Level 1 ICD and Similar Procedures
What 1,290 hospitals in the U.S. charged and were paid for level 1 icd and similar procedures (APC 5231), from 2024 Medicare claims.
Average charge
$119,770
Hospital list price billed
Average allowed
$22,647
Medicare's payment + patient's share
Medicare paid
$21,011
Average per service
Volume
2,175
Medicare services
Hospitals in the U.S. billed an average of $119,770 for level 1 icd and similar procedures, about 5.3 times the average medicare-allowed amount of $22,647.
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 $22,647Billed $119,770
About 19¢ was paid for every $1 hospitals in the U.S. billed for this service.
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
| Arkansas Heart HospitalLittle Rock, AR | $18,906 |
|---|---|
| Baptist Memorial HospitalMemphis, TN | $19,242 |
| Christ HospitalCincinnati, OH | $19,601 |
| Cleveland Clinic - Main CampusCleveland, OH | $20,073 |
| Ohio State University HospitalsColumbus, OH | $20,217 |
| The Heart Hospital Baylor PlanoPlano, TX | $20,229 |
| Oklahoma Heart HospitalOklahoma City, OK | $20,258 |
| Methodist HospitalSan Antonio, TX | $20,403 |
| ECU Health Medical CenterGreenville, NC | $20,462 |
| Deaconess Hospital INCEvansville, IN | $20,942 |
Highest
| Cedars-Sinai Medical CenterLos Angeles, CA | $28,895 |
|---|---|
| New York-Presbyterian HospitalNew York, NY | $26,746 |
| NYU Hospitals CenterNew York, NY | $26,461 |
| St Francis Hospital, RoslynRoslyn, NY | $25,977 |
| Robert Wood Johnson University HospitalNew Brunswick, NJ | $25,497 |
| Morristown Memorial HospitalMorristown, NJ | $25,270 |
| Massachusetts General HospitalBoston, MA | $25,244 |
| Brigham and Women's HosptialBoston, MA | $25,244 |
| Jersey Shore University Medical CenterNeptune City, NJ | $23,983 |
| Cooper University HospitalCamden, NJ | $23,565 |
Level 1 ICD and Similar 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 | 21 | $104,371 | $19,862 | $19,862 – $19,862 |
| Alaska | 1 | – | – | – |
| Arizona | 26 | $106,499 | $22,924 | $22,924 – $22,924 |
| Arkansas | 18 | $62,881 | $18,906 | $18,906 – $18,906 |
| California | 128 | $204,698 | $30,072 | $28,895 – $33,090 |
| Colorado | 25 | – | – | – – – |
| Connecticut | 16 | $55,842 | $26,452 | $26,452 – $26,452 |
| Delaware | 5 | $86,954 | $23,586 | $23,586 – $23,586 |
| Florida | 96 | $140,269 | $20,132 | $18,272 – $21,297 |
| Georgia | 38 | $96,060 | $21,553 | $21,021 – $21,819 |
| Hawaii | 6 | – | – | – – – |
| Idaho | 9 | – | – | – – – |
| Illinois | 57 | $103,801 | $21,639 | $18,873 – $22,865 |
| Indiana | 34 | $76,141 | $21,143 | $20,942 – $21,423 |
| Iowa | 16 | $74,878 | $21,044 | $20,114 – $22,788 |
| Kansas | 18 | $67,416 | $20,609 | $20,609 – $20,609 |
| Kentucky | 20 | $219,083 | $19,787 | $19,787 – $19,787 |
| Louisiana | 24 | – | – | – – – |
| Maine | 6 | – | – | – – – |
| Massachusetts | 31 | $61,341 | $24,790 | $23,277 – $25,244 |
| Michigan | 42 | $141,698 | $20,647 | $19,469 – $21,749 |
| Minnesota | 15 | $73,984 | $23,386 | $22,173 – $24,216 |
| Mississippi | 23 | $85,378 | $21,084 | $21,084 – $21,084 |
| Missouri | 33 | $82,839 | $19,924 | $19,853 – $20,008 |
| Montana | 6 | – | – | – – – |
| Nebraska | 13 | $91,723 | $21,186 | $21,186 – $21,186 |
| Nevada | 11 | – | – | – – – |
| New Hampshire | 9 | – | – | – – – |
| New Jersey | 23 | $138,650 | $25,172 | $23,565 – $26,746 |
| New Mexico | 9 | – | – | – – – |
| New York | 49 | $130,876 | $26,006 | $24,200 – $26,746 |
| North Carolina | 31 | $83,819 | $20,770 | $19,627 – $21,912 |
| North Dakota | 6 | – | – | – – – |
| Ohio | 56 | $82,859 | $20,062 | $18,655 – $21,026 |
| Oklahoma | 20 | $104,103 | $19,509 | $17,545 – $20,259 |
| Oregon | 13 | $67,517 | $24,665 | $24,665 – $24,665 |
| Pennsylvania | 64 | $164,871 | $21,882 | $18,526 – $23,684 |
| Rhode Island | 5 | $89,478 | $23,857 | $23,857 – $23,857 |
| South Carolina | 21 | $145,429 | $20,122 | $17,731 – $22,389 |
| South Dakota | 5 | – | – | – – – |
| Tennessee | 29 | $94,175 | $19,646 | $17,778 – $21,084 |
| Texas | 107 | $165,967 | $20,746 | $19,967 – $22,067 |
| Utah | 8 | $97,114 | $21,062 | $21,062 – $21,062 |
| Vermont | 3 | – | – | – – – |
| Virginia | 35 | $88,949 | $20,788 | $20,269 – $21,230 |
| Washington | 20 | $77,986 | $24,220 | $23,594 – $25,188 |
| West Virginia | 8 | – | – | – – – |
| Wisconsin | 24 | $117,325 | $22,123 | $22,123 – $22,123 |
| Wyoming | 4 | – | – | – – – |
Hospitals that treat the most Medicare patients for this
| Hospital | Services | Avg charge | Avg allowed |
|---|---|---|---|
| New York-Presbyterian HospitalNew York, NY | 56 | $93,848 | $26,746 |
| NYU Hospitals CenterNew York, NY | 50 | $259,231 | $26,461 |
| St Francis Hospital, RoslynRoslyn, NY | 49 | $135,886 | $25,977 |
| Massachusetts General HospitalBoston, MA | 31 | $52,557 | $25,244 |
| Methodist HospitalSan Antonio, TX | 30 | $142,029 | $20,403 |
| Jersey Shore University Medical CenterNeptune City, NJ | 27 | $85,966 | $23,983 |
| Baptist Memorial HospitalMemphis, TN | 27 | $96,802 | $19,242 |
| Robert Wood Johnson University HospitalNew Brunswick, NJ | 26 | $93,721 | $25,497 |
| Lehigh Valley HospitalAllentown, PA | 26 | $244,152 | $22,111 |
| Cleveland Clinic - Main CampusCleveland, OH | 25 | $61,828 | $20,073 |
| Inova Fairfax HospitalFalls Church, VA | 25 | $90,091 | $21,230 |
| Arkansas Heart HospitalLittle Rock, AR | 23 | $62,881 | $18,906 |
| Cedars-Sinai Medical CenterLos Angeles, CA | 23 | $528,404 | $28,895 |
| Brigham and Women's HosptialBoston, MA | 23 | $51,896 | $25,244 |
| ECU Health Medical CenterGreenville, NC | 23 | $56,243 | $20,462 |
Questions
How much does level 1 icd and similar procedures cost in the U.S.?
In 2024 Medicare data, level 1 icd and similar procedures (APC 5231) at 1,290 hospitals in the U.S. was billed at $119,770 on average, while the average medicare-allowed amount was $22,647, of which Medicare paid $21,011. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for level 1 icd and similar procedures?
Among states with at least three hospitals reporting, the average medicare-allowed amount was highest in California ($30,072), Connecticut ($26,452), New York ($26,006) and lowest in Arkansas ($18,906), Oklahoma ($19,509), Tennessee ($19,646).
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 5.3 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.