Level 5 Musculoskeletal Procedures
What 2,645 hospitals in the U.S. charged and were paid for level 5 musculoskeletal procedures (APC 5115), from 2024 Medicare claims.
Average charge
$72,739
Hospital list price billed
Average allowed
$12,402
Medicare's payment + patient's share
Medicare paid
$10,772
Average per service
Volume
362,845
Medicare services
Hospitals in the U.S. billed an average of $72,739 for level 5 musculoskeletal procedures, about 5.9 times the average medicare-allowed amount of $12,402.
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.
Lowest and highest allowed amounts
Among hospitals with at least 20 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Summa Western Reserve HospitalCuyahoga Falls, OH | $3,145 |
|---|---|
| Central Vermont Medical CenterGraniteville-East Barre, VT | $4,341 |
| Metrohealth SystemCleveland, OH | $4,762 |
| Fletcher Allen Hospital of VermontBurlington, VT | $5,619 |
| University Medical Center of El PasoEl Paso, TX | $5,893 |
| Northwestern Medical CenterSt Albans, VT | $5,983 |
| Vanderbilt University HospitalNashville, TN | $6,948 |
| Rutland Regional Medical CenterRutland, VT | $7,060 |
| Townsen Memorial HospitalHumble, TX | $8,107 |
| Brattleboro Memorial HospitalBrattleboro, VT | $8,122 |
Highest
| Northbay Medical CenterFairfield, CA | $18,892 |
|---|---|
| Peninsula Medical CenterBurlingame, CA | $18,769 |
| California Pacific Medical Ctr - St. Luke's CampusSan Francisco, CA | $18,769 |
| Community Hospital of the Monterey PeninsulaMonterey, CA | $18,490 |
| Stanford HospitalPalo Alto, CA | $18,461 |
| Washington HospitalFremont, CA | $18,456 |
| Stanford Health Care Tri-ValleyPleasanton, CA | $18,437 |
| Sequoia HospitalRedwood City, CA | $18,434 |
| St Mary's Medical CenterSan Francisco, CA | $18,419 |
| UCSF Medical CenterSan Francisco, CA | $18,418 |
Level 5 Musculoskeletal Procedures cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital.
| State | Hospitals | Avg charge | Avg allowed | Range |
|---|---|---|---|---|
| Alabama | 49 | $79,159 | $10,733 | $8,267 – $11,983 |
| Alaska | 6 | $126,408 | $13,858 | $13,470 – $14,522 |
| Arizona | 51 | $91,131 | $12,802 | $12,342 – $14,122 |
| Arkansas | 32 | $42,353 | $11,206 | $10,520 – $12,072 |
| California | 238 | $109,425 | $16,486 | $9,770 – $18,892 |
| Colorado | 49 | $89,472 | $12,564 | $12,002 – $13,397 |
| Connecticut | 24 | $49,732 | $14,579 | $13,217 – $15,693 |
| Delaware | 6 | $42,292 | $13,085 | $12,928 – $13,184 |
| Florida | 159 | $106,916 | $11,799 | $10,469 – $12,749 |
| Georgia | 85 | $81,507 | $11,645 | $10,613 – $12,832 |
| Hawaii | 11 | $54,874 | $14,923 | $14,376 – $15,948 |
| Idaho | 15 | $51,453 | $11,894 | $11,156 – $12,720 |
| Illinois | 99 | $67,081 | $12,334 | $11,236 – $13,006 |
| Indiana | 72 | $77,014 | $11,754 | $11,201 – $12,404 |
| Iowa | 31 | $49,145 | $11,405 | $11,079 – $12,565 |
| Kansas | 42 | $53,203 | $11,345 | $10,776 – $12,756 |
| Kentucky | 50 | $87,551 | $11,263 | $9,880 – $12,115 |
| Louisiana | 59 | $63,307 | $10,909 | $10,052 – $11,704 |
| Maine | 16 | $52,852 | $12,045 | $11,077 – $12,731 |
| Massachusetts | 50 | $35,515 | $13,997 | $13,693 – $14,740 |
| Michigan | 85 | $48,377 | $11,535 | $8,398 – $12,425 |
| Minnesota | 45 | $39,240 | $12,735 | $11,857 – $13,419 |
| Mississippi | 33 | $63,812 | $10,843 | $10,149 – $11,787 |
| Missouri | 60 | $52,156 | $11,419 | $10,738 – $12,876 |
| Montana | 10 | $42,843 | $12,302 | $10,666 – $13,194 |
| Nebraska | 24 | $46,105 | $11,799 | $11,229 – $12,570 |
| Nevada | 19 | $113,238 | $13,956 | $12,456 – $15,862 |
| New Hampshire | 14 | $68,606 | $12,713 | $12,198 – $13,281 |
| New Jersey | 57 | $63,534 | $14,069 | $12,494 – $14,948 |
| New Mexico | 21 | $73,686 | $11,704 | $10,818 – $12,980 |
| New York | 114 | $68,071 | $14,226 | $10,591 – $14,948 |
| North Carolina | 75 | $61,099 | $11,652 | $10,388 – $13,102 |
| North Dakota | 6 | $38,474 | $12,448 | $12,236 – $13,194 |
| Ohio | 115 | $58,378 | $11,123 | $3,145 – $12,321 |
| Oklahoma | 53 | $63,568 | $11,159 | $10,020 – $12,127 |
| Oregon | 32 | $52,285 | $13,939 | $11,878 – $17,077 |
| Pennsylvania | 124 | $63,606 | $12,207 | $10,546 – $13,847 |
| Rhode Island | 9 | $31,359 | $13,278 | $13,149 – $13,335 |
| South Carolina | 49 | $80,408 | $11,244 | $10,553 – $12,433 |
| South Dakota | 14 | $48,585 | $12,387 | $12,083 – $13,194 |
| Tennessee | 60 | $65,831 | $10,865 | $6,948 – $12,020 |
| Texas | 237 | $98,406 | $11,614 | $5,893 – $12,723 |
| Utah | 33 | $60,878 | $11,712 | $10,331 – $12,608 |
| Vermont | 6 | $40,026 | $6,642 | $4,341 – $8,811 |
| Virginia | 62 | $83,964 | $11,531 | $8,957 – $12,584 |
| Washington | 46 | $69,882 | $13,453 | $12,437 – $14,496 |
| West Virginia | 22 | $56,053 | $11,015 | $9,800 – $12,095 |
| Wisconsin | 61 | $50,252 | $11,921 | $11,292 – $12,656 |
| Wyoming | 10 | $54,760 | $12,806 | $11,879 – $13,194 |
Hospitals that treat the most Medicare patients for this
| Hospital | Services | Avg charge | Avg allowed |
|---|---|---|---|
| Hospital for Special SurgeryNew York, NY | 2,670 | $88,594 | $14,605 |
| Lehigh Valley HospitalAllentown, PA | 1,465 | $85,743 | $12,688 |
| New England Baptist HospitalBoston, MA | 1,432 | $28,062 | $14,017 |
| Evanston HospitalEvanston, IL | 1,343 | $57,916 | $12,119 |
| Mayo Clinic - Saint Marys HospitalRochester, MN | 1,327 | $43,902 | $13,419 |
| Hoag Orthopedic InstituteIrvine, CA | 1,238 | $69,835 | $15,979 |
| Morristown Memorial HospitalMorristown, NJ | 1,233 | $57,254 | $14,577 |
| Sioux Falls Surgical Hospital LLPSioux Falls, SD | 1,213 | $45,509 | $12,287 |
| Iowa Methodist Medical CenterDes Moines, IA | 1,145 | $57,163 | $11,208 |
| NYU Hospitals CenterNew York, NY | 1,083 | $188,372 | $14,679 |
| Adventist la Grange Memorial HospitalLa Grange, IL | 1,081 | $57,158 | $12,387 |
| Rex HospitalRaleigh, NC | 1,077 | $55,586 | $11,741 |
| Christ HospitalCincinnati, OH | 1,069 | $40,170 | $11,295 |
| Texas Orthopedic HospitalHouston, TX | 1,066 | $169,311 | $12,098 |
| Christiana Care Health Services, INC.Newark, DE | 1,029 | $42,898 | $13,004 |
Questions
How much does level 5 musculoskeletal procedures cost in the U.S.?
In 2024 Medicare data, level 5 musculoskeletal procedures (APC 5115) at 2,645 hospitals in the U.S. was billed at $72,739 on average, while the average medicare-allowed amount was $12,402, of which Medicare paid $10,772. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for level 5 musculoskeletal procedures?
Among states with at least three hospitals reporting, the average medicare-allowed amount was highest in California ($16,486), Hawaii ($14,923), Connecticut ($14,579) and lowest in Vermont ($6,642), Alabama ($10,733), Mississippi ($10,843).
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 the U.S., average charges were 5.9 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.