28285

Correction of toe joint deformity

Medicare pricing data for 10,387 providers across 52 states

🤖AI Overview

This procedure has a 6.8x markup — hospitals charge $2,948 but Medicare allows only $430.90. Uninsured patients may face bills 6.8 times higher than what insurance negotiates. Prices vary significantly by location — from $225 in South Dakota to $618 in Alaska. 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

Correction of toe joint deformity (HCPCS code 28285) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $430.90, but hospitals typically charge $2,948 — a 6.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$86.18

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $430.90, your out-of-pocket cost would be approximately $86.18. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$430.90
Average Hospital Charge
$2,948
Markup Ratio
6.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,948.21
Medicare Allowed$430.90
Medicare Payment$342.14

Hospitals charge 6.8x more than what Medicare allows for this procedure. Medicare actually pays $342.14 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$618$7,55022194+43.5%
Maryland$578$3,0642651,895+34.0%
California$537$3,8299306,264+24.6%
New Jersey$508$4,4004232,017+17.8%
Wyoming$503$3,22226147+16.7%
Delaware$497$2,90856705+15.3%
Washington$489$1,9052502,237+13.6%
Oregon$482$2,4171561,028+11.8%
Illinois$471$3,3804693,558+9.4%
Connecticut$468$3,156128710+8.7%
Utah$464$3,487122776+7.6%
New Hampshire$459$4,62439356+6.4%
Kansas$455$3,358831,096+5.6%
Colorado$452$3,9892111,663+4.8%
Nevada$451$4,22379664+4.6%
Florida$448$3,4917165,613+4.0%
Arizona$448$3,3702682,641+4.0%
Minnesota$448$2,8291701,341+4.0%
Idaho$445$1,70476838+3.2%
Indiana$435$3,2162372,042+0.9%
Virginia$433$2,6182592,428+0.5%
Missouri$425$2,9682021,504-1.4%
Mississippi$418$2,89752518-3.0%
North Carolina$413$2,2662902,446-4.1%
Nebraska$411$2,61178759-4.7%
Georgia$409$3,1273142,304-5.0%
New Mexico$408$2,64466469-5.2%
Iowa$406$2,5131321,512-5.8%
Texas$405$3,3247485,912-6.0%
Louisiana$401$2,5171131,065-6.8%
Alabama$396$1,824135868-8.0%
Pennsylvania$395$1,9995033,110-8.3%
Tennessee$389$2,9022172,208-9.7%
South Carolina$386$2,3881591,902-10.5%
Wisconsin$379$4,2872031,373-12.0%
Michigan$378$2,2183621,840-12.2%
Montana$377$1,72552382-12.4%
New York$375$2,8536043,606-13.0%
Massachusetts$369$2,0602271,576-14.5%
Arkansas$368$1,76384838-14.5%
Puerto Rico$354$7581250-17.8%
Ohio$349$1,9803912,251-19.1%
Maine$344$1,63525102-20.1%
North Dakota$343$1,94327412-20.5%
Hawaii$342$1,4131558-20.7%
District of Columbia$332$1,73927169-23.1%
Rhode Island$322$1,64959329-25.3%
Oklahoma$279$1,207111783-35.2%
West Virginia$267$1,41133170-38.1%
Kentucky$248$1,35199631-42.4%
Vermont$238$1,5131159-44.7%
South Dakota$225$1,39224259-47.8%

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

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