13152

Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm

Medicare pricing data for 5,732 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

Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm (HCPCS code 13152) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $280.73, but hospitals typically charge $1,291 — a 4.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$56.15

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $280.73, your out-of-pocket cost would be approximately $56.15. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$280.73
Average Hospital Charge
$1,291
Markup Ratio
4.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,290.83
Medicare Allowed$280.73
Medicare Payment$222.35

Hospitals charge 4.6x more than what Medicare allows for this procedure. Medicare actually pays $222.35 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$339$2,3923382,256+20.9%
New Jersey$333$3,463171829+18.6%
District of Columbia$331$1,1431853+17.8%
Delaware$330$90311109+17.5%
California$325$1,2796184,519+15.9%
Florida$310$1,1175986,555+10.3%
Virginia$301$1,1551441,532+7.4%
Connecticut$299$1,37058465+6.4%
Alaska$294$1,9264106+4.6%
Hawaii$291$1,197890+3.6%
Maryland$288$1,0821131,198+2.7%
South Carolina$288$1,142971,142+2.5%
Nebraska$285$1,20055245+1.5%
Colorado$284$1,162101865+1.0%
Illinois$282$1,5071791,443+0.5%
Michigan$281$1,139137778+0.0%
Texas$280$1,1583733,426-0.1%
Georgia$277$1,2491892,238-1.3%
Massachusetts$275$1,5121351,392-2.1%
Oregon$274$1,38065430-2.2%
Arizona$274$1,1651681,727-2.4%
Iowa$273$1,66261479-2.8%
West Virginia$271$1,05330315-3.5%
North Carolina$268$1,1501651,778-4.6%
Wyoming$267$1,03210198-5.0%
Rhode Island$266$1,43420187-5.1%
Pennsylvania$265$1,2372472,100-5.6%
Nevada$264$1,00138444-5.9%
Kentucky$263$1,20577756-6.4%
Puerto Rico$261$505836-7.0%
Utah$260$93664479-7.4%
Ohio$259$9861661,224-7.6%
Washington$259$1,1081171,145-7.7%
Minnesota$254$1,43089507-9.7%
Louisiana$253$94856563-9.8%
Mississippi$250$1,23563558-10.9%
Indiana$249$1,429100886-11.1%
Kansas$245$1,09969710-12.9%
Oklahoma$243$1,06850513-13.3%
Missouri$243$1,2361311,410-13.5%
Wisconsin$242$2,233105949-13.8%
Idaho$242$95844373-13.9%
Tennessee$242$9841301,215-14.0%
New Mexico$239$1,13417144-14.9%
Maine$234$1,07710151-16.5%
New Hampshire$234$1,55128256-16.5%
Alabama$233$1,126931,472-16.9%
Montana$233$96624245-17.0%
Vermont$226$63610101-19.4%
Arkansas$224$88053681-20.2%
North Dakota$213$85518281-24.2%
South Dakota$208$63025239-26.0%

⚠️ 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