13133

Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less

Medicare pricing data for 2,040 providers across 49 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, each additional 5.0 cm or less (HCPCS code 13133) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $164.37, but hospitals typically charge $412.43 — a 2.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$32.87

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $164.37, your out-of-pocket cost would be approximately $32.87. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$164.37
Average Hospital Charge
$412.43
Markup Ratio
2.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$412.43
Medicare Allowed$164.37
Medicare Payment$131.26

Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $131.26 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$183$53795347+11.5%
Maryland$182$35022118+11.0%
California$179$3502311,088+8.8%
Hawaii$177$450934+8.0%
New Jersey$177$57042254+7.5%
Massachusetts$173$54444225+5.5%
Illinois$170$54257322+3.6%
Delaware$170$3021133+3.5%
Colorado$170$38951248+3.4%
Florida$169$3812741,096+2.5%
Pennsylvania$167$39770272+1.7%
Washington$167$36348172+1.7%
Montana$167$3741023+1.7%
Connecticut$166$4591777+1.0%
Virginia$165$40247254+0.2%
Minnesota$164$47526880.0%
Oregon$164$4792176-0.1%
Texas$164$429160963-0.1%
Nevada$164$34828174-0.5%
Michigan$163$37548143-1.0%
Louisiana$160$33723130-2.6%
Rhode Island$160$447836-3.0%
Arizona$159$35360210-3.1%
Ohio$159$34853203-3.3%
Georgia$158$46265425-3.6%
North Carolina$158$39769370-3.8%
Kentucky$157$33821106-4.5%
South Carolina$157$41439274-4.6%
Alabama$157$36233204-4.7%
Oklahoma$156$3141895-5.4%
New Hampshire$155$5161331-5.5%
Arkansas$155$32322134-5.7%
West Virginia$154$385939-6.3%
Missouri$154$33533189-6.3%
Utah$152$29626120-7.6%
Tennessee$151$28649166-7.9%
Indiana$151$43436192-8.0%
Nebraska$151$4121325-8.2%
Iowa$150$5851034-9.0%
Kansas$149$3111445-9.1%
South Dakota$146$2361152-11.3%
Maine$146$366430-11.3%
New Mexico$140$407615-14.6%
Wisconsin$140$82741251-14.6%
Idaho$138$3481780-15.8%
Mississippi$137$3341467-16.7%
North Dakota$131$248789-20.1%
Wyoming$121$406226-26.3%
Vermont$117$322713-28.8%

⚠️ 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

💊 Need post-procedure medications? Check costs on OpenPrescriber

🏥 See Medicare hospital data on OpenMedicare