28510

Closed treatment of broken toe

Medicare pricing data for 3,316 providers across 42 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 toe (HCPCS code 28510) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $114.62, but hospitals typically charge $346.87 — a 3.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$22.92

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $114.62, your out-of-pocket cost would be approximately $22.92. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$114.62
Average Hospital Charge
$346.87
Markup Ratio
3.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$346.87
Medicare Allowed$114.62
Medicare Payment$86.33

Hospitals charge 3.0x more than what Medicare allows for this procedure. Medicare actually pays $86.33 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$131$3855051,102+13.9%
New Jersey$128$478202468+12.0%
California$123$332157313+7.5%
Hawaii$121$2741326+5.1%
Maryland$120$316100230+4.9%
Colorado$120$3212735+4.3%
Delaware$119$3231767+3.9%
Connecticut$118$39967135+3.3%
Rhode Island$118$2892354+3.1%
Pennsylvania$115$345253609+0.6%
Florida$114$300273811-0.9%
Michigan$113$268159335-1.3%
Alaska$113$7081111-1.3%
Virginia$111$30377155-3.4%
Massachusetts$111$391122234-3.5%
Minnesota$110$4882130-4.3%
Washington$109$3291318-5.0%
Illinois$109$414137290-5.2%
Oregon$108$3841422-5.7%
Wisconsin$108$6511825-6.0%
Kansas$108$3281929-6.0%
Arizona$107$27446157-6.4%
Texas$106$30988151-7.4%
Iowa$106$4032843-7.9%
Nevada$105$3751319-8.2%
Arkansas$105$2451324-8.6%
Ohio$105$287150256-8.6%
Utah$105$2622736-8.8%
Alabama$104$27763104-9.2%
North Carolina$104$29893151-9.6%
Georgia$103$41182155-10.2%
South Carolina$103$36859129-10.4%
West Virginia$102$2752546-11.3%
Indiana$101$32388143-12.1%
Kentucky$100$3102649-12.5%
Oklahoma$100$2592632-12.9%
Louisiana$99$3503566-13.3%
New Mexico$99$3312654-13.4%
Tennessee$99$2825383-13.7%
Missouri$93$28271147-19.0%
Nebraska$91$3001213-20.2%
Mississippi$89$4243753-22.6%

⚠️ 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