Complex GI Procedures
What 1,697 hospitals in the U.S. charged and were paid for complex gi procedures (APC 5331), from 2024 Medicare claims.
Average charge
$34,865
Hospital list price billed
Average allowed
$5,364
Medicare's payment + patient's share
Medicare paid
$4,263
Average per service
Volume
20,597
Medicare services
Hospitals in the U.S. billed an average of $34,865 for complex gi procedures, about 6.5 times the average medicare-allowed amount of $5,364.
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.
Lowest and highest allowed amounts
Among hospitals with at least 20 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| University of Kentucky HospLexington, KY | $2,951 |
|---|---|
| Fletcher Allen Hospital of VermontBurlington, VT | $3,074 |
| Metrohealth SystemCleveland, OH | $3,349 |
| Jewish HospitalLouisville, KY | $3,631 |
| University Health Care/Univ Hospitals and ClinicsSalt Lake City, UT | $3,845 |
| Thomas HospitalFairhope, AL | $4,066 |
| Wilkes-Barre General HospitalWilkes-Barre, PA | $4,074 |
| Barnes Jewish HospitalSt Louis, MO | $4,130 |
| Missouri Baptist Medical CenterTown and Country, MO | $4,189 |
| Mayo Clinic HospitalPhoenix, AZ | $4,308 |
Highest
| California Pacific Medical Ctr-Pacific Campus HospSan Francisco, CA | $8,033 |
|---|---|
| El Camino HospitalMountain View, CA | $8,025 |
| Good Samaritan HospitalSan Jose, CA | $8,025 |
| UCSF Medical CenterSan Francisco, CA | $7,990 |
| Santa Rosa Memorial HospitalSanta Rosa, CA | $7,982 |
| John Muir Medical Center - Walnut Creek CampusWalnut Creek, CA | $7,935 |
| Sutter General HospitalSacramento, CA | $7,819 |
| Stanford HospitalPalo Alto, CA | $7,501 |
| Stanford Health Care Tri-ValleyPleasanton, CA | $7,181 |
| Community Hospital of the Monterey PeninsulaMonterey, CA | $7,062 |
Complex GI Procedures cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital.
| State | Hospitals | Avg charge | Avg allowed | Range |
|---|---|---|---|---|
| Alabama | 27 | $50,925 | $4,593 | $4,066 – $4,814 |
| Alaska | 5 | $35,216 | $5,883 | $5,883 – $5,883 |
| Arizona | 37 | $27,845 | $4,962 | $4,308 – $5,558 |
| Arkansas | 21 | $21,932 | $4,783 | $4,611 – $5,235 |
| California | 157 | $49,496 | $7,178 | $5,949 – $8,146 |
| Colorado | 36 | $47,026 | $5,379 | $5,271 – $5,811 |
| Connecticut | 22 | $23,676 | $6,266 | $5,897 – $6,420 |
| Delaware | 3 | $18,676 | $5,253 | $4,960 – $5,718 |
| Florida | 103 | $46,510 | $5,073 | $3,442 – $5,163 |
| Georgia | 52 | $37,002 | $4,927 | $4,543 – $5,289 |
| Hawaii | 8 | $25,420 | $6,293 | $6,137 – $6,429 |
| Idaho | 12 | $20,294 | $5,177 | $4,979 – $5,516 |
| Illinois | 77 | $32,612 | $5,069 | $4,479 – $5,543 |
| Indiana | 51 | $38,149 | $5,027 | $4,541 – $5,360 |
| Iowa | 16 | $33,968 | $4,769 | $4,564 – $4,832 |
| Kansas | 20 | $27,030 | $4,777 | $4,565 – $5,211 |
| Kentucky | 29 | $28,628 | $4,113 | $2,951 – $5,273 |
| Louisiana | 31 | $32,773 | $4,788 | $4,658 – $4,876 |
| Maine | 10 | $28,122 | $5,066 | $4,965 – $5,119 |
| Massachusetts | 38 | $25,223 | $5,938 | $5,719 – $6,428 |
| Michigan | 54 | $27,828 | $4,809 | $4,369 – $5,089 |
| Minnesota | 26 | $25,442 | $5,385 | $4,966 – $5,599 |
| Mississippi | 22 | $49,776 | $4,740 | $4,654 – $4,771 |
| Missouri | 36 | $21,245 | $4,447 | $4,130 – $5,072 |
| Montana | 9 | $23,457 | $5,342 | $4,341 – $5,723 |
| Nebraska | 13 | $28,609 | $5,060 | $4,895 – $5,136 |
| Nevada | 15 | $49,341 | $6,104 | $6,104 – $6,104 |
| New Hampshire | 12 | $28,018 | $5,639 | $5,436 – $5,762 |
| New Jersey | 43 | $34,703 | $5,910 | $4,466 – $6,485 |
| New Mexico | 12 | $29,238 | $5,146 | $4,656 – $5,771 |
| New York | 77 | $32,334 | $6,189 | $4,364 – $6,485 |
| North Carolina | 49 | $28,869 | $4,900 | $4,086 – $5,241 |
| North Dakota | 6 | $29,556 | $5,383 | $5,343 – $5,723 |
| Ohio | 70 | $24,807 | $4,759 | $3,349 – $5,089 |
| Oklahoma | 27 | $50,103 | $4,772 | $4,359 – $4,910 |
| Oregon | 18 | $31,308 | $5,805 | $5,482 – $6,920 |
| Pennsylvania | 78 | $46,761 | $5,177 | $4,074 – $5,537 |
| Rhode Island | 6 | $21,717 | $5,784 | $5,784 – $5,784 |
| South Carolina | 31 | $34,038 | $4,632 | $4,161 – $5,427 |
| South Dakota | 7 | $27,701 | $5,258 | $5,162 – $5,343 |
| Tennessee | 38 | $30,354 | $4,762 | $4,539 – $5,228 |
| Texas | 133 | $42,142 | $4,995 | $4,509 – $5,349 |
| Utah | 17 | $18,038 | $4,182 | $3,845 – $5,105 |
| Vermont | 5 | $27,379 | $3,074 | $3,074 – $3,074 |
| Virginia | 44 | $37,984 | $4,903 | $4,401 – $5,605 |
| Washington | 31 | $31,020 | $5,713 | $5,349 – $6,147 |
| West Virginia | 13 | $25,685 | $4,661 | $4,431 – $5,444 |
| Wisconsin | 40 | $28,898 | $5,248 | $5,089 – $5,462 |
| Wyoming | 6 | – | – | – – – |
Hospitals that treat the most Medicare patients for this
| Hospital | Services | Avg charge | Avg allowed |
|---|---|---|---|
| Mayo Clinic - Saint Marys HospitalRochester, MN | 370 | $26,776 | $5,599 |
| MUSC Medical CenterCharleston, SC | 245 | $32,842 | $4,388 |
| Cedars-Sinai Medical CenterLos Angeles, CA | 242 | $76,668 | $6,903 |
| Barnes Jewish HospitalSt Louis, MO | 225 | $18,691 | $4,130 |
| New York-Presbyterian HospitalNew York, NY | 219 | $28,412 | $6,438 |
| Mayo Clinic HospitalPhoenix, AZ | 209 | $29,760 | $4,308 |
| University of Minnesota Medical Center, FairviewMinneapolis, MN | 202 | $28,062 | $4,966 |
| Stanford HospitalPalo Alto, CA | 199 | $70,096 | $7,501 |
| Massachusetts General HospitalBoston, MA | 195 | $20,916 | $5,719 |
| Clarian Health PartnersIndianapolis, IN | 194 | $44,148 | $5,151 |
| Scottsdale Healthcare-Shea Medical CenterScottsdale, AZ | 189 | $29,071 | $4,644 |
| UCSF Medical CenterSan Francisco, CA | 182 | $44,540 | $7,990 |
| Univ of Michigan HospitalsAnn Arbor, MI | 157 | $42,154 | $4,943 |
| University of Iowa Hospital & ClinicsIowa City, IA | 153 | $35,666 | $4,832 |
| University of Virginia Medical CenterCharlottesville, VA | 150 | $30,682 | $4,891 |
Questions
How much does complex gi procedures cost in the U.S.?
In 2024 Medicare data, complex gi procedures (APC 5331) at 1,697 hospitals in the U.S. was billed at $34,865 on average, while the average medicare-allowed amount was $5,364, of which Medicare paid $4,263. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for complex gi procedures?
Among states with at least three hospitals reporting, the average medicare-allowed amount was highest in California ($7,178), Hawaii ($6,293), Connecticut ($6,266) and lowest in Vermont ($3,074), Kentucky ($4,113), Utah ($4,182).
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 service in the U.S., average charges were 6.5 times the average payment. Uninsured patients can ask the hospital about its financial assistance (charity care) policy and cash prices.
Source: CMS, Medicare Outpatient Hospitals by Provider and Service, 2024. The allowed amount is Medicare's payment plus the patient's coinsurance. CMS omits hospitals with fewer than 11 services for privacy. About the data.