Level 4 Breast/Lymphatic Surgery and Related Procedures in Virginia
What 31 hospitals in Virginia charged and were paid for level 4 breast/lymphatic surgery and related procedures (APC 5094), from 2024 Medicare claims.
Average charge
$95,806
Hospital list price billed
Average allowed
$15,429
Medicare's payment + patient's share
Medicare paid
$13,797
Average per service
State rank
#10 of 23
1 = lowest average payment
Hospitals in Virginia billed an average of $95,806 for level 4 breast/lymphatic surgery and related procedures, about 6.2 times the average medicare-allowed amount of $15,429. That payment is 10% 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 $15,429Billed $95,806
About 16¢ was paid for every $1 hospitals in Virginia billed for this service.
Virginia hospitals: level 4 breast/lymphatic surgery and related procedures
Every Virginia hospital that billed Medicare for this service at least 11 times. Click a column to sort.
Level 4 Breast/Lymphatic Surgery and Related Procedures in other states
Questions
How much does level 4 breast/lymphatic surgery and related procedures cost in Virginia?
In 2024 Medicare data, level 4 breast/lymphatic surgery and related procedures (APC 5094) at 31 hospitals in Virginia was billed at $95,806 on average, while the average medicare-allowed amount was $15,429, of which Medicare paid $13,797. 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 Virginia, average charges were 6.2 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.