How Much Does Open Shoulder Surgery (Rotator Cuff Repair) Cost?
Also known as: Reconstruct shoulder joint (CPT 23472)
Traditional open surgery to repair severely torn shoulder tendons through a larger incision.
Open Shoulder Surgery (Rotator Cuff Repair) (CPT 23472) costs $1,300 at Medicare rates. Hospital outpatient rate: $17.
Cost Comparison by Payer
How much Reconstruct shoulder joint costs across different settings and payers
Patient Guide: Open Shoulder Surgery (Rotator Cuff Repair)
What you need to know before your appointment
What to Expect
The surgeon makes an incision over the shoulder to directly repair the torn tendons. Hospital stay may be overnight.
How Long Does It Take?
1-3 hours surgery, same-day or overnight
Common Reasons Doctors Order This
Large or complex rotator cuff tears, failed previous repair, significant tendon retraction
How to Prepare
Same as arthroscopic preparation. Expect a longer recovery than arthroscopic surgery. Arrange several weeks of home help.
Procedures Commonly Done Together
These procedures are frequently performed alongside Reconstruct shoulder joint
Reconstruct shoulder joint Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $1,632 | $2,121 — $3,263 |
| AL — ALABAMA | $1,189 | $1,545 — $2,378 |
| AR — ARKANSAS | $1,174 | $1,527 — $2,349 |
| AZ — ARIZONA | $1,272 | $1,654 — $2,544 |
| CA — BAKERSFIELD | $1,305 | $1,697 — $2,610 |
| CA — CHICO | $1,293 | $1,681 — $2,586 |
| CA — EL CENTRO | $1,294 | $1,682 — $2,588 |
| CA — FRESNO | $1,293 | $1,681 — $2,586 |
| CA — HANFORD-CORCORAN | $1,293 | $1,681 — $2,586 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $1,367 | $1,777 — $2,734 |
| CA — MADERA | $1,293 | $1,681 — $2,586 |
| CA — MERCED | $1,293 | $1,681 — $2,586 |
| CA — MODESTO | $1,293 | $1,681 — $2,586 |
| CA — NAPA | $1,419 | $1,845 — $2,838 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $1,351 | $1,757 — $2,703 |
| CA — REDDING | $1,293 | $1,681 — $2,586 |
| CA — REST OF CALIFORNIA | $1,293 | $1,681 — $2,586 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $1,340 | $1,742 — $2,680 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $1,336 | $1,737 — $2,672 |
| CA — SALINAS | $1,331 | $1,730 — $2,661 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $1,347 | $1,751 — $2,694 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $1,475 | $1,918 — $2,950 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) | $1,470 | $1,911 — $2,940 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | $1,511 | $1,965 — $3,023 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $1,491 | $1,938 — $2,982 |
How to Reduce Your Cost for Reconstruct shoulder joint
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 $1,174 to $1,632 depending on location. Commercial rates vary even more.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $13, compared to $17 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (38.93) x CF ($33.40) = $1,300
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Reconstruct shoulder joint cost?
The Medicare facility rate for Reconstruct shoulder joint is $1,300. In a hospital outpatient setting, the rate is $17. At an ambulatory surgery center, the rate is $13. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Reconstruct shoulder joint cost without insurance?
Without insurance, the cost of Reconstruct shoulder joint 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 Reconstruct shoulder joint?
Most commercial health insurance plans and Medicare cover Reconstruct shoulder joint 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.