69222

Complex removal of skin debris and drainage of mastoid cavity

Medicare pricing data for 1,132 providers across 40 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

Complex removal of skin debris and drainage of mastoid cavity (HCPCS code 69222) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $228.96, but hospitals typically charge $537.11 — a 2.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$45.79

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $228.96, your out-of-pocket cost would be approximately $45.79. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$228.96
Average Hospital Charge
$537.11
Markup Ratio
2.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$537.11
Medicare Allowed$228.96
Medicare Payment$170.56

Hospitals charge 2.3x more than what Medicare allows for this procedure. Medicare actually pays $170.56 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Rhode Island$273$750229+19.3%
New York$262$70295473+14.6%
District of Columbia$258$707257+12.6%
California$257$6721261,015+12.2%
New Jersey$256$67744196+11.6%
Maryland$248$44028199+8.3%
Massachusetts$247$65434190+8.0%
Connecticut$238$6161843+4.0%
Pennsylvania$234$46457340+2.3%
Virginia$228$51036152-0.4%
Washington$228$5112771-0.5%
Illinois$227$48536113-0.7%
Nevada$226$5121031-1.4%
Texas$224$54853223-2.2%
Delaware$222$532556-3.1%
Florida$221$4791271,125-3.3%
Colorado$221$57123103-3.4%
Arkansas$220$551832-3.9%
Missouri$216$49020127-5.7%
Minnesota$212$7391338-7.3%
North Carolina$212$48945160-7.6%
South Carolina$210$36438138-8.2%
Oregon$208$567651-9.2%
Oklahoma$205$6121337-10.3%
Utah$205$2276208-10.3%
Arizona$203$48326227-11.4%
Alabama$202$27225152-11.6%
Wisconsin$201$1,2831644-12.2%
Indiana$200$3291698-12.6%
Louisiana$200$5571645-12.9%
Kentucky$199$44722148-12.9%
Georgia$199$52320122-13.2%
Iowa$197$271729-14.1%
Michigan$197$36126120-14.2%
Kansas$195$567616-14.7%
Mississippi$194$521526-15.2%
Ohio$192$5662550-16.3%
Tennessee$191$5041431-16.4%
New Hampshire$173$666443-24.3%
New Mexico$140$698429-39.0%

⚠️ 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