01630

Anesthesia for other procedure on top of arm bone and shoulder joint

Medicare pricing data for 40,188 providers across 52 states

🤖AI Overview

This procedure has a 10.1x markup — hospitals charge $1,878 but Medicare allows only $186.79. Uninsured patients may face bills 10.1 times higher than what insurance negotiates. Prices vary significantly by location — from $129 in Alabama to $319 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 other procedure on top of arm bone and shoulder joint (HCPCS code 01630) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $186.79, but hospitals typically charge $1,878 — a 10.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$37.36

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $186.79, your out-of-pocket cost would be approximately $37.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$186.79
Average Hospital Charge
$1,878
Markup Ratio
10.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,877.80
Medicare Allowed$186.79
Medicare Payment$147.06

Hospitals charge 10.1x more than what Medicare allows for this procedure. Medicare actually pays $147.06 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$319$2,29385265+70.8%
Puerto Rico$308$8373990+65.1%
California$268$2,0802,4077,589+43.2%
Wyoming$251$1,93263252+34.2%
Idaho$248$1,478199559+33.0%
Washington$240$1,5637692,257+28.4%
Hawaii$235$1,67995304+25.8%
Utah$235$1,3223551,121+25.7%
Oregon$234$1,4653611,133+25.4%
Arizona$232$2,6646342,047+24.5%
New Mexico$230$2,062163406+23.3%
Montana$229$1,401150621+22.7%
Oklahoma$224$1,6465031,894+20.0%
Nevada$220$2,074246992+17.9%
Nebraska$215$1,285278899+15.1%
Maryland$215$1,9385942,181+15.0%
Arkansas$213$1,4674131,620+13.8%
Iowa$212$1,3713931,103+13.3%
New Jersey$210$2,3728492,216+12.6%
Colorado$210$2,0006432,034+12.2%
Illinois$209$2,3971,4954,131+12.1%
Indiana$209$1,6607812,212+12.1%
Louisiana$206$1,7806651,817+10.3%
New York$200$2,6971,9075,784+6.8%
Florida$199$2,1802,6878,036+6.4%
New Hampshire$194$2,243259708+3.7%
Kansas$193$1,3485441,701+3.5%
Vermont$192$1,32065169+2.9%
Texas$190$2,5042,9999,002+1.6%
District of Columbia$181$2,025126346-3.0%
Missouri$180$1,5611,0203,009-3.9%
Massachusetts$177$1,4461,1403,817-5.5%
Tennessee$175$1,6951,2244,051-6.3%
Kentucky$175$1,5896221,716-6.5%
Wisconsin$174$2,5268612,055-6.7%
Delaware$170$1,909155468-8.9%
Connecticut$166$1,9164431,310-11.1%
Mississippi$166$1,0353861,656-11.2%
Ohio$162$1,4301,7405,026-13.2%
North Dakota$159$1,269198621-15.1%
Rhode Island$158$1,220108319-15.5%
Virginia$156$1,8801,1034,217-16.5%
West Virginia$154$1,404247666-17.5%
Minnesota$154$1,4429462,195-17.7%
Maine$154$1,631297704-17.7%
South Dakota$151$1,526238855-19.2%
Michigan$150$1,8551,4844,063-19.6%
Pennsylvania$150$1,5102,1956,215-19.8%
Georgia$147$1,6641,5564,886-21.5%
South Carolina$145$1,9068973,655-22.4%
North Carolina$143$1,9191,5815,718-23.4%
Alabama$129$1,1768933,549-31.2%

⚠️ 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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