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If you're a candidate for shoulder surgery, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for shoulder surgery before scheduling your appointment.
If you have health insurance and use an in-network doctor, you can expect to pay $8,003 for shoulder surgery on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $19,918.
Average costs are based on the primary cost of shoulder surgery in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.
|CPT code||Procedure||ZIP used||Description||In network total costs||Out of network total costs|
|29826||Shoulder surgery||90201||Shaving of shoulder bone using an endoscope||$8,003||$19,918|
|CPT code||Primary procedure||Description||In network cost||Out of network cost|
|29826||Hospital (outpatient)||Hospital outpatient facility (HOSPF) estimate for procedure code 29826 (in addition to your doctor's fee)||$4,088||$77,863|
|Total primary & related costs||$4,088||$77,863|
Most health insurance policies cover shoulder surgery if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of shoulder surgery out of pocket. The exact amount your insurance pays for shoulder surgery comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking shoulder surgery.
It depends on your Medicare plan, but generally Medicare covers procedures like shoulder surgery that are considered medically necessary by your doctor.
The price you'll pay for shoulder surgery varies based on factors like:
In the leadup to shoulder surgery, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.
The price of shoulder surgery is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for shoulder surgery can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.
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