What 56 hospitals in Wisconsin charged and were paid for level 3 lower gi procedures (APC 5313), from 2024 Medicare claims.
APC 5313Outpatient2024 Medicare data
Average charge$15,764Hospital list price billed
Average allowed$2,488Medicare's payment + patient's share
Medicare paid$2,005Average per service
State rank#21 of 491 = lowest average payment
Hospitals in Wisconsin billed an average of $15,764 for level 3 lower gi procedures, about 6.3 times the average medicare-allowed amount of $2,488. That payment is 8% below the U.S. average of $2,703.
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 $2,488Billed $15,764
About 16¢ was paid for every $1 hospitals in Wisconsin billed for this service.
Wisconsin hospitals: level 3 lower gi procedures
Every Wisconsin 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 lower gi procedures cost in Wisconsin?
In 2024 Medicare data, level 3 lower gi procedures (APC 5313) at 56 hospitals in Wisconsin was billed at $15,764 on average, while the average medicare-allowed amount was $2,488, of which Medicare paid $2,005. 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 Wisconsin, average charges were 6.3 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.
