65435

Removal of outer layer of cornea

Medicare pricing data for 1,594 providers across 46 states

🤖AI Overview

Prices vary significantly by location — from $28 in Montana to $90 in New Jersey. Where you get this procedure matters more than almost any other factor. 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

Removal of outer layer of cornea (HCPCS code 65435) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $74.30, but hospitals typically charge $206.80 — a 2.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$14.86

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $74.30, your out-of-pocket cost would be approximately $14.86. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$74.30
Average Hospital Charge
$206.80
Markup Ratio
2.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$206.80
Medicare Allowed$74.30
Medicare Payment$56.06

Hospitals charge 2.8x more than what Medicare allows for this procedure. Medicare actually pays $56.06 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$90$2224997+21.2%
California$88$250140421+18.4%
New York$87$30277162+17.4%
Massachusetts$87$39739143+17.4%
Connecticut$87$2141743+16.9%
Utah$84$2511322+12.5%
Washington$83$2032545+11.6%
South Dakota$82$150613+10.5%
Illinois$82$22570196+10.4%
Colorado$82$3312467+9.8%
Maryland$81$2282654+9.6%
Texas$81$240120354+9.2%
Nevada$80$223923+8.3%
Delaware$80$1131123+8.1%
Iowa$80$1762665+7.8%
North Dakota$79$2101020+5.8%
Maine$79$165516+5.7%
Oregon$78$1922328+5.5%
Minnesota$78$2322541+5.3%
Virginia$78$24354241+4.6%
Nebraska$77$1951428+4.1%
New Hampshire$77$1481316+3.5%
North Carolina$77$15643101+3.2%
Pennsylvania$76$19878251+2.5%
Missouri$76$14932131+1.9%
Georgia$75$2053889+1.6%
Indiana$75$1563045+1.4%
Rhode Island$75$215714+1.1%
Wisconsin$75$40939102+0.8%
Alabama$75$1421844+0.3%
Hawaii$75$1911026+0.3%
Kentucky$74$1452660+0.2%
South Carolina$74$21434111+0.0%
Kansas$74$2142576-0.3%
Mississippi$74$1962240-0.4%
Louisiana$74$2252247-0.5%
Ohio$73$27657172-1.2%
Idaho$73$1411128-1.8%
Arizona$72$1452672-2.6%
Oklahoma$72$1982045-3.3%
Michigan$70$20751105-5.8%
Arkansas$69$1401122-7.3%
Tennessee$68$20443120-8.4%
Florida$68$1731232,791-9.1%
New Mexico$59$148931-20.7%
Montana$28$100343-62.6%

⚠️ 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