Level 4 Breast/Lymphatic Surgery and Related Procedures in Texas
What 66 hospitals in Texas charged and were paid for level 4 breast/lymphatic surgery and related procedures (APC 5094), from 2024 Medicare claims.
APC 5094Outpatient2024 Medicare data
Average charge$77,964Hospital list price billed
Average allowed$15,873Medicare's payment + patient's share
Medicare paid$14,239Average per service
State rank#12 of 231 = lowest average payment
Hospitals in Texas billed an average of $77,964 for level 4 breast/lymphatic surgery and related procedures, about 4.9 times the average medicare-allowed amount of $15,873. That payment is 8% below the U.S. average 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 $15,873Billed $77,964
About 20¢ was paid for every $1 hospitals in Texas billed for this service.
Texas hospitals: level 4 breast/lymphatic surgery and related 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 4 breast/lymphatic surgery and related procedures cost in Texas?
In 2024 Medicare data, level 4 breast/lymphatic surgery and related procedures (APC 5094) at 66 hospitals in Texas was billed at $77,964 on average, while the average medicare-allowed amount was $15,873, of which Medicare paid $14,239. 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 4.9 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.
