12051

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less

Medicare pricing data for 12,078 providers across 52 states

🤖AI Overview

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

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less (HCPCS code 12051) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $191.32, but hospitals typically charge $649.78 — a 3.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$38.26

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $191.32, your out-of-pocket cost would be approximately $38.26. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$191.32
Average Hospital Charge
$649.78
Markup Ratio
3.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$649.78
Medicare Allowed$191.32
Medicare Payment$148.24

Hospitals charge 3.4x more than what Medicare allows for this procedure. Medicare actually pays $148.24 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$266$6612679+39.3%
Hawaii$246$57746201+28.7%
Wyoming$223$62321195+16.6%
California$223$7001,1424,855+16.3%
Delaware$218$61649141+13.8%
New York$215$8746141,935+12.1%
Washington$214$607274817+11.7%
Maryland$211$6462681,466+10.4%
Nevada$206$61186275+7.9%
New Jersey$203$8603111,014+6.3%
Mississippi$203$525145853+6.1%
Colorado$201$663207844+5.3%
Connecticut$201$725129692+5.1%
Illinois$200$7425131,991+4.8%
Pennsylvania$199$5925542,225+4.2%
Puerto Rico$196$2901042+2.3%
Louisiana$195$554181789+1.9%
South Carolina$195$561252877+1.8%
Oregon$194$704169950+1.4%
Virginia$192$5363121,894+0.2%
Alaska$191$8251974+0.0%
Montana$191$52259299-0.4%
North Dakota$190$61334117-0.8%
Texas$189$6867533,057-1.2%
Rhode Island$189$66646118-1.4%
Michigan$188$6353631,237-1.9%
Florida$187$5819984,985-2.2%
Nebraska$187$625102436-2.4%
Massachusetts$182$8013541,590-5.0%
North Carolina$181$5533901,542-5.2%
Missouri$181$566255994-5.4%
Wisconsin$181$1,007239753-5.5%
Alabama$180$475149583-6.0%
Ohio$178$6004662,038-6.9%
Georgia$176$6592851,665-7.9%
Tennessee$176$5612491,056-8.0%
New Hampshire$176$82175230-8.1%
Kentucky$176$595168477-8.2%
Idaho$174$51073369-9.1%
Arizona$174$5962481,499-9.2%
Oklahoma$172$698168555-10.0%
Indiana$170$6272411,077-11.0%
West Virginia$169$50866282-11.9%
Utah$168$518126528-12.2%
Iowa$167$705157714-12.7%
Arkansas$166$536104368-13.1%
Minnesota$166$772211965-13.1%
Kansas$166$572145764-13.2%
Maine$162$64861206-15.6%
Vermont$155$49734130-18.8%
New Mexico$155$55857292-18.9%
South Dakota$151$66052303-20.9%

⚠️ 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

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