What 107 hospitals in Texas charged and were paid for level 1 icd and similar procedures (APC 5231), from 2024 Medicare claims.
APC 5231Outpatient2024 Medicare data
Average charge$165,967Hospital list price billed
Average allowed$20,746Medicare's payment + patient's share
Medicare paid$19,107Average per service
State rank#12 of 341 = lowest average payment
Hospitals in Texas billed an average of $165,967 for level 1 icd and similar procedures, about 8.0 times the average medicare-allowed amount of $20,746. That payment is 8% 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 $20,746Billed $165,967
About 13¢ was paid for every $1 hospitals in Texas billed for this service.
Texas hospitals: level 1 icd and similar procedures
Every Texas 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.
How much does level 1 icd and similar procedures cost in Texas?
In 2024 Medicare data, level 1 icd and similar procedures (APC 5231) at 107 hospitals in Texas was billed at $165,967 on average, while the average medicare-allowed amount was $20,746, of which Medicare paid $19,107. 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 Texas, average charges were 8.0 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.
