01250

Anesthesia for procedure on nerves, muscles, tendons, and tissue of upper leg

Medicare pricing data for 15,089 providers across 52 states

🤖AI Overview

This procedure has a 10.3x markup — hospitals charge $1,559 but Medicare allows only $151.79. Uninsured patients may face bills 10.3 times higher than what insurance negotiates. Prices vary significantly by location — from $115 in North Dakota to $266 in Alaska. Where you get this procedure matters more than almost any other factor. 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

Anesthesia for procedure on nerves, muscles, tendons, and tissue of upper leg (HCPCS code 01250) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $151.79, but hospitals typically charge $1,559 — a 10.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$30.36

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $151.79, your out-of-pocket cost would be approximately $30.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$151.79
Average Hospital Charge
$1,559
Markup Ratio
10.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,558.54
Medicare Allowed$151.79
Medicare Payment$119.65

Hospitals charge 10.3x more than what Medicare allows for this procedure. Medicare actually pays $119.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$266$1,7133441+75.4%
California$210$1,6869511,186+38.5%
Utah$204$1,31192119+34.4%
Puerto Rico$202$1,2471517+32.8%
Wyoming$196$1,6111515+29.3%
Idaho$191$1,2425368+25.8%
Washington$190$1,439329382+25.1%
Montana$187$1,1545260+23.3%
Nebraska$184$1,125126154+21.3%
Iowa$182$1,162103121+19.8%
New Mexico$180$1,6356577+18.6%
Oregon$179$1,080145182+17.8%
Indiana$171$1,420275334+12.8%
Maryland$170$1,550287378+12.2%
Nevada$169$1,93596120+11.1%
Colorado$167$1,656291384+9.7%
New York$165$2,0768851,188+8.7%
Massachusetts$164$1,274457606+8.3%
Missouri$162$1,332361436+6.4%
Illinois$161$1,955523642+5.9%
Arkansas$161$1,061130163+5.8%
Florida$158$1,7161,0751,358+4.2%
New Hampshire$157$1,8797184+3.5%
District of Columbia$157$1,2817782+3.4%
Kentucky$156$1,425192229+2.5%
Vermont$154$8732836+1.5%
Oklahoma$153$1,421165217+1.1%
Arizona$153$2,355269400+0.7%
Texas$151$1,9601,0811,449-0.8%
Tennessee$148$1,494405477-2.4%
Louisiana$147$1,335224275-2.9%
Delaware$146$1,4265664-3.9%
Connecticut$142$1,642171208-6.4%
Ohio$141$1,286676822-7.0%
New Jersey$138$1,366303447-8.9%
Wisconsin$138$2,177345419-9.1%
Hawaii$134$2,2122270-11.7%
Virginia$130$1,565357436-14.2%
Kansas$130$754242360-14.7%
Minnesota$129$1,299388450-14.8%
Pennsylvania$127$1,1399251,186-16.1%
South Dakota$127$1,55188122-16.4%
North Carolina$127$1,514555666-16.6%
Georgia$125$1,283483583-17.5%
Rhode Island$124$9114050-18.4%
Maine$124$1,4607890-18.6%
Michigan$123$1,778491641-18.9%
South Carolina$121$1,647370488-20.0%
Mississippi$118$786144197-22.3%
West Virginia$117$990107134-22.8%
Alabama$116$1,293244290-23.7%
North Dakota$115$1,0336887-24.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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