Price AtlasInteractive atlas · All states · techysurgeon.comWhat the whole upper arm (shoulder) fracture fixation costs
Plate and screws for a broken top of the upper-arm bone. Every bill that usually comes with it, who sends it, and where each number comes from.
Price it for your ZIP, hospital or insurerRates by insurer
Medicare, national amounts, 2026
| Bill | Surgery center | Hospital outpatient |
|---|---|---|
| Facility | $9,194 | $13,117 |
| Surgeon | $824 | $824 |
| Assistant | $132 | $132 |
| Anesthesia | $252 | $252 |
| Before surgery (typical) | $213 | $213 |
| After surgery (typical) | $599 | $599 |
| Total | $11,213 | $15,136 |
National Medicare amounts (payment-area and wage adjustments at 1.0). Facility: OPPS Addendum B, July 2026 (national unadjusted rate); local = rate × (0.6 × wage index + 0.4); ASC Addendum AA, July 2026 (national rate); local = rate × (0.5 × wage index + 0.5); device-intensive (J8) codes keep the device portion unadjusted; FY 2026 IPPS final rule CMS-1833-F, Table 5; standard amounts from Tables 1A-1E; local = weight × (labor × wage index + non-labor + capital × wage index^0.6848). Leaves out teaching (IME), safety-net (DSH) and outlier add-ons. Surgeon: CMS Physician Fee Schedule CY2026 (RVU26D). Anesthesia: CMS base units × the CY2026 anesthesia conversion factor, with an assumed case time. An educational estimate, not a quote.
Line by line (surgery center)
- Surgery center facility fee: $9,194. Billed by The surgery center. CMS ASC Addendum AA, July 2026: national rate $9,193.89
- Surgeon, CPT 23615: $824. Billed by The surgeon's group. CMS Physician Fee Schedule CY2026 (RVU26D, Oct 2026 release), facility rate, PFS locality national (GPCI 1.0)
- Assistant surgeon (modifier 80): $132. Billed by The assistant surgeon. Medicare Claims Processing Manual, Ch. 12, §20.4.3: assistant-at-surgery (modifiers 80/81/82) = 16% of the surgeon's fee schedule amount; a PA, NP or CNS assisting (modifier AS) = 85% of that, 13.6%. Indicator from the RVU26D ASST SURG column (0 = only with documented medical necessity, 1 = not paid, 2 = paid).
- Anesthesia, ASA code 01630: $252. Billed by The anesthesia group. CMS anesthesia base units (CY2022 file, unchanged for CY2026) + CY2026 anesthesia conversion factor $20.49754 for the nation (ANES2026, RVU26D). Code mapping is ours, from the ASA code descriptors.
- Consultation visit (new patient): $177. Billed by The surgeon's group. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 99204
- X-rays before surgery: $36. Billed by Office or imaging center. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 73030
- Follow-up X-ray: $36. Billed by Office or imaging center. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 73030
- Physical therapy, 8 visits: $563. Billed by The therapy clinic. CMS PFS CY2026 (RVU26D), non-facility rates for 97161 and 97110
Questions
How much does a upper arm (shoulder) fracture fixation cost in total, with every bill?
At national Medicare rates for 2026, the whole upper arm (shoulder) fracture fixation comes to about $11,213 in a surgery center and about $15,136 in a hospital outpatient, counting the facility, the surgeon, anesthesia and typical care before and after. Commercial plans usually pay more; local rates differ by area.
Why do I get separate bills for a upper arm (shoulder) fracture fixation?
The surgery center bills for the facility; the surgeon's group bills for the operation (Surgeon, CPT 23615, about $824 from Medicare nationally); the anesthesia group bills by base units plus time (about $252 at our default time); labs, imaging, pathology and therapy each come from their own provider.
What does the surgeon's fee include?
90-day global: the fee covers the operation plus the visit the day before and routine follow-up visits for 90 days.