What 70 hospitals in Ohio charged and were paid for complex gi procedures (APC 5331), from 2024 Medicare claims.
APC 5331Outpatient2024 Medicare data
Average charge$24,807Hospital list price billed
Average allowed$4,759Medicare's payment + patient's share
Medicare paid$3,764Average per service
State rank#9 of 481 = lowest average payment
Hospitals in Ohio billed an average of $24,807 for complex gi procedures, about 5.2 times the average medicare-allowed amount of $4,759. That payment is 11% below the U.S. average 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.
Paid $4,759Billed $24,807
About 19¢ was paid for every $1 hospitals in Ohio billed for this service.
Ohio hospitals: complex gi procedures
Every Ohio hospital that billed Medicare for this service at least 11 times. Click a column to sort.
Among hospitals with at least 11 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
In 2024 Medicare data, complex gi procedures (APC 5331) at 70 hospitals in Ohio was billed at $24,807 on average, while the average medicare-allowed amount was $4,759, of which Medicare paid $3,764. 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 service in Ohio, average charges were 5.2 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.
