13122

Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less

Medicare pricing data for 5,708 providers across 50 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

Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less (HCPCS code 13122) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $109.76, but hospitals typically charge $366.38 — a 3.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$21.95

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $109.76, your out-of-pocket cost would be approximately $21.95. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$109.76
Average Hospital Charge
$366.38
Markup Ratio
3.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$366.38
Medicare Allowed$109.76
Medicare Payment$87.60

Hospitals charge 3.3x more than what Medicare allows for this procedure. Medicare actually pays $87.60 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$126$30718102+14.9%
New York$122$9132971,405+11.2%
Vermont$119$252416+8.4%
Florida$118$3146923,582+7.8%
California$118$3706233,299+7.6%
Massachusetts$118$415132629+7.3%
Colorado$118$308104392+7.3%
Connecticut$117$36960263+6.6%
Nevada$116$27161367+5.7%
New Jersey$116$603166815+5.4%
Illinois$113$471179719+2.9%
Virginia$110$446129555+0.6%
Washington$110$276133539+0.6%
Texas$110$3083692,164+0.5%
North Carolina$109$294158823-0.9%
Georgia$108$3371811,049-1.3%
Delaware$108$31216161-1.7%
Rhode Island$107$31727144-2.3%
Maryland$107$29299568-2.4%
South Carolina$107$265110449-2.9%
Arizona$106$2711631,059-3.2%
Pennsylvania$105$3192351,013-4.0%
District of Columbia$104$2982096-5.3%
West Virginia$104$28832116-5.4%
Louisiana$104$30759239-5.4%
Michigan$103$294134540-5.7%
Montana$102$2822551-7.2%
Kentucky$101$28169255-7.6%
Tennessee$101$236123450-8.3%
Wisconsin$100$59781422-8.7%
Oklahoma$100$26452216-8.8%
Minnesota$99$39872190-9.6%
Alabama$99$31396558-10.1%
Maine$99$2491028-10.2%
Utah$98$25046225-10.3%
Oregon$98$32865204-10.3%
Ohio$98$298190686-10.4%
New Mexico$98$3052141-10.7%
Idaho$97$32339129-11.7%
South Dakota$97$23034148-12.1%
Missouri$96$333130558-12.9%
New Hampshire$96$33433120-13.0%
Arkansas$95$22562322-13.8%
Indiana$94$286109546-14.4%
Iowa$93$4173687-15.2%
Kansas$92$29063260-16.4%
Nebraska$90$3813387-18.0%
Mississippi$88$36161226-19.5%
North Dakota$83$28824104-24.1%
Wyoming$80$367646-26.8%

⚠️ 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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