Billed is the hospital's list price. Average payment is what Medicare, the patient and any other insurer paid in total. Medicare paid is Medicare's part. A Medicare category can group several related procedures, and these are averages, not a quote.
According to HospitalsInEachState.com's analysis of 2024 Medicare inpatient claims data from CMS, the average total payment for a hospital stay for breast biopsy, local excision and other breast procedures without complications (DRG 585) in the U.S. was $18,578 (what Medicare and the patient, plus any other insurer, paid), of which Medicare paid $8,686, across 2 hospitals. Hospitals billed $157,793 on average, their list charge. The payments are averages for original Medicare patients, not a price quote.
Hospitals in the U.S. billed an average of $157,793 for breast biopsy, local excision and other breast procedures without complications, about 8.5 times the average total payment of $18,578.
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.
About 12¢ was paid for every $1 hospitals in the U.S. billed for this stay.
Breast biopsy, local excision and other breast procedures without complications cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital. Use the column headings to sort.
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg billed | Avg payment |
|---|---|---|---|
| St Charles Surgical HospitalNew Orleans, LA | 24 | $156,438 | $12,759 |
| The University of Kansas HospitalKansas City, KS | 11 | $160,748 | $31,275 |
Questions
How much does breast biopsy, local excision and other breast procedures without complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for breast biopsy, local excision and other breast procedures without complications (DRG 585) at 2 hospitals in the U.S. was billed at $157,793 on average, while the average total payment was $18,578, of which Medicare paid $8,686. Your own cost depends on your insurance, deductible and the hospital.
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 8.5 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.
Cite this data
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