Level 5 Musculoskeletal Procedures in Rhode Island
What 9 hospitals in Rhode Island charged and were paid for level 5 musculoskeletal procedures (APC 5115), from 2024 Medicare claims.
Average charge
$31,359
Hospital list price billed
Average allowed
$13,278
Medicare's payment + patient's share
Medicare paid
$11,644
Average per service
State rank
#39 of 49
1 = lowest average payment
Hospitals in Rhode Island billed an average of $31,359 for level 5 musculoskeletal procedures, about 2.4 times the average medicare-allowed amount of $13,278. That payment is 7% 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 $13,278Billed $31,359
About 42¢ was paid for every $1 hospitals in Rhode Island billed for this service.
Rhode Island hospitals: level 5 musculoskeletal 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 |
|---|---|---|---|---|
| South County Hospital INCWakefield | 353 | $34,310 | $13,235 | $11,598 |
| Miriam HospitalProvidence | 180 | $25,469 | $13,335 | $11,703 |
| Our Lady of Fatima HospitalNorth Providence | 90 | $35,127 | $13,335 | $11,702 |
| Kent County Memorial HospitalWarwick | 63 | $30,517 | $13,149 | $11,517 |
| Newport HospitalNewport | 53 | $26,650 | $13,335 | $11,703 |
| Westerly HospitalWesterly | 36 | $29,705 | $13,335 | $11,703 |
| Roger Williams Medical CenterProvidence | 32 | $36,703 | $13,335 | $11,703 |
| Rhode Island HospitalProvidence | 18 | $24,168 | $13,335 | $11,703 |
| Landmark Medical Center, INCWoonsocket | – | – | – | – |
Lowest and highest allowed amounts in Rhode Island
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
| Kent County Memorial HospitalWarwick, RI | $13,149 |
|---|---|
| South County Hospital INCWakefield, RI | $13,235 |
| Roger Williams Medical CenterProvidence, RI | $13,335 |
| Newport HospitalNewport, RI | $13,335 |
| Rhode Island HospitalProvidence, RI | $13,335 |
Highest
| Our Lady of Fatima HospitalNorth Providence, RI | $13,335 |
|---|---|
| Roger Williams Medical CenterProvidence, RI | $13,335 |
| Newport HospitalNewport, RI | $13,335 |
| Rhode Island HospitalProvidence, RI | $13,335 |
| Miriam HospitalProvidence, RI | $13,335 |
Level 5 Musculoskeletal Procedures in other states
Questions
How much does level 5 musculoskeletal procedures cost in Rhode Island?
In 2024 Medicare data, level 5 musculoskeletal procedures (APC 5115) at 9 hospitals in Rhode Island was billed at $31,359 on average, while the average medicare-allowed amount was $13,278, of which Medicare paid $11,644. 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 2.4 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.