28470

Closed treatment of broken bone in forefoot or midfoot

Medicare pricing data for 9,358 providers across 47 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

Closed treatment of broken bone in forefoot or midfoot (HCPCS code 28470) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $194.31, but hospitals typically charge $762.81 — a 3.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$38.86

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $194.31, your out-of-pocket cost would be approximately $38.86. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$194.31
Average Hospital Charge
$762.81
Markup Ratio
3.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$762.81
Medicare Allowed$194.31
Medicare Payment$149.24

Hospitals charge 3.9x more than what Medicare allows for this procedure. Medicare actually pays $149.24 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$228$542811+17.5%
New York$226$1,0577841,854+16.5%
New Jersey$222$1,158371978+14.1%
Connecticut$210$649142365+8.0%
Maryland$208$727266628+7.2%
Montana$206$517613+6.3%
Massachusetts$205$791303725+5.4%
Delaware$204$80944134+5.0%
Rhode Island$202$66549109+4.1%
California$200$8595731,033+2.8%
Pennsylvania$199$6737051,884+2.4%
Florida$198$7016731,987+1.8%
Illinois$196$836383868+0.8%
Colorado$195$84096165+0.4%
Virginia$194$696232484-0.4%
Michigan$191$534435898-1.6%
North Dakota$190$7422152-2.1%
Arizona$188$712158406-3.1%
Maine$188$4921119-3.1%
Nevada$188$1,0825281-3.5%
Utah$187$56182153-4.0%
New Hampshire$185$8243057-4.8%
Alabama$185$585212534-4.8%
Minnesota$185$866149234-4.9%
New Mexico$184$54554127-5.4%
Georgia$183$813239563-5.7%
Louisiana$183$62297222-5.9%
Oregon$182$7374781-6.1%
South Carolina$182$630174502-6.3%
Indiana$182$635237586-6.3%
West Virginia$182$59983196-6.4%
South Dakota$182$8122748-6.5%
Ohio$180$6365761,084-7.3%
Kentucky$179$660124318-7.7%
Kansas$179$631101189-7.9%
North Carolina$179$684290531-8.1%
Wisconsin$178$1,21799154-8.5%
Iowa$178$713104251-8.6%
Washington$177$786115164-9.2%
Arkansas$176$49450134-9.4%
Missouri$176$696205446-9.4%
Texas$173$858433717-11.1%
Tennessee$171$694185354-11.7%
Mississippi$171$772110330-12.1%
Oklahoma$170$72080151-12.6%
Nebraska$164$6194372-15.6%
Idaho$156$6663657-19.5%

⚠️ 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