28010

Repair of toe tendon

Medicare pricing data for 4,256 providers across 50 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

Repair of toe tendon (HCPCS code 28010) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $173.90, but hospitals typically charge $775.96 — a 4.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$34.78

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $173.90, your out-of-pocket cost would be approximately $34.78. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$173.90
Average Hospital Charge
$775.96
Markup Ratio
4.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$775.96
Medicare Allowed$173.90
Medicare Payment$134.38

Hospitals charge 4.5x more than what Medicare allows for this procedure. Medicare actually pays $134.38 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Rhode Island$224$4471751+29.0%
Maine$213$556728+22.5%
District of Columbia$211$543521+21.2%
Alaska$205$1,7831762+17.8%
Massachusetts$204$76680255+17.6%
West Virginia$204$5041224+17.3%
Delaware$203$5061143+16.6%
New Jersey$200$92998252+15.1%
Hawaii$195$530935+12.1%
Connecticut$194$8082680+11.7%
California$190$7733211,258+9.3%
Wyoming$190$866518+9.2%
Maryland$190$1,03588343+9.0%
Virginia$189$671100457+8.9%
Pennsylvania$188$556209651+8.3%
Colorado$188$1,18694351+8.0%
Florida$185$6872811,100+6.6%
Illinois$183$753162672+5.3%
Georgia$183$732130459+5.0%
Washington$182$594144714+4.5%
Michigan$181$480153445+4.2%
New York$180$614173784+3.3%
New Mexico$179$4142193+2.8%
Oregon$179$65784488+2.8%
Oklahoma$179$49849324+2.7%
South Dakota$174$4901144-0.1%
Ohio$173$686183610-0.5%
Missouri$173$92482345-0.7%
Kentucky$172$47556307-0.9%
New Hampshire$171$1,57530233-1.5%
Texas$171$6972531,016-1.8%
Arizona$170$562138820-2.1%
Kansas$169$1,04145194-2.7%
North Carolina$169$629134627-2.9%
Louisiana$167$86949207-3.7%
Utah$166$85388436-4.3%
Tennessee$165$663121608-5.4%
Idaho$163$60950213-6.1%
South Carolina$163$61981502-6.1%
Indiana$162$710141781-6.7%
Mississippi$162$6305123-6.8%
Alabama$161$43939256-7.2%
Arkansas$155$97832198-10.6%
Minnesota$151$86477330-13.3%
Iowa$150$77261294-13.6%
Wisconsin$146$2,74894483-16.2%
Nebraska$143$68344290-17.5%
Montana$141$78734170-19.0%
Nevada$131$1,25927200-24.7%
North Dakota$123$83323196-29.3%

⚠️ 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

💊 Need post-procedure medications? Check costs on OpenPrescriber

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