A hip replacement was billed to Medicare at about $5,596 per surgical service in 2024 — and paid about $608
The services-weighted average of $5,596 is pulled up by a right tail: the median group lists about $3,678, while the highest-listing tenth list about $9,137 or more.
The gap widened over 2020 to 2024 — from about 7.2 to about 9.2 times as much billed as paid.
Charged about 9.2 times what it paid: for the average hip-replacement service in 2024, these groups billed about $5,596 and Medicare paid about $608.
The gap is a list price set against a fee schedule. Submitted charges are amounts each group sets on its own. Medicare pays its allowed amount for the surgical service, whatever the list price.
Medicare is one payer. The submitted charge is a list price, and a higher one does not raise Medicare's payment. The gap measures a list price against one payer's schedule, from Medicare claims only. It says nothing about what any other payer pays.
This is the surgeon's professional fee. The hospital facility charge for the operation is billed separately and is not included.
A record of what was billed and what Medicare paid — not a verdict on price, value, or fairness. The charge is a list amount each group sets; the payment is the fee schedule's fixed amount.
The average submitted charge and the average Medicare payment per hip-replacement (physician surgical) service, across named physician groups, in 2024.
Not a total-spending figure, not the facility charge and not all-payer.