12052

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm

Medicare pricing data for 11,837 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, 2.6-5.0 cm (HCPCS code 12052) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $190.59, but hospitals typically charge $701.31 — a 3.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$38.12

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $190.59, your out-of-pocket cost would be approximately $38.12. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$190.59
Average Hospital Charge
$701.31
Markup Ratio
3.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$701.31
Medicare Allowed$190.59
Medicare Payment$149.50

Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $149.50 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$248$66947160+30.3%
District of Columbia$243$7104387+27.7%
California$224$8061,0806,996+17.3%
Washington$217$6672681,682+14.0%
Maryland$216$6792602,311+13.5%
Puerto Rico$214$325717+12.4%
Nevada$213$71878409+11.9%
Wyoming$212$84831428+11.4%
South Carolina$211$6352452,229+10.6%
New Jersey$206$8422741,381+8.0%
Nebraska$206$65695661+7.9%
Connecticut$203$8591591,366+6.5%
Oregon$202$8121591,522+6.2%
Illinois$201$7374463,210+5.6%
Texas$200$6867636,843+4.9%
New York$198$8335082,935+3.8%
Delaware$197$64652223+3.2%
Michigan$196$7043351,704+2.9%
Idaho$195$56581895+2.2%
Florida$195$6131,0128,794+2.1%
Alaska$195$1,02430381+2.1%
Rhode Island$194$92156148+1.9%
Colorado$194$7012171,589+1.5%
Virginia$191$5903374,720+0.4%
Montana$191$51658698+0.3%
Louisiana$189$5741721,587-0.7%
Massachusetts$186$9003313,238-2.6%
Pennsylvania$186$6455654,312-2.6%
Alabama$185$5251791,388-2.8%
Mississippi$185$6831381,546-3.2%
Arizona$184$6902202,434-3.4%
North Carolina$184$6354214,952-3.7%
Maine$183$67950237-4.0%
Georgia$182$7122982,945-4.6%
Oklahoma$180$7141501,426-5.3%
Kansas$179$7531431,818-5.9%
Missouri$178$6692732,236-6.4%
Utah$178$5881301,126-6.6%
South Dakota$176$65449307-7.6%
Tennessee$175$6242432,488-8.3%
Iowa$174$8491531,540-8.8%
Ohio$172$7114463,706-9.5%
Indiana$171$6732251,847-10.1%
Vermont$169$42426430-11.4%
Kentucky$168$6631661,271-11.7%
Arkansas$163$5051241,522-14.7%
West Virginia$162$64266720-14.8%
Wisconsin$162$1,0712341,598-14.9%
Minnesota$159$8682242,264-16.4%
New Mexico$159$66257602-16.4%
New Hampshire$156$76171765-18.4%
North Dakota$126$39231223-33.7%

⚠️ 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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