15734

Creation of muscle graft to trunk

Medicare pricing data for 6,059 providers across 50 states

🤖AI Overview

This procedure has a 6.4x markup — hospitals charge $6,338 but Medicare allows only $996.55. Uninsured patients may face bills 6.4 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

Creation of muscle graft to trunk (HCPCS code 15734) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $996.55, but hospitals typically charge $6,338 — a 6.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$199.31

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $996.55, your out-of-pocket cost would be approximately $199.31. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$996.55
Average Hospital Charge
$6,338
Markup Ratio
6.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$6,338.18
Medicare Allowed$996.55
Medicare Payment$794.67

Hospitals charge 6.4x more than what Medicare allows for this procedure. Medicare actually pays $794.67 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$1,314$8,631932+31.8%
Puerto Rico$1,307$2,785824+31.2%
Hawaii$1,269$3,817519+27.3%
District of Columbia$1,233$4,94736272+23.7%
Massachusetts$1,136$5,203156491+14.0%
Maryland$1,124$3,988142884+12.8%
New York$1,096$10,0164394,718+10.0%
Connecticut$1,091$6,07988267+9.4%
Michigan$1,075$3,991144498+7.9%
Pennsylvania$1,062$5,2512701,277+6.5%
California$1,049$5,4375652,663+5.2%
New Hampshire$1,031$9,5083982+3.5%
Illinois$1,018$7,033215929+2.2%
Virginia$1,017$8,458129480+2.1%
Missouri$1,003$4,296126596+0.6%
Georgia$998$4,657178717+0.1%
Louisiana$997$5,71477218+0.0%
Tennessee$994$3,763127628-0.3%
Minnesota$989$6,31286351-0.8%
Iowa$983$6,1723495-1.4%
Texas$979$6,0364371,835-1.8%
Florida$968$5,0375092,077-2.9%
South Carolina$963$5,593101528-3.3%
Ohio$958$5,5902211,095-3.8%
New Jersey$952$12,9792541,455-4.5%
Mississippi$946$3,88151150-5.1%
West Virginia$943$3,1662651-5.4%
Oregon$935$4,18970296-6.2%
Montana$930$3,7062765-6.7%
North Dakota$914$3,6622042-8.3%
Kansas$910$3,57265212-8.7%
Utah$901$3,56839125-9.6%
Kentucky$893$3,56984323-10.4%
Oklahoma$890$3,98850131-10.6%
Washington$886$3,517151540-11.1%
Arkansas$885$3,24760248-11.2%
Alabama$874$4,116101485-12.3%
Arizona$868$5,474148607-12.9%
Rhode Island$860$3,37818151-13.7%
Delaware$848$3,04843150-14.9%
New Mexico$845$2,92629142-15.3%
Colorado$830$4,79989356-16.8%
Indiana$827$4,039124447-17.0%
North Carolina$826$4,727139746-17.1%
Wisconsin$821$10,400101269-17.6%
Idaho$821$3,69833143-17.6%
Nebraska$789$3,9413391-20.8%
South Dakota$788$3,0161952-20.9%
Nevada$780$4,94348208-21.7%
Maine$737$3,93632154-26.1%

⚠️ 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