Outpatient / APC 5091
APC 5091 · 1,184 hospitals · 51,576 services
Level 1 Breast/Lymphatic Surgery and Related Procedures
Hospital outpatient departments billed Medicare for 51,576 services in APC 5091 in 2024. They charged an average of $27,836; Medicare allowed $3,679 — a ratio of 7.6 to 1 — and paid $2,922 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $4,865 to $126,246 across hospitals.
- 1Average charge $27,836
- 2Medicare allowed $3,679
- 3Reporting hospitals 1,184
- 4Services 51,576
By state
The average charge for this service was highest in Nevada ($47,283) and lowest in North Dakota ($12,380). The allowed amount is set by Medicare's outpatient fee schedule, adjusted for local wages, so it varies much less.
| State | Services | Avg charge | Avg allowed |
|---|---|---|---|
| Nevada | 295 | $47,283 | $4,018 |
| California | 4,384 | $41,942 | $4,841 |
| Florida | 3,742 | $40,626 | $3,383 |
| New Mexico | 231 | $32,593 | $3,434 |
| Texas | 2,723 | $32,487 | $3,399 |
| District of Columbia | 263 | $32,428 | $3,865 |
| Pennsylvania | 2,624 | $32,030 | $3,507 |
| Colorado | 662 | $31,726 | $3,617 |
| South Carolina | 1,319 | $30,272 | $3,258 |
| Alaska | 96 | $29,635 | $3,995 |
| Georgia | 1,435 | $29,487 | $3,363 |
| Arizona | 1,290 | $29,185 | $3,725 |
| Alabama | 720 | $28,860 | $3,097 |
| Virginia | 1,780 | $28,575 | $3,395 |
| Indiana | 983 | $27,845 | $3,458 |
| Washington | 1,098 | $27,280 | $3,898 |
| Illinois | 2,141 | $27,172 | $3,603 |
| New York | 4,032 | $26,582 | $4,205 |
| New Hampshire | 368 | $25,774 | $3,745 |
| Oklahoma | 625 | $25,691 | $3,271 |
| Ohio | 2,042 | $25,430 | $3,250 |
| Mississippi | 514 | $25,235 | $3,166 |
| New Jersey | 1,528 | $24,930 | $4,069 |
| Louisiana | 584 | $23,947 | $3,167 |
| Kentucky | 794 | $22,763 | $3,265 |
| Connecticut | 638 | $22,501 | $4,261 |
| Tennessee | 1,046 | $22,331 | $3,181 |
| Iowa | 477 | $22,165 | $3,343 |
| Nebraska | 409 | $21,791 | $3,434 |
| Wisconsin | 834 | $21,699 | $3,524 |
| West Virginia | 352 | $21,474 | $3,201 |
| North Carolina | 1,685 | $21,033 | $3,385 |
| Idaho | 229 | $20,761 | $3,512 |
| Kansas | 500 | $20,673 | $3,323 |
| Missouri | 1,110 | $20,180 | $3,301 |
| Oregon | 584 | $19,760 | $4,036 |
| South Dakota | 291 | $19,557 | $3,588 |
| Michigan | 1,496 | $19,399 | $3,376 |
| Maine | 262 | $19,322 | $3,457 |
| Hawaii | 164 | $19,258 | $4,304 |
| Wyoming | 94 | $18,431 | $3,737 |
| Delaware | 332 | $18,244 | $3,811 |
| Minnesota | 861 | $17,768 | $3,728 |
| Massachusetts | 2,318 | $17,509 | $4,079 |
| Arkansas | 414 | $16,990 | $3,268 |
| Utah | 388 | $15,867 | $3,411 |
| Montana | 266 | $15,773 | $3,619 |
| Rhode Island | 203 | $13,201 | $3,845 |
| Vermont | 125 | $12,792 | $1,801 |
| North Dakota | 215 | $12,380 | $3,615 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Desert Regional Medical Center Palm Springs, CA | $126,246 | $4,686 |
| Grandview Medical Center Birmingham, AL | $119,156 | $2,876 |
| HCA Florida St Petersburg Hospital Saint Petersburg, FL | $110,321 | $3,453 |
| HCA Florida Oak Hill Hospital Brooksville, FL | $105,203 | $3,453 |
| HCA Florida Trinity Hospital Trinity, FL | $101,981 | $3,453 |
| HCA Florida North Florida Hospital Gainesville, FL | $97,397 | $3,453 |
| Stanford Health Care Stanford, CA | $94,623 | $5,328 |
| HCA Florida West Hospital Pensacola, FL | $89,824 | $3,453 |
| Tampa General Hospital Tampa, FL | $84,998 | $3,406 |
| Good Samaritan Hospital San Jose, CA | $84,195 | $5,368 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Physicians Medical Center Houma, LA | $4,865 | $3,169 |
| Arkansas Surgical Hospital No Little Rock, AR | $4,900 | $3,267 |
| Nmc Health Newton, KS | $6,386 | $3,254 |
| Providence Hospital Mobile, AL | $6,594 | $3,160 |
| Mobile Infirmary Medical Center Mobile, AL | $7,153 | $3,074 |
| Sanford Bemidji Medical Center Bemidji, MN | $7,261 | $3,800 |
| Billings Clinic Hospital Billings, MT | $7,491 | $3,540 |
| Marshall Medical Centers South Campus Boaz, AL | $7,628 | $2,985 |
| Parkwest Medical Center Knoxville, TN | $7,659 | $3,144 |
| Wooster Community Hospital Wooster, OH | $7,915 | $3,261 |
An APC groups services of similar cost, so a hospital's average mixes the specific procedures it does most. Charges are list prices; the allowed amount is the fee-schedule total that Medicare and the patient together pay the hospital.
Source: CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024. Checked 2026-10-24. Methodology.