What 76 hospitals in Michigan charged and were paid for level 6 musculoskeletal procedures (APC 5116), from 2024 Medicare claims.
APC 5116Outpatient2024 Medicare data
Average charge$63,398Hospital list price billed
Average allowed$16,380Medicare's payment + patient's share
Medicare paid$14,749Average per service
State rank#18 of 491 = lowest average payment
Hospitals in Michigan billed an average of $63,398 for level 6 musculoskeletal procedures, about 3.9 times the average medicare-allowed amount of $16,380. That payment is 6% below the U.S. average of $17,392.
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 $16,380Billed $63,398
About 26¢ was paid for every $1 hospitals in Michigan billed for this service.
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 6 musculoskeletal procedures cost in Michigan?
In 2024 Medicare data, level 6 musculoskeletal procedures (APC 5116) at 76 hospitals in Michigan was billed at $63,398 on average, while the average medicare-allowed amount was $16,380, of which Medicare paid $14,749. 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 Michigan, average charges were 3.9 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.
