Manipulation Of Wrist Under Anesthesia

Medicare Payment (avg)
$292.52
What Medicare actually pays
Billed Charge (avg)
$1,647.51
What providers submit
Markup
5.6x
463% above Medicare rate
246
Total Services
209
Beneficiaries
156
Providers
6
States with Data

Price Range Across States

Lowest State Avg
$220.44
Texas
Highest State Avg
$402.62
New York

What You Might Pay

Est. Commercial Insurance
$823.61
Range: $576.53 – $1,153.05
Est. Cash / Self-Pay
$728.83
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Musculoskeletal Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
New York $402.62 $1,020.25
Pennsylvania $345.00 $1,689.82
Georgia $287.62 $1,371.55
Florida $273.63 $1,585.51
California $262.10 $1,819.18
Texas $220.44 $1,193.18

What the Data Says About Manipulation Of Wrist Under Anesthesia

Across 6 states with reporting providers, CPT code 25259 (Manipulation Of Wrist Under Anesthesia) shows a national average Medicare payment of $292.52 against an average billed charge of $1,647.51. That gap — a 5.6x markup, or 463% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Musculoskeletal Surgery procedures like this one saw 246 services billed to Medicare in 2023 by 156 distinct providers, serving 209 unique beneficiaries. State-level variation is significant: Texas reports the lowest average payment at $220.44, while New York reports the highest at $402.62. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Musculoskeletal Surgery category (2.24x), the estimated commercial insurance price lands near $823.61, with self-pay cash discounts commonly bringing the figure closer to $728.83. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Manipulation Of Wrist Under Anesthesia cost?

The national average Medicare payment for Manipulation Of Wrist Under Anesthesia (CPT 25259) is $292.52, while providers typically bill $1,647.51. Prices vary significantly by state, ranging from $220.44 to $402.62.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Manipulation Of Wrist Under Anesthesia cost with insurance?

With commercial insurance, Manipulation Of Wrist Under Anesthesia costs an estimated $823.61 on average (range: $576.53 – $1,153.05). Without insurance, the estimated cash price is $728.83. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Manipulation Of Wrist Under Anesthesia?

Texas has the lowest average Medicare payment for Manipulation Of Wrist Under Anesthesia at $220.44, while New York has the highest at $402.62. This $182.18 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Manipulation Of Wrist Under Anesthesia?

Nationally, 156 providers billed Medicare for Manipulation Of Wrist Under Anesthesia in 2023, performing 246 total services for 209 beneficiaries across 6 states and territories.

What is the billed-to-Medicare markup for Manipulation Of Wrist Under Anesthesia?

Providers bill 5.6x what Medicare pays for Manipulation Of Wrist Under Anesthesia — a 463% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial