Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less
What Medicare pays for 12011, what providers bill, and how the price varies across 53 states, drawn from CMS 2023 claims data.
12011 · the short answer
For simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less, Medicare pays about $43.57 while providers bill $448.12 on average, a 10.3× markup, one of the steepest markups in the catalog. State-level Medicare rates range 47% from lowest to highest.
- Medicare pays
- $43.57
- Providers bill
- $448.12
- Markup
- 10.3×
- Markup percentile
- 91th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Skin/Integumentary Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
10 Among the most affordable more affordable than 91% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Alaska | $54.98 | $661.54 |
| New York | $49.10 | $591.62 |
| New Jersey | $48.07 | $525.85 |
| California | $47.94 | $399.72 |
| Maryland | $46.87 | $406.12 |
| Delaware | $46.68 | $364.30 |
| Florida | $45.43 | $520.67 |
| Washington | $45.09 | $407.73 |
| Illinois | $44.87 | $476.25 |
| Nevada | $44.68 | $513.38 |
| Colorado | $44.41 | $404.98 |
| Rhode Island | $44.29 | $541.61 |
| Hawaii | $44.21 | $408.24 |
| Connecticut | $44.08 | $450.65 |
| Massachusetts | $43.94 | $353.87 |
| District of Columbia | $43.90 | $377.06 |
| Guam | $43.85 | $578.83 |
| Pennsylvania | $43.62 | $385.36 |
| Michigan | $43.46 | $414.89 |
| Utah | $43.13 | $335.42 |
| New Hampshire | $42.80 | $446.58 |
| Montana | $42.75 | $289.13 |
| Georgia | $42.66 | $437.39 |
| Virginia | $42.36 | $395.68 |
| Puerto Rico | $42.32 | $454.48 |
| Texas | $42.24 | $537.46 |
| West Virginia | $41.99 | $382.67 |
| Arizona | $41.91 | $449.28 |
| South Carolina | $41.86 | $408.66 |
| Louisiana | $41.50 | $605.06 |
| Oregon | $41.45 | $352.95 |
| New Mexico | $41.44 | $439.34 |
| Missouri | $41.18 | $371.28 |
| North Carolina | $41.10 | $380.65 |
| Minnesota | $40.73 | $500.85 |
| Kansas | $40.26 | $393.59 |
| Ohio | $40.19 | $418.75 |
| Alabama | $40.06 | $405.48 |
| Arkansas | $40.05 | $406.22 |
| Wyoming | $39.83 | $364.27 |
| Idaho | $39.75 | $292.99 |
| Mississippi | $39.67 | $481.96 |
| Tennessee | $39.52 | $423.21 |
| Maine | $39.47 | $351.57 |
| Kentucky | $39.41 | $419.22 |
| Iowa | $39.27 | $390.92 |
| Indiana | $39.14 | $417.83 |
| Wisconsin | $39.00 | $620.85 |
| Oklahoma | $38.93 | $382.97 |
| North Dakota | $38.93 | $406.85 |
| Nebraska | $38.25 | $359.18 |
| Vermont | $37.89 | $409.01 |
| South Dakota | $37.42 | $368.85 |
What the Data Says About Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less
Across 53 states with reporting providers, CPT code 12011 (Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less) shows a national average Medicare payment of $43.57 against an average billed charge of $448.12. That gap, a 10.3x markup, or 929% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.
Skin/Integumentary Surgery procedures like this one saw 79.7K services billed to Medicare in 2023 by 43.1K distinct providers, serving 78.1K unique beneficiaries. State-level variation is significant: South Dakota reports the lowest average payment at $37.42, while Alaska reports the highest at $54.98. The 47% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Skin/Integumentary Surgery category (2.24x), the estimated commercial insurance price lands near $128.25, with self-pay cash discounts commonly bringing the figure closer to $166.17. Within Skin/Integumentary Surgery, Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less ranks #363 of 395 tracked procedures by national average Medicare payment.
What to do with this
If you may have simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less cost?
Medicare's national average payment for Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less (CPT 12011) is $43.57, with providers billing $448.12 on average; state rates run from $37.42 to $54.98, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less cost with insurance?
With commercial insurance, simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less costs an estimated $128.25 on average (range: $89.78-$179.55), a moderate premium over Medicare's $43.57. Without insurance, the estimated cash price is $166.17.
Which state has the lowest cost for Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less?
South Dakota has the lowest average Medicare payment for Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less at $37.42, while Alaska has the highest at $54.98 - a meaningful $17.57 spread.
How many providers perform Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less?
Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less is a widely-performed procedure: 43.1K providers billed Medicare for it in 2023 across 53 states, together handling 79.7K services for 78.1K beneficiaries.
What is the billed-to-Medicare markup for Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less?
Providers bill 10.3x what Medicare pays for Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 Cm Or Less - one of the steepest markups in the catalog at 929% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.