Level 5 Musculoskeletal Procedures in California
What 238 hospitals in California charged and were paid for level 5 musculoskeletal procedures (APC 5115), from 2024 Medicare claims.
Average charge
$109,425
Hospital list price billed
Average allowed
$16,486
Medicare's payment + patient's share
Medicare paid
$14,852
Average per service
State rank
#49 of 49
1 = lowest average payment
Hospitals in California billed an average of $109,425 for level 5 musculoskeletal procedures, about 6.6 times the average medicare-allowed amount of $16,486. That payment is 33% above the U.S. average 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.
Paid $16,486Billed $109,425
About 15¢ was paid for every $1 hospitals in California billed for this service.
California hospitals: level 5 musculoskeletal procedures
Every California hospital that billed Medicare for this service at least 11 times. Click a column to sort.
| Hospital | Services | Avg charge | Avg allowed | Medicare paid |
|---|---|---|---|---|
| Hoag Orthopedic InstituteIrvine | 1,238 | $69,835 | $15,979 | $14,345 |
| Washington HospitalFremont | 991 | $142,177 | $18,456 | $16,824 |
| Fresno Surgical HospitalFresno | 891 | $45,124 | $15,992 | $14,360 |
| Eisenhower Memorial HospitalRancho Mirage | 797 | $69,986 | $16,020 | $14,388 |
| St Helena HospitalDeer Park | 626 | $191,731 | $16,667 | $15,035 |
| Scripps Green HospitalLa Jolla | 603 | $128,762 | $16,052 | $14,420 |
| El Camino HospitalMountain View | 588 | $153,342 | $18,376 | $16,742 |
| Cedars-Sinai Medical CenterLos Angeles | 580 | $221,497 | $15,998 | $14,365 |
| University of California San Diego Medical CenterSan Diego | 534 | $78,549 | $16,094 | $14,459 |
| Los Robles Hospital & Medical CenterThousand Oaks | 507 | $244,958 | $15,948 | $14,314 |
| Stanford HospitalPalo Alto | 464 | $176,897 | $18,461 | $16,830 |
| Enloe Medical CenterChico | 461 | $89,004 | $16,116 | $14,484 |
| Mercy Medical Center ReddingRedding | 427 | $84,680 | $15,945 | $14,311 |
| Stanford Health Care Tri-ValleyPleasanton | 420 | $95,440 | $18,437 | $16,805 |
| Goleta Valley Cottage HospitalSanta Barbara | 418 | $80,974 | $16,044 | $14,411 |
| Huntington Memorial HospitalPasadena | 415 | $74,124 | $16,043 | $14,410 |
| University of California Davis Medical CenterSacramento | 379 | $122,550 | $16,254 | $14,621 |
| USC Arcadia HospitalArcadia | 374 | $85,464 | $15,876 | $14,244 |
| Mission Hospital Regional Med CenterMission Viejo | 365 | $95,295 | $16,148 | $14,513 |
| Santa Monica - UCLA Med Ctr & Orthopaedic HospitalSanta Monica | 346 | $72,584 | $15,737 | $14,105 |
| Saint Agnes Medical CenterFresno | 331 | $74,401 | $15,821 | $14,187 |
| Adventist Health BakersfieldBakersfield | 325 | $124,753 | $15,975 | $14,342 |
| Sutter Medical Center of Santa RosaSanta Rosa | 316 | $82,713 | $17,429 | $15,793 |
| Lodi Memorial HospitalLodi | 316 | $137,428 | $16,447 | $14,814 |
| USC University HospitalLos Angeles | 303 | $100,189 | $15,956 | $14,322 |
| Sequoia HospitalRedwood City | 299 | $130,111 | $18,434 | $16,801 |
| French Hospital Medical CenterSan Luis Obispo | 290 | $100,710 | $16,045 | $14,412 |
| Grossmont HospitalLa Mesa | 287 | $136,051 | $16,148 | $14,516 |
| Novato Community HospitalNovato | 284 | $88,984 | $18,221 | $16,588 |
| Saint John's Health CenterSanta Monica | 265 | $68,176 | $16,006 | $14,374 |
| Kaweah Delta Medical CenterVisalia | 258 | $46,809 | $15,870 | $14,238 |
| Sonora Community HospitalSonora | 256 | $147,471 | $16,873 | $15,240 |
| Sutter Roseville Medical CenterRoseville | 254 | $80,421 | $16,594 | $14,961 |
| Torrance Memorial Medical CenterTorrance | 246 | $115,096 | $16,148 | $14,516 |
| Santa Barbara Cottage HospitalSanta Barbara | 242 | $82,713 | $17,098 | $15,465 |
| Marina del Rey HospitalMarina del Rey | 237 | $80,564 | $16,026 | $14,393 |
| St Johns Regional Medical CenterOxnard | 235 | $104,376 | $16,086 | $14,452 |
| UCSF Medical CenterSan Francisco | 233 | $95,650 | $18,418 | $16,786 |
| Bakersfield Memorial HospitalBakersfield | 229 | $81,936 | $16,085 | $14,452 |
| Patients' Hospital of ReddingRedding | 229 | $67,344 | $15,651 | $14,014 |
| Palomar Medical CenterEscondido | 222 | $88,607 | $9,770 | $8,135 |
| St Jude Medical CenterFullerton | 221 | $61,076 | $16,021 | $14,389 |
| Sharp Coronado Hospital and Hlthcr CtrCoronado | 217 | $106,362 | $16,081 | $14,446 |
| Community Memorial Hospital - VenturaVentura | 207 | $75,943 | $16,148 | $14,515 |
| Good Samaritan HospitalSan Jose | 196 | $293,615 | $18,234 | $16,598 |
| Sutter Auburn Faith HospitalAuburn | 196 | $85,593 | $16,696 | $15,063 |
| Redlands Community HospitalRedlands | 194 | $86,185 | $16,148 | $14,511 |
| Sutter Surgical Hospital - North ValleyYuba City | 194 | $81,827 | $16,095 | $14,463 |
| Marinhealth Medical CenterGreenbrae | 182 | $172,209 | $18,338 | $16,706 |
| Providence Tarzana Medical CenterTarzana | 178 | $99,178 | $16,085 | $14,453 |
| Community Hospital of the Monterey PeninsulaMonterey | 177 | $69,287 | $18,490 | $16,858 |
| Marian Medical CenterSanta Maria | 173 | $99,971 | $15,757 | $14,133 |
| St Joseph HospitalEureka | 166 | $94,768 | $16,148 | $14,516 |
| Sutter General HospitalSacramento | 165 | $83,263 | $18,187 | $16,552 |
| Salinas Valley Memorial HospitalSalinas | 155 | $132,945 | $18,273 | $16,641 |
| Providence Saint Joseph Medical CtrBurbank | 154 | $75,197 | $16,055 | $14,422 |
| Casa Colina HospitalPomona | 151 | $63,194 | $16,148 | $14,516 |
| Mercy Medical Ctr MercedMerced | 150 | $53,276 | $15,956 | $14,311 |
| Peninsula Medical CenterBurlingame | 149 | $85,650 | $18,769 | $17,137 |
| Dameron HospitalStockton | 143 | $185,512 | $16,286 | $14,652 |
| Downey Regional Medical CenterDowney | 143 | $70,138 | $15,750 | $14,112 |
| Long Beach Memorial Medical CenterLong Beach | 143 | $82,326 | $15,945 | $14,313 |
| PIH Health Hospital-WhittierWhittier | 141 | $80,528 | $15,947 | $14,311 |
| Rideout Memorial HospitalMarysville | 140 | $97,283 | $16,964 | $15,331 |
| Barton Memorial HospitalSouth Lake Tahoe | 136 | $150,475 | $16,461 | $14,834 |
| Northridge Hospital Medical CenterNorthridge | 135 | $102,556 | $15,825 | $14,193 |
| Memorial Medical CenterModesto | 135 | $81,166 | $15,933 | $14,301 |
| Palomar Medical Center PowayPoway | 133 | $68,451 | $11,347 | $9,710 |
| St Joseph HospitalOrange | 129 | $71,794 | $16,148 | $14,516 |
| UCI Health-OrangeOrange | 127 | $87,391 | $15,688 | $14,073 |
| Marshall Medical Center (1-Rh)Placerville | 124 | $158,605 | $16,651 | $15,017 |
| Sierra Nevada Memorial HospitalGrass Valley | 121 | $71,068 | $16,773 | $15,139 |
| Scripps Memorial Hospital la JollaLa Jolla | 121 | $156,838 | $16,028 | $14,394 |
| Mercy General HospitalSacramento | 120 | $118,003 | $16,396 | $14,761 |
| Dominican HospitalSanta Cruz | 119 | $108,417 | $17,206 | $15,569 |
| Providence Little Company of Mary Med Ctr TorranceTorrance | 119 | $101,940 | $16,043 | $14,411 |
| Verdugo Hills HospitalGlendale | 118 | $85,764 | $15,902 | $14,270 |
| Santa Rosa Memorial HospitalSanta Rosa | 118 | $171,714 | $18,390 | $16,758 |
| Temecula Valley HospitalTemecula | 118 | $81,856 | $16,047 | $14,410 |
| Mercy San Juan Medical CenterCarmichael | 116 | $119,777 | $16,773 | $15,139 |
| Northbay Medical CenterFairfield | 115 | $256,656 | $18,892 | $17,257 |
| Mercy HospitalBakersfield | 106 | $82,285 | $16,148 | $14,514 |
| Clovis Community Medical CenterClovis | 106 | $76,364 | $15,896 | $14,262 |
| Southwest Healthcare SystemMurrieta | 101 | $76,665 | $16,148 | $14,515 |
| Simi Valley Hospital & Health Care ServicesSimi Valley | 95 | $102,617 | $15,997 | $14,363 |
| Sutter Maternity & Surgery Center of Santa CruzSanta Cruz | 95 | $92,235 | $17,546 | $15,914 |
| Emanuel Medical Center INCTurlock | 93 | $227,196 | $16,340 | $14,701 |
| Doctors Medical CenterModesto | 93 | $163,052 | $16,148 | $14,514 |
| Glendale Adventist Medical CtrGlendale | 90 | $125,190 | $16,018 | $14,385 |
| Mercy Hospital of FolsomFolsom | 89 | $112,374 | $16,263 | $14,631 |
| Scripps Mercy HospitalSan Diego | 86 | $159,638 | $15,979 | $14,347 |
| Orange Coast Memorial Medical CenterFountain Valley | 86 | $76,019 | $15,992 | $14,360 |
| Queen of the Valley Medical CenterNapa | 85 | $138,552 | $18,390 | $16,758 |
| Stanislaus Surgical HospitalModesto | 85 | $100,744 | $16,499 | $14,866 |
| Loma Linda University Medical CenterLoma Linda | 82 | $95,335 | $16,148 | $14,516 |
| Scripps Memorial Hospital - EncinitasEncinitas | 82 | $153,658 | $16,148 | $14,516 |
| Riverside Community HospitalRiverside | 79 | $199,678 | $16,148 | $14,510 |
| Woodland Memorial HospitalWoodland | 78 | $78,163 | $16,580 | $14,946 |
| Los Alamitos Medical CenterLos Alamitos | 78 | $177,989 | $15,971 | $14,339 |
| Twin Cities Community HospitalTempleton | 78 | $172,852 | $16,148 | $14,509 |
| San Antonio Community HospitalUpland | 77 | $90,725 | $15,959 | $14,327 |
| Sharp Memorial HospitalSan Diego | 76 | $116,383 | $16,148 | $14,516 |
| Hanford Community Medical CenterHanford | 76 | $79,505 | $15,878 | $14,244 |
| John Muir Medical Center - Walnut Creek CampusWalnut Creek | 75 | $168,272 | $18,061 | $16,426 |
| Tri-City Medical CenterOceanside | 74 | $84,573 | $15,420 | $13,783 |
| St Josephs Med Center of StocktonStockton | 73 | $117,711 | $18,015 | $16,383 |
| Pomona Valley Hospital Medical CenterPomona | 68 | $87,250 | $15,947 | $14,312 |
| San Ramon Regional Medical CtrSan Ramon | 64 | $152,031 | $18,023 | $16,391 |
| Methodist Hospital of SacramentoSacramento | 62 | $109,832 | $16,449 | $14,825 |
| Glendale Mem Hospital & Hlth CenterGlendale | 60 | $103,925 | $16,148 | $14,511 |
| Pioneers Memorial Healthcare DistrictBrawley | 58 | $32,508 | $16,148 | $14,514 |
| Loma Linda University Medical Center-MurrietaMurrieta | 57 | $72,048 | $16,148 | $14,513 |
| Saddleback Memorial Medical CenterLaguna Hills | 55 | $77,810 | $16,148 | $14,516 |
| West Hills Hospital & Medical CenterWest Hills | 54 | $237,712 | $16,148 | $14,511 |
| Sutter Davis HospitalDavis | 50 | $100,113 | $16,475 | $14,838 |
| St Mary's Medical CenterSan Francisco | 49 | $82,802 | $18,419 | $16,785 |
| Mission Community Hospital - PanoramaPanorama City | 43 | $127,549 | $16,148 | $14,516 |
| Lac/Rancho los Amigos National Rehabilitation CtrDowney | 43 | $154,751 | $16,148 | $14,496 |
| White Memorial Medical CenterLos Angeles | 41 | $155,677 | $16,148 | $14,497 |
| Sierra View District HospitalPorterville | 41 | $51,836 | $15,794 | $14,160 |
| Sierra Vista Regional Medical CenterSan Luis Obispo | 41 | $146,111 | $16,148 | $14,516 |
| St Elizabeth Community HospitalRed Bluff | 40 | $85,353 | $17,292 | $15,658 |
| UCI Health-Placentia LindaPlacentia | 40 | $161,783 | $16,148 | $14,514 |
| Sutter Tracy Community HospitalTracy | 37 | $99,944 | $16,093 | $14,460 |
| Desert Regional Medical CenterPalm Springs | 36 | $222,846 | $15,341 | $13,701 |
| Eden Medical CenterCastro Valley | 36 | $77,099 | $17,773 | $16,141 |
| Providence Holy Cross Medical CenterMission Hills | 31 | $82,915 | $15,709 | $14,077 |
| Emanate Health Inter-Community HospitalCovina | 31 | $56,808 | $16,148 | $14,516 |
| Lakewood Regional Medical CenterLakewood | 31 | $148,738 | $15,679 | $14,047 |
| St Mary Medical CenterApple Valley | 30 | $80,956 | $16,148 | $14,510 |
| Valley Presbyterian HospitalVan Nuys | 29 | $82,327 | $16,148 | $14,516 |
| Highland HospitalOakland | 29 | $93,855 | $18,234 | $16,602 |
| Henry Mayo Newhall Memorial HospitalValencia | 29 | $80,918 | $15,681 | $14,049 |
| Sharp Chula Vista Medical CenterChula Vista | 27 | $131,572 | $15,610 | $13,973 |
| San Gabriel Valley Medical CenterSan Gabriel | 26 | $93,905 | $16,148 | $14,516 |
| Hoag Memorial Hospital PresbyterianNewport Beach | 26 | $94,175 | $16,148 | $14,516 |
| Antelope Valley Hospital Med CenterLancaster | 25 | $74,766 | $16,148 | $14,516 |
| California Pacific Medical Ctr - St. Luke's CampusSan Francisco | 23 | $80,219 | $18,769 | $17,137 |
| Community Regional Medical CenterFresno | 22 | $84,363 | $16,148 | $14,516 |
| Kaiser Foundation Hospital - San DiegoSan Diego | 22 | $53,186 | $15,190 | $13,558 |
| Corona Regional Medical CenterCorona | 21 | $107,515 | $16,148 | $14,516 |
| Shasta Regional Medical CenterRedding | 21 | $150,162 | $16,148 | $14,516 |
| Santa Clara Valley Medical CenterSan Jose | 19 | $61,423 | $18,490 | $16,858 |
| San Dimas Community HospitalSan Dimas | 19 | $118,860 | $16,148 | $14,516 |
| Kaiser Foundation Hospital - San LeandroSan Leandro | 19 | $76,733 | $16,653 | $14,991 |
| Palmdale Regional Medical CenterLancaster | 18 | $202,716 | $15,341 | $13,709 |
| Ukiah Valley Medical Center/Hospital DUkiah | 18 | $104,290 | $17,292 | $15,660 |
| St Bernardine Medical CenterSan Bernardino | 17 | $90,967 | $16,148 | $14,503 |
| California Hospital Medical Center laLos Angeles | 17 | $78,746 | $16,148 | $14,502 |
| Petaluma Valley HospitalPetaluma | 16 | $133,001 | $17,529 | $15,897 |
| UCLA Medical CenterLos Angeles | 16 | $80,837 | $16,148 | $14,516 |
| Kern Medical CenterBakersfield | 16 | $62,078 | $15,835 | $14,203 |
| Good Samaritan HospitalLos Angeles | 16 | $109,523 | $16,148 | $14,516 |
| Kaiser Foundation Hospital - AntiochAntioch | 16 | $70,286 | $13,900 | $12,208 |
| Alta Bates Summit Medical CenterOakland | 15 | $92,612 | $18,234 | $16,602 |
| Sonoma Valley HospitalSonoma | 15 | $165,141 | $17,529 | $15,868 |
| John Muir Medical Center - Concord CampusConcord | 15 | $139,843 | $17,176 | $15,541 |
| Kaiser Foundation Hospital AnaheimAnaheim | 15 | $66,845 | $14,889 | $13,220 |
| Kaiser Foundation Hospital - RosevilleRoseville | 15 | $61,928 | $16,449 | $14,785 |
| San Joaquin General HospitalFrench Camp | 13 | $52,907 | $16,494 | $14,862 |
| Kaiser Foundation Hosp So SacramentoSacramento | 13 | $78,350 | $18,035 | $16,363 |
| Kaiser Foundation Hospital - VacavilleVacaville | 13 | $68,784 | $18,526 | $16,888 |
| Docs Surgical HospitalLos Angeles | 13 | $109,219 | $16,148 | $14,516 |
| Parkview Community Hospital Medical CenterRiverside | 12 | $83,842 | $16,148 | $14,516 |
| California Pacific Medical Ctr-Davies Campus HospSan Francisco | – | – | – | – |
| Sutter Amador HospitalJackson | – | – | – | – |
| Mad River Community HospitalArcata | – | – | – | – |
| Lac/Olive View-UCLA Medical CenterSylmar | – | – | – | – |
| El Centro Regional Medical CenterEl Centro | – | – | – | – |
| California Pacific Medical Ctr-Pacific Campus HospSan Francisco | – | – | – | – |
| San Gorgonio Memorial HospitalBanning | – | – | – | – |
| Hollywood Presbyterian Medical CenterLos Angeles | – | – | – | – |
| Kaiser Foundation Hospital - South San FranciscoMillbrae | – | – | – | – |
| Kaiser Foundation HospitalSanta Clara | – | – | – | – |
| John Muir/Mt Diablo Hlth SystWalnut Creek | – | – | – | – |
| Kaiser Foundation Hospital and Rehab CenterVallejo | – | – | – | – |
| Kaiser Foundation Hospital Oakland/RichmondOakland | – | – | – | – |
| Kaiser Foundation Hospital - San FranciscoSan Francisco | – | – | – | – |
| Providence Little Co of Mary Med Ctr San PedroLos Angeles | – | – | – | – |
| Community Hospital of San BernardinoSan Bernardino | – | – | – | – |
| Sutter Solano Medical CenterVallejo | – | – | – | – |
| Lompoc Healthcare DistrictLompoc | – | – | – | – |
| San Mateo Medical CenterSan Mateo | – | – | – | – |
| Doctors Hospital of MantecaManteca | – | – | – | – |
| Regional Medical Center of San JoseSan Jose | – | – | – | – |
| Hollywood Community Hospital of HollywoodLos Angeles | – | – | – | – |
| Kaiser Foundation Hospital - Panorama CityPanorama City | – | – | – | – |
| Kaiser Foundation Hospital - los AngelesLos Angeles | – | – | – | – |
| Kaiser Foundation HospitalBellflower | – | – | – | – |
| Kaiser Foundation Hospital FontanaFontana | – | – | – | – |
| City of Hope Natl Medical CtrDuarte | – | – | – | – |
| Saint Francis Memorial HospitalSan Francisco | – | – | – | – |
| Ventura County Medical CenterVentura | – | – | – | – |
| St Mary Medical CenterLong Beach | – | – | – | – |
| Watsonville Community HospitalWatsonville | – | – | – | – |
| Ahmc Anaheim Regional Medical CenterAnaheim | – | – | – | – |
| San Francisco General HospitalSan Francisco | – | – | – | – |
| Arrowhead Regional Medical CenterColton | – | – | – | – |
| Natividad Medical CenterSalinas | – | – | – | – |
| Hi-Desert Medical CenterJoshua Tree | – | – | – | – |
| Alhambra Hospital Medical CenterAlhambra | – | – | – | – |
| Seton Medical CenterDaly City | – | – | – | – |
| Riverside County Regional Medical CenterMoreno Valley | – | – | – | – |
| Barstow Community HospitalBarstow | – | – | – | – |
| Alta Bates Summit Medical Center - Alta Bates CampBerkeley | – | – | – | – |
| Los Angeles General Medical CenterLos Angeles | – | – | – | – |
| Lac/Harbor-UCLA Med CenterTorrance | – | – | – | – |
| Hemet Valley Medical CenterHemet | – | – | – | – |
| Chinese HospitalSan Francisco | – | – | – | – |
| Kaiser Foundation Hospital - Harbor CityHarbor City | – | – | – | – |
| Sutter Coast HospitalCrescent City | – | – | – | – |
| Kaiser Foundation Hospital - Sacramento/RosevilleSacramento | – | – | – | – |
| Memorial Hospital of GardenaGardena | – | – | – | – |
| Kaiser Foundation Hospital Fremont/HaywardHayward | – | – | – | – |
| Sutter Delta Medical CenterAntioch | – | – | – | – |
| John F Kennedy Memorial HospIndio | – | – | – | – |
| Kaiser Foundation Hospital - Redwood CityRedwood City | – | – | – | – |
| Kaiser Foundation Hospital - West laLos Angeles | – | – | – | – |
| Fountain Valley Regional Hospital & Medical CenterFountain Valley | – | – | – | – |
| Chino Valley Medical CenterChino | – | – | – | – |
| Foothill Presbyterian HospitalGlendora | – | – | – | – |
| Kaiser Foundation Hospital-San JoseSan Jose | – | – | – | – |
| Delano Regional Medical CenterDelano | – | – | – | – |
| USC Kenneth Norris Jr Cancer HospitalLos Angeles | – | – | – | – |
| Kaiser Foundation Hospital - Woodland HillsWoodland Hills | – | – | – | – |
| Kaiser Foundation Hospital, RiversideRiverside | – | – | – | – |
| Kaiser Foundation Hospital-Santa RosaSanta Rosa | – | – | – | – |
| Desert Valley HospitalVictorville | – | – | – | – |
| Kaiser Foundation Hospital - FresnoFresno | – | – | – | – |
| Kaiser Foundation Hospital - Baldwin ParkBaldwin Park | – | – | – | – |
| Monterey Park HospitalMonterey Park | – | – | – | – |
| Orange County Global Medical CenterSanta Ana | – | – | – | – |
| Kaiser Foundation Hospital MantecaManteca | – | – | – | – |
| L a Downtown Medical CenterLos Angeles | – | – | – | – |
| Kaiser Foundation Hospital-Moreno ValleyMoreno Valley | – | – | – | – |
| Foothill Regional Medical CenterTustin | – | – | – | – |
| Adventist Health TulareTulare | – | – | – | – |
| Kaiser Foundation Hospital - San MarcosSan Marcos | – | – | – | – |
Lowest and highest allowed amounts in California
Among hospitals with at least 11 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Palomar Medical CenterEscondido, CA | $9,770 |
|---|---|
| Palomar Medical Center PowayPoway, CA | $11,347 |
| Kaiser Foundation Hospital - AntiochAntioch, CA | $13,900 |
| Kaiser Foundation Hospital AnaheimAnaheim, CA | $14,889 |
| Kaiser Foundation Hospital - San DiegoSan Diego, CA | $15,190 |
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 |
| Kaiser Foundation Hospital - VacavilleVacaville, CA | $18,526 |
| Santa Clara Valley Medical CenterSan Jose, CA | $18,490 |
Level 5 Musculoskeletal Procedures in other states
Questions
How much does level 5 musculoskeletal procedures cost in California?
In 2024 Medicare data, level 5 musculoskeletal procedures (APC 5115) at 238 hospitals in California was billed at $109,425 on average, while the average medicare-allowed amount was $16,486, of which Medicare paid $14,852. 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 California, average charges were 6.6 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.