Level 1 ICD and Similar Procedures in Pennsylvania
What 64 hospitals in Pennsylvania charged and were paid for level 1 icd and similar procedures (APC 5231), from 2024 Medicare claims.
APC 5231Outpatient2024 Medicare data
Average charge$164,871Hospital list price billed
Average allowed$21,882Medicare's payment + patient's share
Medicare paid$20,239Average per service
State rank#22 of 341 = lowest average payment
Hospitals in Pennsylvania billed an average of $164,871 for level 1 icd and similar procedures, about 7.5 times the average medicare-allowed amount of $21,882. That payment is 3% below the U.S. average 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 $21,882Billed $164,871
About 13¢ was paid for every $1 hospitals in Pennsylvania billed for this service.
Pennsylvania hospitals: level 1 icd and similar procedures
Every Pennsylvania hospital that billed Medicare for this service at least 11 times. Click a column to sort.
Lowest and highest allowed amounts in Pennsylvania
Among hospitals with at least 11 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
How much does level 1 icd and similar procedures cost in Pennsylvania?
In 2024 Medicare data, level 1 icd and similar procedures (APC 5231) at 64 hospitals in Pennsylvania was billed at $164,871 on average, while the average medicare-allowed amount was $21,882, of which Medicare paid $20,239. 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 Pennsylvania, average charges were 7.5 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.
