Level 5 Musculoskeletal Procedures in Maine
What 16 hospitals in Maine charged and were paid for level 5 musculoskeletal procedures (APC 5115), from 2024 Medicare claims.
Average charge
$52,852
Hospital list price billed
Average allowed
$12,045
Medicare's payment + patient's share
Medicare paid
$10,411
Average per service
State rank
#27 of 49
1 = lowest average payment
Hospitals in Maine billed an average of $52,852 for level 5 musculoskeletal procedures, about 4.4 times the average medicare-allowed amount of $12,045. That payment is 3% below 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 $12,045Billed $52,852
About 23¢ was paid for every $1 hospitals in Maine billed for this service.
Maine hospitals: level 5 musculoskeletal procedures
Every Maine hospital that billed Medicare for this service at least 11 times. Click a column to sort.
| Hospital | Services | Avg charge | Avg allowed | Medicare paid |
|---|---|---|---|---|
| Maine Medical CenterPortland | 551 | $57,351 | $12,212 | $10,579 |
| Mercy HospitalPortland | 355 | $47,688 | $12,197 | $10,565 |
| St Joseph HospitalBangor | 143 | $51,122 | $11,077 | $9,442 |
| York HospitalYork | 79 | $55,547 | $12,213 | $10,581 |
| Penobscot Bay Medical CenterRockport | 68 | $49,512 | $12,078 | $10,446 |
| Maine General Medical CenterWaterville | 66 | $49,300 | $12,731 | $11,097 |
| Mid Coast HospitalBrunswick | 62 | $41,888 | $12,006 | $10,371 |
| Southern Maine Health CareBiddeford | 54 | $48,070 | $12,348 | $10,716 |
| Central Maine Medical CenterLewiston | 54 | $47,332 | $11,924 | $10,290 |
| Eastern Maine Medical CenterBangor | 46 | $50,433 | $11,452 | $9,816 |
| St Marys Regional Medical CenterLewiston | 33 | $77,015 | $11,412 | $9,780 |
| Northern Light a R Gould HospitalPresque Isle | 32 | $61,641 | $11,280 | $9,640 |
| Maine Coast Memorial HospitalEllsworth | 26 | $62,996 | $12,505 | $10,873 |
| Cary Medical CenterCaribou | 21 | $45,921 | $11,280 | $9,647 |
| Franklin Memorial HospitalFarmington | – | – | – | – |
| Northern Light Inland HospitalWaterville | – | – | – | – |
Lowest and highest allowed amounts in Maine
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
| St Joseph HospitalBangor, ME | $11,077 |
|---|---|
| Cary Medical CenterCaribou, ME | $11,280 |
| Northern Light a R Gould HospitalPresque Isle, ME | $11,280 |
| St Marys Regional Medical CenterLewiston, ME | $11,412 |
| Eastern Maine Medical CenterBangor, ME | $11,452 |
Highest
| Maine General Medical CenterWaterville, ME | $12,731 |
|---|---|
| Maine Coast Memorial HospitalEllsworth, ME | $12,505 |
| Southern Maine Health CareBiddeford, ME | $12,348 |
| York HospitalYork, ME | $12,213 |
| Maine Medical CenterPortland, ME | $12,212 |
Level 5 Musculoskeletal Procedures in other states
Questions
How much does level 5 musculoskeletal procedures cost in Maine?
In 2024 Medicare data, level 5 musculoskeletal procedures (APC 5115) at 16 hospitals in Maine was billed at $52,852 on average, while the average medicare-allowed amount was $12,045, of which Medicare paid $10,411. 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 Maine, average charges were 4.4 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.