Level 4 Breast/Lymphatic Surgery and Related Procedures
What 859 hospitals in the U.S. charged and were paid for level 4 breast/lymphatic surgery and related procedures (APC 5094), from 2024 Medicare claims.
Average charge
$100,681
Hospital list price billed
Average allowed
$17,182
Medicare's payment + patient's share
Medicare paid
$15,549
Average per service
Volume
789
Medicare services
Hospitals in the U.S. billed an average of $100,681 for level 4 breast/lymphatic surgery and related procedures, about 5.9 times the average medicare-allowed amount of $17,182.
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 $17,182Billed $100,681
About 17¢ was paid for every $1 hospitals in the U.S. billed for this service.
Lowest and highest allowed amounts
Among hospitals with at least 20 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Cleveland Clinic - Main CampusCleveland, OH | $15,015 |
|---|---|
| University of Kansas HospitalKansas City, KS | $15,416 |
| Northside HospitalAtlanta, GA | $15,586 |
| Univ of Tx M D Anderson CtrHouston, TX | $15,817 |
| Evanston HospitalEvanston, IL | $16,359 |
| Northwestern Memorial HospitalChicago, IL | $17,102 |
| Faulkner HospitalBoston, MA | $18,881 |
| NYU Hospitals CenterNew York, NY | $19,793 |
| Mem Sloan-Kettering Cancer CtrNew York, NY | $20,004 |
| Scripps Memorial Hospital la JollaLa Jolla, CA | $21,610 |
Highest
| Scripps Memorial Hospital la JollaLa Jolla, CA | $21,610 |
|---|---|
| Mem Sloan-Kettering Cancer CtrNew York, NY | $20,004 |
| NYU Hospitals CenterNew York, NY | $19,793 |
| Faulkner HospitalBoston, MA | $18,881 |
| Northwestern Memorial HospitalChicago, IL | $17,102 |
| Evanston HospitalEvanston, IL | $16,359 |
| Univ of Tx M D Anderson CtrHouston, TX | $15,817 |
| Northside HospitalAtlanta, GA | $15,586 |
| University of Kansas HospitalKansas City, KS | $15,416 |
| Cleveland Clinic - Main CampusCleveland, OH | $15,015 |
Level 4 Breast/Lymphatic Surgery and Related Procedures cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital.
| State | Hospitals | Avg charge | Avg allowed | Range |
|---|---|---|---|---|
| Alabama | 11 | – | – | – – – |
| Alaska | 4 | – | – | – – – |
| Arizona | 19 | $142,285 | $16,500 | $15,953 – $17,146 |
| Arkansas | 8 | $101,324 | $15,076 | $15,076 – $15,076 |
| California | 84 | $192,881 | $21,610 | $21,610 – $21,610 |
| Colorado | 19 | – | – | – – – |
| Connecticut | 14 | – | – | – – – |
| Delaware | 3 | $75,924 | $17,641 | $17,641 – $17,641 |
| Florida | 53 | $129,297 | $15,930 | $15,930 – $15,930 |
| Georgia | 30 | $105,013 | $15,586 | $15,586 – $15,586 |
| Hawaii | 5 | – | – | – – – |
| Idaho | 3 | – | – | – – – |
| Illinois | 35 | $86,146 | $16,689 | $16,359 – $17,102 |
| Indiana | 23 | $66,459 | $14,054 | $14,054 – $14,054 |
| Iowa | 6 | – | – | – – – |
| Kansas | 10 | $120,790 | $15,416 | $15,416 – $15,416 |
| Kentucky | 11 | $151,920 | $14,052 | $14,052 – $14,052 |
| Louisiana | 15 | $62,474 | $14,872 | $14,872 – $14,872 |
| Maine | 4 | – | – | – – – |
| Massachusetts | 16 | $64,361 | $18,881 | $18,881 – $18,881 |
| Michigan | 23 | $50,734 | $16,268 | $16,268 – $16,268 |
| Minnesota | 21 | $72,255 | $17,377 | $16,809 – $18,112 |
| Mississippi | 9 | – | – | – – – |
| Missouri | 18 | $42,809 | $13,594 | $13,594 – $13,594 |
| Montana | 3 | – | – | – – – |
| Nebraska | 6 | – | – | – – – |
| Nevada | 7 | – | – | – – – |
| New Hampshire | 4 | – | – | – – – |
| New Jersey | 29 | $102,526 | $19,036 | $18,406 – $19,783 |
| New Mexico | 5 | – | – | – – – |
| New York | 47 | $87,976 | $19,850 | $19,307 – $20,004 |
| North Carolina | 23 | – | – | – – – |
| North Dakota | 3 | – | – | – – – |
| Ohio | 28 | $90,874 | $15,288 | $15,015 – $15,784 |
| Oklahoma | 7 | $111,542 | $15,153 | $15,153 – $15,153 |
| Oregon | 8 | – | – | – – – |
| Pennsylvania | 43 | – | – | – – – |
| Rhode Island | 4 | – | – | – – – |
| South Carolina | 20 | – | – | – – – |
| South Dakota | 4 | $94,861 | $16,487 | $16,487 – $16,487 |
| Tennessee | 18 | $108,770 | $14,684 | $14,684 – $14,684 |
| Texas | 66 | $77,964 | $15,873 | $15,817 – $16,307 |
| Utah | 10 | – | – | – – – |
| Vermont | 1 | – | – | – |
| Virginia | 31 | $95,806 | $15,429 | $15,429 – $15,429 |
| Washington | 20 | – | – | – – – |
| West Virginia | 3 | – | – | – – – |
| Wisconsin | 21 | – | – | – – – |
| Wyoming | 1 | – | – | – |
Hospitals that treat the most Medicare patients for this
| Hospital | Services | Avg charge | Avg allowed |
|---|---|---|---|
| Univ of Tx M D Anderson CtrHouston, TX | 60 | $58,339 | $15,817 |
| Mem Sloan-Kettering Cancer CtrNew York, NY | 58 | $56,396 | $20,004 |
| Faulkner HospitalBoston, MA | 29 | $64,361 | $18,881 |
| NYU Hospitals CenterNew York, NY | 28 | $169,336 | $19,793 |
| Evanston HospitalEvanston, IL | 25 | $64,826 | $16,359 |
| University of Kansas HospitalKansas City, KS | 23 | $120,790 | $15,416 |
| Scripps Memorial Hospital la JollaLa Jolla, CA | 22 | $198,575 | $21,610 |
| Northside HospitalAtlanta, GA | 20 | $105,013 | $15,586 |
| Northwestern Memorial HospitalChicago, IL | 20 | $112,796 | $17,102 |
| Cleveland Clinic - Main CampusCleveland, OH | 20 | $78,171 | $15,015 |
| H Lee Moffitt Cancer CenterTampa, FL | 18 | $88,810 | $15,930 |
| Mayo Clinic - Saint Marys HospitalRochester, MN | 17 | $79,689 | $18,112 |
| Overlook HospitalSummit, NJ | 16 | $123,985 | $19,783 |
| University HospitalStony Brook, NY | 16 | $69,593 | $19,634 |
| Sharp Memorial HospitalSan Diego, CA | 15 | $112,893 | $21,610 |
Questions
How much does level 4 breast/lymphatic surgery and related procedures cost in the U.S.?
In 2024 Medicare data, level 4 breast/lymphatic surgery and related procedures (APC 5094) at 859 hospitals in the U.S. was billed at $100,681 on average, while the average medicare-allowed amount was $17,182, of which Medicare paid $15,549. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for level 4 breast/lymphatic surgery and related procedures?
Among states with at least three hospitals reporting, the average medicare-allowed amount was highest in California ($21,610), New York ($19,850), New Jersey ($19,036) and lowest in Missouri ($13,594), Kentucky ($14,052), Indiana ($14,054).
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 the U.S., average charges were 5.9 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.