29425

Application of walking cast covering below knee to toe

Medicare pricing data for 2,072 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

Application of walking cast covering below knee to toe (HCPCS code 29425) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $72.45, but hospitals typically charge $261.04 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$14.49

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $72.45, your out-of-pocket cost would be approximately $14.49. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$72.45
Average Hospital Charge
$261.04
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$261.04
Medicare Allowed$72.45
Medicare Payment$55.65

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $55.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$87$2172382+20.0%
New Jersey$84$39384913+15.4%
New York$81$304106309+11.8%
California$80$2382691,038+10.9%
Hawaii$78$168319+7.8%
Connecticut$77$19734227+6.9%
Massachusetts$76$2603066+5.4%
Pennsylvania$76$24557126+5.4%
Rhode Island$76$165420+4.2%
Puerto Rico$75$100319+2.9%
Illinois$74$29278388+2.5%
Colorado$74$19735138+2.1%
New Mexico$72$164823-0.1%
Washington$72$23232155-0.1%
Michigan$71$208101415-1.4%
Nevada$71$2302675-1.7%
Arizona$71$22462347-2.3%
Virginia$70$24464141-2.9%
Texas$70$231131650-3.0%
Minnesota$70$2832461-4.1%
Louisiana$69$2612084-5.2%
West Virginia$68$226840-5.5%
Missouri$68$26942199-5.7%
Ohio$68$23459156-5.7%
New Hampshire$68$2601031-6.2%
Florida$68$232133794-6.5%
Kansas$68$33614123-6.6%
Oregon$67$2542568-7.7%
Alabama$67$24152219-7.9%
Kentucky$66$21744124-9.3%
Iowa$66$3053184-9.6%
Georgia$66$24760263-9.6%
Indiana$66$25156173-9.6%
North Carolina$65$24294318-9.8%
Utah$65$184927-9.9%
Oklahoma$65$17225108-10.0%
Wisconsin$65$6092193-10.6%
Nebraska$64$3031018-11.2%
South Carolina$64$2193180-11.3%
Tennessee$64$27482235-11.5%
Mississippi$62$25828195-14.3%
Arkansas$60$2141254-17.2%

⚠️ 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