What 75 hospitals in Ohio charged and were paid for level 3 ent procedures (APC 5163), from 2024 Medicare claims.
APC 5163Outpatient2024 Medicare data
Average charge$5,137Hospital list price billed
Average allowed$1,223Medicare's payment + patient's share
Medicare paid$960Average per service
State rank#10 of 441 = lowest average payment
Hospitals in Ohio billed an average of $5,137 for level 3 ent procedures, about 4.2 times the average medicare-allowed amount of $1,223. That payment is 13% below the U.S. average of $1,397.
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 $1,223Billed $5,137
About 24¢ was paid for every $1 hospitals in Ohio billed for this service.
Ohio hospitals: level 3 ent 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.
How much does level 3 ent procedures cost in Ohio?
In 2024 Medicare data, level 3 ent procedures (APC 5163) at 75 hospitals in Ohio was billed at $5,137 on average, while the average medicare-allowed amount was $1,223, of which Medicare paid $960. 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 4.2 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.
