Level 5 ENT Procedures in Rhode Island
What 4 hospitals in Rhode Island charged and were paid for level 5 ent procedures (APC 5165), from 2024 Medicare claims.
Average charge
$15,158
Hospital list price billed
Average allowed
$5,943
Medicare's payment + patient's share
Medicare paid
$4,735
Average per service
State rank
#40 of 49
1 = lowest average payment
Hospitals in Rhode Island billed an average of $15,158 for level 5 ent procedures, about 2.6 times the average medicare-allowed amount of $5,943. That payment is 6% above the U.S. average of $5,586.
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 $5,943Billed $15,158
About 39¢ was paid for every $1 hospitals in Rhode Island billed for this service.
Rhode Island hospitals: level 5 ent procedures
Every Rhode Island hospital that billed Medicare for this service at least 11 times. Click a column to sort.
| Hospital | Services | Avg charge | Avg allowed | Medicare paid |
|---|---|---|---|---|
| Miriam HospitalProvidence | 36 | $13,765 | $5,943 | $4,735 |
| Rhode Island HospitalProvidence | 29 | $16,887 | $5,943 | $4,735 |
| Our Lady of Fatima HospitalNorth Providence | – | – | – | – |
| Westerly HospitalWesterly | – | – | – | – |
Level 5 ENT Procedures in other states
Questions
How much does level 5 ent procedures cost in Rhode Island?
In 2024 Medicare data, level 5 ent procedures (APC 5165) at 4 hospitals in Rhode Island was billed at $15,158 on average, while the average medicare-allowed amount was $5,943, of which Medicare paid $4,735. 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 Rhode Island, average charges were 2.6 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.