13120

Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm

Medicare pricing data for 2,495 providers across 46 states

🤖AI Overview

Prices vary significantly by location — from $157 in South Dakota to $379 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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

Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm (HCPCS code 13120) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $275.47, but hospitals typically charge $746.94 — a 2.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$55.09

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $275.47, your out-of-pocket cost would be approximately $55.09. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$275.47
Average Hospital Charge
$746.94
Markup Ratio
2.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$746.94
Medicare Allowed$275.47
Medicare Payment$215.15

Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $215.15 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$379$1,0237128+37.6%
New York$317$1,132156634+14.9%
Delaware$312$864823+13.1%
Hawaii$307$797611+11.6%
Pennsylvania$300$69974223+9.0%
California$298$6954051,842+8.3%
Virginia$293$1,06750141+6.2%
Kansas$292$7942039+6.1%
Nevada$288$77343135+4.5%
Florida$286$6684142,907+3.8%
Oregon$285$8003189+3.6%
Maryland$282$71235100+2.3%
New Jersey$277$81573335+0.5%
Michigan$268$79946109-2.9%
Arizona$267$672111377-3.2%
Wisconsin$263$1,0661634-4.7%
South Carolina$257$77338101-6.7%
Texas$256$709133446-7.1%
Louisiana$255$6192176-7.3%
Illinois$255$1,00386291-7.5%
Georgia$254$80490260-7.7%
North Carolina$254$74450131-7.7%
Colorado$253$85552171-8.1%
Idaho$250$6251629-9.3%
Connecticut$250$9351525-9.3%
Massachusetts$246$1,03739118-10.6%
Washington$246$72055151-10.9%
Indiana$245$7033180-11.0%
Tennessee$236$59045241-14.3%
Missouri$232$76233112-15.6%
Minnesota$230$8411426-16.6%
Ohio$230$59661212-16.7%
Rhode Island$229$755656-16.9%
Iowa$220$8291438-20.3%
Utah$219$6242267-20.7%
Nebraska$218$8281434-20.8%
Mississippi$216$6251450-21.4%
Oklahoma$212$78918108-23.1%
Kentucky$205$6281877-25.5%
Montana$203$579515-26.3%
Arkansas$203$6251667-26.4%
Alabama$202$6612787-26.5%
New Mexico$200$6591454-27.4%
West Virginia$188$5551497-31.8%
New Hampshire$187$7381018-32.2%
South Dakota$157$868822-43.1%

⚠️ 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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