10.3%
Ohio$267$9842331,077-10.5%
Nevada$264$82657625-11.7%
Missouri$259$1,256119448-13.2%
Rhode Island$259$1,433877-13.3%
Montana$259$696712-13.3%
Indiana$258$1,203116534-13.4%
West Virginia$256$8292471-14.3%
Wisconsin$255$1,99790266-14.4%
Tennessee$255$1,409158891-14.4%
Kansas$255$83657263-14.7%
Georgia$251$1,0901791,722-15.8%
Utah$250$83349275-16.1%
Arizona$248$1,2812483,275-16.8%
Minnesota$245$1,47582351-17.9%
Oregon$245$1,13535146-18.0%
North Dakota$241$7871124-19.2%
Iowa$240$1,56049174-19.6%
Maine$238$6811725-20.2%
New Hampshire$233$1,0971135-22.0%
Nebraska$228$1,28533205-23.6%
South Dakota$224$1,01223161-25.1%
Delaware$219$799321,792-26.8%
Alaska$211$2,391850-29.4%
Idaho$200$7562259-32.9%

⚠️ 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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