Level 1 Icd and Similar Procedures — what U.S. hospitals charge
APC 5231 · Hospital outpatient visit · 135 U.S. hospitals publish a price
Cheapest quarter
under $72,458
Typical charge
$94,300
Dearest quarter
over $142,312
Actually paid
$22,465
The middle U.S. hospital bills $94,300 for Level 1 Icd and Similar Procedures. The dearest hospitals charge about 3.5x what the cheapest do for the same coded work. Medicare actually paid about $22,465 per case.
These are charges, not quotes. What you pay depends on your insurance and your own case. The figures matter because the charge is where an uninsured or out-of-network bill starts.
Level 1 Icd and Similar Procedures cost by state
The middle charge in each state where at least three hospitals publish a price, cheapest first.
| State | Hospitals | Typical charge | Range |
|---|---|---|---|
| Massachusetts | 6 | $53,905 | $42,704 – $100,757 |
| Indiana | 5 | $72,150 | $69,733 – $89,151 |
| Iowa | 4 | $75,600 | $42,079 – $107,147 |
| North Carolina | 6 | $76,963 | $46,662 – $155,159 |
| Ohio | 9 | $81,553 | $61,442 – $150,250 |
| Tennessee | 7 | $85,769 | $49,599 – $166,710 |
| Oklahoma | 5 | $86,856 | $85,904 – $163,040 |
| Virginia | 3 | $90,091 | $63,353 – $112,348 |
| Georgia | 3 | $91,556 | $71,643 – $128,021 |
| New Jersey | 9 | $94,026 | $57,811 – $435,191 |
| Illinois | 4 | $95,769 | $88,516 – $129,761 |
| New York | 11 | $98,648 | $44,532 – $259,231 |
| Florida | 6 | $130,374 | $77,747 – $211,697 |
| Pennsylvania | 10 | $137,557 | $56,874 – $244,152 |
| Michigan | 4 | $142,768 | $128,774 – $149,924 |
| California | 10 | $145,343 | $61,072 – $528,404 |
| South Carolina | 6 | $146,920 | $92,865 – $208,387 |
| Texas | 8 | $155,395 | $54,289 – $307,850 |
Where Level 1 Icd and Similar Procedures is charged least
Hospitals that performed it at least eleven times, so a single case cannot set the figure.
| Hospital | Charged | Actually paid |
|---|---|---|
|
Mercyone North Iowa Medical Center
Mason City, IA |
$42,079 | $22,788 |
|
Beth Israel Deaconess Medical Center
Boston, MA |
$42,704 | $25,244 |
|
Kaleida Health
Buffalo, NY |
$44,532 | $24,922 |
|
Rex Hospital
Raleigh, NC |
$46,662 | $21,168 |
|
St Peter's Hospital
Albany, NY |
$48,038 | $24,922 |
|
Memorial Healthcare System, Inc
Chattanooga, TN |
$49,599 | $20,039 |
|
Brigham And Women's Hospital
Boston, MA |
$51,896 | $25,244 |
|
Massachusetts General Hospital
Boston, MA |
$52,557 | $25,244 |
|
Memorial Hermann Hospital System
Houston, TX |
$54,289 | $19,967 |
|
University Of Iowa Hospital & Clinics
Iowa City, IA |
$54,696 | $20,984 |
|
South Shore Hospital
South Weymouth, MA |
$55,253 | $23,277 |
|
Yale-New Haven Hospital
New Haven, CT |
$55,842 | $26,452 |
Where it is charged most
Hospitals that performed it at least eleven times, so a single case cannot set the figure.
| Hospital | Charged | Actually paid |
|---|---|---|
|
Cedars-Sinai Medical Center
Los Angeles, CA |
$528,404 | $28,895 |
|
Englewood Hospital And Medical Center
Englewood, NJ |
$435,191 | $26,746 |
|
St David's Medical Center
Austin, TX |
$307,850 | $20,695 |
|
Stanford Health Care
Stanford, CA |
$273,510 | $33,090 |
|
Hendrick Medical Center
Abilene, TX |
$262,255 | $22,067 |
|
Nyu Langone Hospitals
New York, NY |
$259,231 | $26,461 |
|
Lehigh Valley Hospital
Allentown, PA |
$244,152 | $22,111 |
|
Hospital Of Univ Of Pennsylvania
Philadelphia, PA |
$235,937 | $23,684 |
|
Upmc Presbyterian Shadyside
Pittsburgh, PA |
$234,118 | $21,000 |
|
Virtua Our Lady Of Lourdes Hospital
Camden, NJ |
$229,111 | $24,609 |
|
Houston Methodist Hospital
Houston, TX |
$220,458 | $21,800 |
|
Baptist Health Lexington
Lexington, KY |
$219,083 | $19,787 |
Questions people ask
What do U.S. hospitals charge for Level 1 Icd and Similar Procedures?
Across 135 U.S. hospitals, the middle charge for Level 1 Icd and Similar Procedures is $94,300. Half of hospitals charge less than that and half charge more. The cheapest quarter charge under $72,458 and the dearest quarter over $142,312.
Why do hospitals charge such different amounts for the same procedure?
Because a hospital charge is a list price it sets itself, not a regulated rate. For Level 1 Icd and Similar Procedures, the hospitals in the dearest tenth charge about 3.5x what the cheapest tenth charge for the same coded work. Insurers negotiate their own rates from those lists, which is why the charge and what is actually paid can be very far apart.
Is that what I would actually pay?
No. $22,465 is roughly what Medicare actually paid per case, against an average charge of $119,770. If you have insurance, your plan pays a negotiated rate and you pay your deductible and coinsurance. If you are uninsured or out of network, the hospital's charge is where your bill starts — which is why the gap matters. Ask for a written good-faith estimate before treatment.
What this code covers
CMS records this work as APC 5231: “Level 1 ICD and Similar Procedures”. An APC covers one outpatient visit for that level of service — you go home the same day.