Prosthetic repair of shoulder joint, total shoulder
Medicare pricing data for 12,191 providers across 52 states
This procedure has a 5.2x markup — hospitals charge $4,933 but Medicare allows only $948.93. Uninsured patients may face bills 5.2 times higher than what insurance negotiates. Prices vary significantly by location — from $735 in Nebraska to $1,560 in District of Columbia. 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
Prosthetic repair of shoulder joint, total shoulder (HCPCS code 23472) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $948.93, but hospitals typically charge $4,933 — a 5.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $948.93, your out-of-pocket cost would be approximately $189.79. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 5.2x more than what Medicare allows for this procedure. Medicare actually pays $754.40 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $1,560 | $6,857 | 13 | 167 | +64.4% |
| Puerto Rico | $1,418 | $1,984 | 17 | 38 | +49.4% |
| Hawaii | $1,254 | $5,514 | 22 | 123 | +32.1% |
| New York | $1,124 | $7,239 | 579 | 4,337 | +18.4% |
| Alaska | $1,078 | $9,061 | 58 | 515 | +13.6% |
| Maryland | $1,077 | $4,186 | 190 | 2,303 | +13.5% |
| California | $1,069 | $4,174 | 814 | 7,827 | +12.6% |
| Nevada | $1,065 | $6,046 | 93 | 958 | +12.2% |
| Rhode Island | $1,044 | $6,824 | 36 | 301 | +10.0% |
| Mississippi | $1,030 | $4,903 | 85 | 1,004 | +8.6% |
| Michigan | $1,025 | $3,500 | 378 | 3,341 | +8.0% |
| Pennsylvania | $1,024 | $5,159 | 575 | 4,937 | +8.0% |
| Missouri | $1,018 | $5,923 | 267 | 3,084 | +7.3% |
| Massachusetts | $1,010 | $6,827 | 271 | 3,011 | +6.4% |
| Illinois | $989 | $7,538 | 457 | 4,456 | +4.2% |
| Tennessee | $981 | $4,132 | 251 | 3,109 | +3.4% |
| Georgia | $978 | $5,233 | 307 | 2,861 | +3.1% |
| New Mexico | $977 | $3,618 | 71 | 592 | +3.0% |
| New Jersey | $975 | $13,368 | 302 | 2,392 | +2.7% |
| Virginia | $972 | $4,338 | 248 | 3,966 | +2.4% |
| Florida | $970 | $4,862 | 858 | 10,179 | +2.2% |
| Kentucky | $961 | $3,323 | 165 | 2,097 | +1.3% |
| Ohio | $956 | $3,678 | 500 | 5,221 | +0.8% |
| Texas | $954 | $4,326 | 770 | 7,472 | +0.5% |
| South Carolina | $953 | $4,386 | 207 | 2,793 | +0.4% |
| Vermont | $943 | $5,017 | 24 | 220 | -0.6% |
| Wyoming | $941 | $5,822 | 49 | 523 | -0.9% |
| Louisiana | $931 | $4,031 | 179 | 1,610 | -1.9% |
| West Virginia | $926 | $5,073 | 73 | 568 | -2.4% |
| Minnesota | $910 | $5,785 | 351 | 2,442 | -4.1% |
| Oklahoma | $902 | $2,816 | 184 | 2,011 | -4.9% |
| Connecticut | $901 | $5,441 | 197 | 1,403 | -5.1% |
| Washington | $900 | $3,619 | 319 | 3,381 | -5.2% |
| New Hampshire | $899 | $7,882 | 91 | 795 | -5.3% |
| Arkansas | $892 | $2,854 | 112 | 1,385 | -6.0% |
| Iowa | $886 | $3,916 | 148 | 1,734 | -6.7% |
| North Carolina | $883 | $3,632 | 430 | 4,413 | -6.9% |
| Arizona | $881 | $3,822 | 294 | 3,839 | -7.1% |
| Colorado | $879 | $4,806 | 280 | 3,653 | -7.4% |
| Utah | $869 | $2,845 | 136 | 1,654 | -8.4% |
| Montana | $864 | $3,033 | 77 | 1,024 | -8.9% |
| North Dakota | $855 | $4,029 | 50 | 544 | -9.9% |
| Oregon | $855 | $3,932 | 151 | 1,767 | -10.0% |
| Delaware | $853 | $4,316 | 42 | 611 | -10.1% |
| Indiana | $828 | $4,395 | 309 | 3,431 | -12.7% |
| Maine | $813 | $2,492 | 57 | 561 | -14.4% |
| Alabama | $809 | $4,005 | 243 | 1,952 | -14.8% |
| Wisconsin | $795 | $11,825 | 318 | 2,424 | -16.2% |
| Kansas | $791 | $3,927 | 176 | 2,330 | -16.6% |
| South Dakota | $780 | $3,699 | 75 | 1,165 | -17.8% |
| Idaho | $768 | $3,888 | 120 | 1,438 | -19.1% |
| Nebraska | $735 | $4,539 | 122 | 1,688 | -22.6% |
⚠️ 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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