Shoulder, elbow or forearm procedures, except major joint procedures with complications
What 9 hospitals in the U.S. charged and were paid for a Medicare hospital stay for shoulder, elbow or forearm procedures, except major joint procedures with complications (DRG 511), from 2024 Medicare claims.
Average charge
$113,404
Hospital list price billed
Average payment
$15,909
Medicare + patient + other payers
Medicare paid
$13,239
Average per stay
Volume
114
Medicare hospital stays
Hospitals in the U.S. billed an average of $113,404 for shoulder, elbow or forearm procedures, except major joint procedures with complications, about 7.1 times the average total payment of $15,909.
These are averages for patients with original (fee-for-service) Medicare. Private insurance pays different, negotiated prices, and what you owe depends on your plan's deductible and coinsurance. Use these figures to compare hospitals, not as a quote.
Paid $15,909Billed $113,404
About 14¢ was paid for every $1 hospitals in the U.S. billed for this stay.
Medicare prices this stay in 2 versions, by how sick the patient was. Compare them:
Shoulder, elbow or forearm procedures, except major joint procedures with complications cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital.
| State | Hospitals | Avg charge | Avg payment | Range |
|---|---|---|---|---|
| Florida | 4 | $128,100 | $14,803 | $14,342 – $15,336 |
| Minnesota | 1 | $64,450 | $23,184 | – |
| Pennsylvania | 1 | $127,362 | $17,267 | – |
| Texas | 1 | $150,693 | $14,793 | – |
| Virginia | 1 | $47,264 | $14,686 | – |
| West Virginia | 1 | $96,374 | $15,549 | – |
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg charge | Avg payment |
|---|---|---|---|
| Gulf Coast Medical Center Lee HealthFort Myers, FL | 21 | $97,024 | $14,853 |
| Sarasota Memorial HospitalSarasota, FL | 13 | $108,099 | $14,656 |
| Adventhealth OrlandoOrlando, FL | 12 | $120,271 | $15,336 |
| HCA Florida Lawnwood HospitalFort Pierce, FL | 12 | $211,977 | $14,342 |
| Covenant Medical CenterLubbock, TX | 12 | $150,693 | $14,793 |
| Mayo Clinic - Saint Marys HospitalRochester, MN | 11 | $64,450 | $23,184 |
| Lehigh Valley HospitalAllentown, PA | 11 | $127,362 | $17,267 |
| Riverside Regional Medical CenterNewport News, VA | 11 | $47,264 | $14,686 |
| Charleston Area Medical CenterCharleston, WV | 11 | $96,374 | $15,549 |
Questions
How much does shoulder, elbow or forearm procedures, except major joint procedures with complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for shoulder, elbow or forearm procedures, except major joint procedures with complications (DRG 511) at 9 hospitals in the U.S. was billed at $113,404 on average, while the average total payment was $15,909, of which Medicare paid $13,239. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for shoulder, elbow or forearm procedures, except major joint procedures with complications?
Among states with at least three hospitals reporting, the average total payment was highest in Florida ($14,803) and lowest in Florida ($14,803).
Why are hospital charges so much higher than payments?
Charges are a hospital's list prices. Medicare pays fixed rates set in advance, and private insurers negotiate their own discounts, so almost nobody pays the full charge. For this stay in the U.S., average charges were 7.1 times the average payment. Uninsured patients can ask the hospital about its financial assistance (charity care) policy and cash prices.
Source: CMS, Medicare Inpatient Hospitals by Provider and Service, 2024. Average total payment includes Medicare's payment, the patient's deductible and coinsurance, and any other payer. CMS omits hospitals with fewer than 11 hospital stays for privacy. About the data.