What 56 hospitals in Kentucky charged and were paid for level 2 musculoskeletal procedures (APC 5112), from 2024 Medicare claims.
APC 5112Outpatient2024 Medicare data
Average charge$10,580Hospital list price billed
Average allowed$1,363Medicare's payment + patient's share
Medicare paid$1,079Average per service
State rank#10 of 491 = lowest average payment
Hospitals in Kentucky billed an average of $10,580 for level 2 musculoskeletal procedures, about 7.8 times the average medicare-allowed amount of $1,363. That payment is 10% below the U.S. average of $1,511.
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 $1,363Billed $10,580
About 13¢ was paid for every $1 hospitals in Kentucky billed for this service.
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 2 musculoskeletal procedures cost in Kentucky?
In 2024 Medicare data, level 2 musculoskeletal procedures (APC 5112) at 56 hospitals in Kentucky was billed at $10,580 on average, while the average medicare-allowed amount was $1,363, of which Medicare paid $1,079. 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 Kentucky, average charges were 7.8 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.
