28750

Fusion of big toe at joint with foot

Medicare pricing data for 5,787 providers across 51 states

🤖AI Overview

Prices vary significantly by location — from $484 in South Dakota to $2,486 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

Fusion of big toe at joint with foot (HCPCS code 28750) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,450, but hospitals typically charge $5,557 — a 3.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$290.02

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,450, your out-of-pocket cost would be approximately $290.02. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,450
Average Hospital Charge
$5,557
Markup Ratio
3.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$5,556.52
Medicare Allowed$1,450.11
Medicare Payment$1,151.45

Hospitals charge 3.8x more than what Medicare allows for this procedure. Medicare actually pays $1,151 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$2,486$13,0611846+71.4%
Oregon$2,092$6,529102357+44.2%
Maryland$2,003$8,933109361+38.1%
Delaware$1,996$6,42026131+37.6%
California$1,878$7,3194601,422+29.5%
Wyoming$1,855$6,0651850+27.9%
Nevada$1,826$6,42943147+25.9%
Connecticut$1,821$6,69266175+25.6%
Hawaii$1,816$4,0021026+25.2%
New Hampshire$1,778$8,97731160+22.6%
Mississippi$1,762$8,22129215+21.5%
Illinois$1,675$6,766228738+15.5%
Iowa$1,665$6,54599568+14.8%
Colorado$1,625$6,898143489+12.1%
Georgia$1,612$5,657168558+11.2%
Minnesota$1,587$6,480130424+9.4%
Washington$1,577$4,210186603+8.8%
Virginia$1,564$4,726154781+7.9%
New Jersey$1,530$7,497114250+5.5%
North Carolina$1,493$4,504188850+3.0%
Alabama$1,488$3,67869206+2.6%
Arizona$1,480$5,369170691+2.1%
Tennessee$1,470$4,641144596+1.4%
Florida$1,427$6,2163761,307-1.6%
Missouri$1,423$4,617112395-1.9%
Indiana$1,414$7,750170553-2.5%
New Mexico$1,388$4,17343116-4.3%
Utah$1,360$5,56776185-6.2%
Montana$1,336$4,17937161-7.9%
Kansas$1,308$4,71948190-9.8%
Texas$1,307$5,1393911,369-9.8%
Louisiana$1,299$5,06571189-10.4%
New York$1,276$5,764212541-12.0%
Michigan$1,272$5,724217538-12.3%
Pennsylvania$1,265$4,310250798-12.8%
Arkansas$1,226$5,30147260-15.4%
South Carolina$1,222$4,314104454-15.7%
North Dakota$1,178$5,16718148-18.8%
Rhode Island$1,178$4,0352770-18.8%
Maine$1,122$3,6661831-22.6%
Idaho$1,115$2,85245123-23.1%
Nebraska$1,114$4,79077328-23.2%
Ohio$1,073$3,374248669-26.0%
District of Columbia$1,038$3,9301129-28.4%
Massachusetts$1,006$4,250101309-30.6%
Wisconsin$954$6,153143403-34.2%
Kentucky$835$2,90555237-42.4%
Oklahoma$725$1,88345141-50.0%
West Virginia$673$2,5352560-53.6%
Vermont$513$2,225821-64.6%
South Dakota$484$1,98626134-66.6%

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

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