01392

Anesthesia for procedure on kneecap and/or upper part of lower leg bones

Medicare pricing data for 16,795 providers across 52 states

🤖AI Overview

This procedure has a 10.3x markup — hospitals charge $1,944 but Medicare allows only $188.41. Uninsured patients may face bills 10.3 times higher than what insurance negotiates. Prices vary significantly by location — from $139 in South Carolina to $321 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 kneecap and/or upper part of lower leg bones (HCPCS code 01392) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $188.41, but hospitals typically charge $1,944 — a 10.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$37.68

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $188.41, your out-of-pocket cost would be approximately $37.68. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$188.41
Average Hospital Charge
$1,944
Markup Ratio
10.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,943.78
Medicare Allowed$188.41
Medicare Payment$148.10

Hospitals charge 10.3x more than what Medicare allows for this procedure. Medicare actually pays $148.10 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$321$1,8693743+70.3%
Montana$269$1,4985368+42.9%
California$264$2,0651,1251,521+39.9%
Utah$252$1,585116157+33.8%
Hawaii$251$1,7472530+33.3%
Puerto Rico$249$1,2221618+32.4%
Oregon$247$1,598158194+31.1%
Idaho$234$1,6326881+24.4%
Washington$231$1,744361447+22.8%
Nebraska$231$1,527140172+22.5%
District of Columbia$226$1,9227792+20.1%
Arizona$223$2,539315413+18.6%
Nevada$222$2,057124167+18.1%
New York$218$2,8177771,023+15.6%
New Mexico$217$2,04877102+15.4%
Maryland$215$2,056303404+13.9%
New Jersey$214$2,563349448+13.6%
Delaware$214$1,8336290+13.4%
Iowa$207$1,427144174+9.8%
Indiana$205$1,763287368+8.5%
Wyoming$203$1,9842228+7.9%
Illinois$201$2,495641805+6.7%
Colorado$196$1,908318415+4.2%
Arkansas$196$1,428129158+3.9%
Massachusetts$194$1,534414541+2.8%
Florida$193$2,1291,2441,599+2.6%
Rhode Island$193$1,6692732+2.4%
Oklahoma$190$1,785209268+1.0%
Kansas$190$1,400220275+0.7%
Kentucky$189$1,758264341+0.1%
Connecticut$187$2,133217271-0.8%
Vermont$182$1,2623341-3.2%
Texas$178$2,2541,2911,659-5.4%
New Hampshire$178$2,48584102-5.8%
Tennessee$177$1,621508660-5.8%
Louisiana$177$1,445270330-6.2%
Wisconsin$172$2,650303385-8.7%
Ohio$171$1,507651805-9.3%
Missouri$167$1,449465616-11.2%
Maine$162$2,00786110-14.2%
Michigan$160$2,179551717-14.9%
Pennsylvania$157$1,6638491,056-16.4%
Mississippi$157$1,063181237-16.9%
Virginia$156$1,953518683-17.0%
West Virginia$152$1,77294118-19.1%
Minnesota$150$1,467390473-20.2%
North Carolina$146$1,869648840-22.4%
Georgia$144$1,678589751-23.3%
North Dakota$143$1,2817188-24.1%
South Dakota$140$1,64297131-25.9%
Alabama$139$1,487329435-26.0%
South Carolina$139$1,973397536-26.2%

⚠️ 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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