28820

Amputation of toe at joint between forefoot and toes

Medicare pricing data for 9,223 providers across 51 states

🤖AI Overview

This procedure has a 6.5x markup — hospitals charge $1,576 but Medicare allows only $243.18. Uninsured patients may face bills 6.5 times higher than what insurance negotiates. Prices vary significantly by location — from $137 in District of Columbia to $388 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

Amputation of toe at joint between forefoot and toes (HCPCS code 28820) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $243.18, but hospitals typically charge $1,576 — a 6.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$48.64

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $243.18, your out-of-pocket cost would be approximately $48.64. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$243.18
Average Hospital Charge
$1,576
Markup Ratio
6.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,576.38
Medicare Allowed$243.18
Medicare Payment$192.31

Hospitals charge 6.5x more than what Medicare allows for this procedure. Medicare actually pays $192.31 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$388$4,9773697+59.7%
Utah$350$2,03399286+44.0%
Iowa$344$2,123131423+41.5%
Wyoming$328$2,0302899+34.9%
Colorado$327$2,193186489+34.5%
Maryland$314$1,708181662+29.0%
Kansas$306$2,03290371+26.0%
Oregon$302$1,637126325+24.1%
Washington$300$1,238247715+23.2%
Idaho$298$1,28574231+22.5%
Nebraska$291$1,80789287+19.8%
Delaware$281$1,01237116+15.5%
New Mexico$279$1,30153148+14.7%
Arizona$276$1,622198542+13.6%
Indiana$275$1,827225814+13.2%
Montana$272$1,34046129+11.9%
Illinois$266$1,9503641,051+9.3%
New Hampshire$261$2,33257147+7.2%
California$255$1,6237762,095+4.7%
Florida$252$1,4175991,666+3.7%
Alabama$252$1,206127382+3.6%
Tennessee$251$1,451231668+3.1%
Virginia$248$1,223249844+1.9%
Louisiana$246$1,581131353+1.4%
Georgia$246$1,712239600+1.1%
Michigan$238$1,269327808-2.2%
North Carolina$233$1,424294851-4.1%
Missouri$233$1,450198623-4.2%
Pennsylvania$232$1,1954871,209-4.5%
Texas$219$1,4486391,889-9.9%
New York$214$1,847388920-12.0%
Minnesota$212$1,800143522-12.7%
Mississippi$212$1,58890265-12.9%
Ohio$212$1,2603681,004-12.9%
Connecticut$211$1,65479227-13.1%
Nevada$210$1,64361132-13.5%
Arkansas$208$1,259106334-14.3%
New Jersey$207$1,572229562-14.9%
South Carolina$192$1,440174428-20.9%
Massachusetts$189$1,606175468-22.4%
Wisconsin$184$3,240219639-24.3%
Rhode Island$184$1,30042110-24.4%
North Dakota$183$1,54930172-24.9%
Kentucky$174$953135438-28.6%
Oklahoma$173$1,037112355-29.0%
Maine$167$1,13655140-31.2%
Hawaii$150$1,0962550-38.5%
Vermont$149$1,4052373-38.8%
West Virginia$146$92863212-40.0%
South Dakota$143$1,34933143-41.0%
District of Columbia$137$1,1281377-43.8%

⚠️ 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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