How Much Does Repair biceps tendon Cost?
Repair biceps tendon (CPT 23430) costs vary by location and insurance at Medicare rates. Hospital outpatient rate: $7.
Cost Comparison by Payer
How much Repair biceps tendon costs across different settings and payers
Repair biceps tendon Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $856 | $1,113 — $1,712 |
| AL — ALABAMA | $633 | $823 — $1,267 |
| AR — ARKANSAS | $625 | $813 — $1,250 |
| AZ — ARIZONA | $681 | $885 — $1,362 |
| CA — BAKERSFIELD | $709 | $922 — $1,418 |
| CA — CHICO | $703 | $914 — $1,407 |
| CA — EL CENTRO | $704 | $915 — $1,407 |
| CA — FRESNO | $703 | $914 — $1,407 |
| CA — HANFORD-CORCORAN | $703 | $914 — $1,407 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $746 | $970 — $1,492 |
| CA — MADERA | $703 | $914 — $1,407 |
| CA — MERCED | $703 | $914 — $1,407 |
| CA — MODESTO | $703 | $914 — $1,407 |
| CA — NAPA | $783 | $1,018 — $1,567 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $739 | $960 — $1,477 |
| CA — REDDING | $703 | $914 — $1,407 |
| CA — REST OF CALIFORNIA | $703 | $914 — $1,407 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $725 | $942 — $1,450 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $730 | $949 — $1,460 |
| CA — SALINAS | $727 | $945 — $1,454 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $738 | $960 — $1,476 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $818 | $1,064 — $1,637 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) | $816 | $1,061 — $1,632 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | $838 | $1,090 — $1,676 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $829 | $1,078 — $1,658 |
How to Reduce Your Cost for Repair biceps tendon
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Medicare rates for this procedure range from $625 to $856 depending on location. Commercial rates vary even more.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $4, compared to $7 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
Frequently Asked Questions
How much does Repair biceps tendon cost?
The Medicare facility rate for Repair biceps tendon is variable. In a hospital outpatient setting, the rate is $7. At an ambulatory surgery center, the rate is $4. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Repair biceps tendon cost without insurance?
Without insurance, the cost of Repair biceps tendon can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Repair biceps tendon?
Most commercial health insurance plans and Medicare cover Repair biceps tendon when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.