12002

Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm

Medicare pricing data for 58,014 providers across 52 states

🤖AI Overview

This procedure has a 7.1x markup — hospitals charge $454.62 but Medicare allows only $63.78. Uninsured patients may face bills 7.1 times higher than what insurance negotiates. 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

Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm (HCPCS code 12002) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $63.78, but hospitals typically charge $454.62 — a 7.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$12.76

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $63.78, your out-of-pocket cost would be approximately $12.76. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$63.78
Average Hospital Charge
$454.62
Markup Ratio
7.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$454.62
Medicare Allowed$63.78
Medicare Payment$47.64

Hospitals charge 7.1x more than what Medicare allows for this procedure. Medicare actually pays $47.64 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$80$635158329+25.5%
New York$73$5373,2906,375+15.2%
New Jersey$71$5211,3803,055+10.6%
Maryland$70$4171,1072,681+9.4%
Wyoming$70$381121232+9.1%
California$69$4364,74010,523+8.4%
New Hampshire$69$427336650+7.8%
Delaware$68$357228546+7.4%
Washington$68$4131,1262,216+5.9%
Florida$66$5223,7419,160+3.9%
Rhode Island$66$528261534+3.8%
Massachusetts$66$3611,5173,456+3.5%
Illinois$65$4782,4115,204+2.6%
Montana$65$305214437+2.5%
Utah$65$3515531,051+2.3%
Colorado$65$4211,0411,914+2.1%
Hawaii$65$392177418+1.7%
Virginia$64$4091,6093,624+0.5%
Pennsylvania$64$4272,8615,884+0.1%
Connecticut$64$4567591,522+0.1%
Georgia$64$4451,7163,533-0.1%
Nevada$63$542454855-0.7%
Idaho$63$291350682-0.8%
District of Columbia$63$383154340-0.9%
North Dakota$63$405160324-0.9%
Louisiana$63$5789341,828-1.5%
Michigan$63$4352,1834,293-1.5%
South Carolina$62$4241,2433,055-2.3%
Oregon$62$3746661,310-2.3%
New Mexico$62$468364716-2.9%
Texas$61$5443,9258,321-4.0%
West Virginia$61$394384715-4.8%
Arizona$61$4561,1182,526-4.8%
North Carolina$60$3912,1334,577-5.4%
Iowa$60$3946041,250-5.8%
Nebraska$60$369364702-6.5%
Puerto Rico$60$42474124-6.6%
Alabama$59$4028471,777-7.2%
Oklahoma$59$3808111,878-7.3%
Mississippi$59$4856411,548-7.4%
Arkansas$59$3986501,518-7.7%
Missouri$59$4081,1482,583-7.8%
Minnesota$59$5281,0671,865-7.8%
Maine$59$363317590-8.0%
Tennessee$58$4381,3302,949-8.4%
Ohio$58$4302,4074,928-8.9%
South Dakota$58$386201401-8.9%
Indiana$58$4311,3112,861-9.0%
Vermont$58$404125233-9.1%
Kentucky$58$4269351,950-9.7%
Wisconsin$58$6421,1222,061-9.8%
Kansas$57$4245921,207-10.2%

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

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