What 96 hospitals in Pennsylvania charged and were paid for level 5 gynecologic procedures (APC 5415), from 2024 Medicare claims.
APC 5415Outpatient2024 Medicare data
Average charge$37,095Hospital list price billed
Average allowed$4,630Medicare's payment + patient's share
Medicare paid$3,679Average per service
State rank#30 of 481 = lowest average payment
Hospitals in Pennsylvania billed an average of $37,095 for level 5 gynecologic procedures, about 8.0 times the average medicare-allowed amount of $4,630. That payment is 3% below the U.S. average of $4,779.
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 $4,630Billed $37,095
About 12¢ was paid for every $1 hospitals in Pennsylvania billed for this service.
Lowest and highest allowed amounts in Pennsylvania
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 5 gynecologic procedures cost in Pennsylvania?
In 2024 Medicare data, level 5 gynecologic procedures (APC 5415) at 96 hospitals in Pennsylvania was billed at $37,095 on average, while the average medicare-allowed amount was $4,630, of which Medicare paid $3,679. 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 Pennsylvania, average charges were 8.0 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.
