Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less
Medicare pricing data for 43,089 providers across 52 states
This procedure has a 7.8x markup — hospitals charge $448.12 but Medicare allows only $57.26. Uninsured patients may face bills 7.8 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 face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less (HCPCS code 12011) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $57.26, but hospitals typically charge $448.12 — a 7.8x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $57.26, your out-of-pocket cost would be approximately $11.45. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 7.8x more than what Medicare allows for this procedure. Medicare actually pays $43.57 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $72 | $662 | 86 | 136 | +26.3% |
| New York | $64 | $592 | 2,892 | 5,225 | +11.2% |
| California | $63 | $400 | 3,649 | 7,849 | +9.6% |
| Maryland | $63 | $406 | 850 | 1,784 | +9.2% |
| New Jersey | $62 | $526 | 1,152 | 2,426 | +8.8% |
| Utah | $62 | $335 | 394 | 602 | +7.5% |
| Delaware | $61 | $364 | 183 | 331 | +6.5% |
| Montana | $61 | $289 | 166 | 287 | +6.4% |
| Washington | $61 | $408 | 751 | 1,274 | +6.0% |
| Illinois | $59 | $476 | 1,906 | 3,751 | +2.9% |
| Colorado | $59 | $405 | 748 | 1,245 | +2.4% |
| Wyoming | $59 | $364 | 85 | 157 | +2.3% |
| Florida | $58 | $521 | 2,811 | 5,572 | +2.1% |
| Hawaii | $58 | $408 | 135 | 246 | +2.0% |
| Nevada | $58 | $513 | 328 | 642 | +0.9% |
| Massachusetts | $58 | $354 | 1,212 | 2,427 | +0.7% |
| Pennsylvania | $57 | $385 | 2,168 | 3,861 | +0.4% |
| Connecticut | $57 | $451 | 573 | 1,081 | -0.2% |
| Michigan | $57 | $415 | 1,647 | 2,699 | -0.8% |
| New Hampshire | $57 | $447 | 267 | 441 | -0.8% |
| Rhode Island | $57 | $542 | 212 | 405 | -1.2% |
| Oregon | $56 | $353 | 480 | 751 | -1.6% |
| District of Columbia | $56 | $377 | 126 | 237 | -1.6% |
| Georgia | $56 | $437 | 1,092 | 1,878 | -2.4% |
| Louisiana | $56 | $605 | 720 | 1,235 | -2.4% |
| Virginia | $56 | $396 | 1,178 | 2,296 | -2.5% |
| Arizona | $55 | $449 | 814 | 1,538 | -3.2% |
| Idaho | $55 | $293 | 236 | 380 | -3.4% |
| New Mexico | $55 | $439 | 241 | 385 | -3.5% |
| Puerto Rico | $55 | $454 | 46 | 78 | -3.6% |
| Texas | $55 | $537 | 2,821 | 5,129 | -3.9% |
| West Virginia | $55 | $383 | 279 | 422 | -4.2% |
| South Carolina | $55 | $409 | 909 | 1,799 | -4.7% |
| Missouri | $54 | $371 | 886 | 1,614 | -5.3% |
| Iowa | $54 | $391 | 471 | 865 | -5.5% |
| Minnesota | $54 | $501 | 757 | 1,142 | -5.8% |
| Maine | $54 | $352 | 238 | 386 | -6.0% |
| North Carolina | $54 | $381 | 1,388 | 2,432 | -6.1% |
| Alabama | $53 | $405 | 567 | 944 | -6.7% |
| Nebraska | $53 | $359 | 264 | 465 | -6.8% |
| North Dakota | $53 | $407 | 119 | 183 | -6.9% |
| Kansas | $53 | $394 | 467 | 885 | -7.2% |
| Arkansas | $53 | $406 | 432 | 811 | -8.3% |
| Ohio | $53 | $419 | 1,731 | 3,097 | -8.3% |
| Oklahoma | $52 | $383 | 564 | 1,083 | -8.5% |
| Indiana | $52 | $418 | 946 | 1,748 | -8.8% |
| Mississippi | $52 | $482 | 432 | 823 | -9.0% |
| Wisconsin | $52 | $621 | 825 | 1,363 | -9.1% |
| Kentucky | $52 | $419 | 668 | 1,144 | -10.0% |
| Vermont | $51 | $409 | 103 | 187 | -10.4% |
| South Dakota | $51 | $369 | 150 | 313 | -10.7% |
| Tennessee | $51 | $423 | 891 | 1,631 | -11.3% |
⚠️ 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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