What 58 hospitals in North Carolina charged and were paid for level 4 ent procedures (APC 5164), from 2024 Medicare claims.
APC 5164Outpatient2024 Medicare data
Average charge$20,537Hospital list price billed
Average allowed$2,589Medicare's payment + patient's share
Medicare paid$2,051Average per service
State rank#8 of 481 = lowest average payment
Hospitals in North Carolina billed an average of $20,537 for level 4 ent procedures, about 7.9 times the average medicare-allowed amount of $2,589. That payment is 7% below the U.S. average of $2,798.
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 $2,589Billed $20,537
About 13¢ was paid for every $1 hospitals in North Carolina billed for this service.
North Carolina hospitals: level 4 ent procedures
Every North Carolina hospital that billed Medicare for this service at least 11 times. Click a column to sort.
Lowest and highest allowed amounts in North Carolina
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 ent procedures cost in North Carolina?
In 2024 Medicare data, level 4 ent procedures (APC 5164) at 58 hospitals in North Carolina was billed at $20,537 on average, while the average medicare-allowed amount was $2,589, of which Medicare paid $2,051. 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 North Carolina, average charges were 7.9 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.
