CPT 12011 Surgery - Integumentary

How Much Does Repair of F/e/e/n/l/m 2.5 Cm/< Cost?

Also known as: Rpr f/e/e/n/l/m 2.5 cm/< (CPT 12011)

Simple wound repair on the face, ears, eyelids, nose, or lips, 2.5 cm or less.

The total estimated cost of Repair of F/e/e/n/l/m 2.5 Cm/< (CPT 12011) is $131 to $212, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $54.

Total Estimated Cost of Care

$131 — $212

This estimate includes hospital facility fees, anesthesia, and supplies .

Surgeon/Physician Fee
$54
Hospital Facility Fee
$109
Important: The physician fee of $54 shown in the cost cards below is what Medicare pays the surgeon/doctor only. The hospital charges a separate facility fee that typically makes up 70-85% of the total cost.
Medicare Physician Fee (Facility Setting)
$54
Physician component only — CMS PFS 2026
Medicare Physician Fee (Office/Clinic)
$140
Non-facility setting

Patient Guide: Repair of F/e/e/n/l/m 2.5 Cm/<

What you need to know before your appointment

What to Expect

The doctor cleans and numbs the wound, then carefully closes it with fine stitches to minimize scarring on the face.

How Long Does It Take?

15-30 minutes

Common Reasons Doctors Order This

Facial laceration, cut on the face from accident or injury

How to Prepare

Apply pressure to stop bleeding. Do not apply ointments. Facial stitches out in 5-7 days for best cosmetic result.

Procedures Commonly Done Together

These procedures are frequently performed alongside Rpr f/e/e/n/l/m 2.5 cm/<

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What Insurance Companies Actually Pay

Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)

Lowest
$0
Highest
$5,841
Average
$816
Insurance Company Avg Rate Range Hospitals
Cigna $1,038 $0 - $3,244 8
United $1,243 $119 - $2,749 9
Humana $1,654 $118 - $4,690 7
KAISER FOUNDATION HEALTH PLAN, INC. $415 $240 - $752 5
BCBS $308 $46 - $477 4
Aetna $340 $109 - $848 4
BCBS-TX $243 $131 - $335 2
Superior Health Plan $889 $299 - $948 3
CHC $404 $89 - $614 2
Anthem $3,592 $2,125 - $4,764 2
UNITED $132 $44 - $279 2
Wellpoint $170 $89 - $299 2
Average by State
KY: $233 (21) CA: $415 (15) GA: $506 (20) TN: $546 (19) TX: $824 (172) CO: $1,825 (28)
Disclaimer: These rates are from hospital Machine-Readable Files (MRFs) required by federal price transparency law. They reflect specific hospital-payer contracts and may not represent your actual cost, which depends on your plan, deductible, and network status. Data sourced from CommonSpirit Health, HCA Healthcare, and Kaiser Permanente filings.

How to Reduce Your Cost for Rpr f/e/e/n/l/m 2.5 cm/<

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    For this procedure, the office rate ($140) differs from the facility rate ($54). Ask if it can be done in an office setting.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

How is the Price Calculated?

Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.

1.04
Work RVU
0.36
Practice Expense RVU
0.23
Malpractice RVU
4.18
Total RVU

Payment = Total RVU (4.18) x CF ($33.40) = $140

Frequently Asked Questions

How much does Rpr f/e/e/n/l/m 2.5 cm/< cost?

The Medicare facility rate for Rpr f/e/e/n/l/m 2.5 cm/< is $54. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Rpr f/e/e/n/l/m 2.5 cm/< cost without insurance?

Without insurance, the cost of Rpr f/e/e/n/l/m 2.5 cm/< can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover Rpr f/e/e/n/l/m 2.5 cm/<?

Most commercial health insurance plans and Medicare cover Rpr f/e/e/n/l/m 2.5 cm/< when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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