15101

Partial thickness self skin graft 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 1,429 providers across 42 states

🤖AI Overview

This procedure has a 6.3x markup — hospitals charge $689.65 but Medicare allows only $109.04. Uninsured patients may face bills 6.3 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

Partial thickness self skin graft of trunk, arms, or legs, each additional 100.0 sq cm or 1% body area for infants and children, or less (HCPCS code 15101) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $109.04, but hospitals typically charge $689.65 — a 6.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$21.81

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $109.04, your out-of-pocket cost would be approximately $21.81. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$109.04
Average Hospital Charge
$689.65
Markup Ratio
6.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$689.65
Medicare Allowed$109.04
Medicare Payment$87.01

Hospitals charge 6.3x more than what Medicare allows for this procedure. Medicare actually pays $87.01 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$126$1,24175514+15.9%
District of Columbia$125$63510100+14.5%
New Jersey$120$1,25731152+9.8%
Maryland$119$46341219+9.3%
Massachusetts$118$47646444+8.4%
Connecticut$117$472956+7.5%
Illinois$117$1,00647422+7.2%
Washington$117$52419305+7.0%
Florida$114$64292830+4.8%
New Hampshire$113$1,1141222+3.8%
California$112$7991321,883+2.6%
Michigan$111$73934194+1.4%
Pennsylvania$110$81079793+0.5%
New Mexico$110$4611040+0.4%
Oregon$109$63717293+0.3%
Colorado$109$50232439-0.0%
Texas$109$758114770-0.3%
Virginia$108$81631314-0.8%
Louisiana$108$50223301-0.9%
Arizona$108$38828328-1.2%
Ohio$108$52655348-1.2%
Maine$108$316855-1.4%
Missouri$107$50028435-1.6%
Georgia$107$639371,004-1.6%
Utah$106$5629137-3.0%
Minnesota$104$46525537-4.2%
Oklahoma$104$30717412-4.5%
North Carolina$104$56633473-4.5%
Kentucky$103$43122262-5.3%
South Dakota$103$5251133-5.8%
Kansas$102$38224176-6.2%
Mississippi$102$65814154-6.6%
Nevada$102$5541280-6.7%
South Carolina$102$6751942-6.8%
Iowa$101$1,28915512-7.4%
Idaho$100$3311034-8.2%
Tennessee$100$78136573-8.7%
Indiana$99$61125174-9.1%
Wisconsin$99$1,32437136-9.1%
Nebraska$99$47816195-9.2%
Alabama$99$67617353-9.4%
Arkansas$98$45916107-10.3%

⚠️ 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

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