Outpatient / APC 5092
APC 5092 · 1,216 hospitals · 49,643 services
Level 2 Breast/Lymphatic Surgery and Related Procedures
Hospital outpatient departments billed Medicare for 49,643 services in APC 5092 in 2024. They charged an average of $46,718; Medicare allowed $6,254 — a ratio of 7.5 to 1 — and paid $4,975 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $8,387 to $272,432 across hospitals.
- 1Average charge $46,718
- 2Medicare allowed $6,254
- 3Reporting hospitals 1,216
- 4Services 49,643
By state
The average charge for this service was highest in Nevada ($68,585) and lowest in Rhode Island ($23,575). 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 | 349 | $68,585 | $6,965 |
| California | 4,499 | $68,398 | $8,273 |
| Florida | 3,674 | $68,066 | $5,782 |
| Colorado | 651 | $57,442 | $6,242 |
| Arizona | 1,348 | $55,397 | $6,376 |
| Pennsylvania | 2,153 | $52,767 | $6,046 |
| Texas | 3,366 | $50,879 | $5,827 |
| New Mexico | 247 | $49,828 | $5,913 |
| District of Columbia | 246 | $49,714 | $6,559 |
| Indiana | 916 | $49,534 | $5,884 |
| Georgia | 1,411 | $47,510 | $5,769 |
| Illinois | 1,996 | $47,301 | $6,162 |
| South Carolina | 1,193 | $47,283 | $5,599 |
| Washington | 1,153 | $47,110 | $6,650 |
| Virginia | 1,829 | $46,967 | $5,788 |
| Alabama | 645 | $46,734 | $5,421 |
| Ohio | 1,878 | $45,587 | $5,575 |
| Alaska | 121 | $44,835 | $6,800 |
| New Hampshire | 344 | $44,697 | $6,409 |
| New Jersey | 1,103 | $44,118 | $6,916 |
| Louisiana | 714 | $43,668 | $5,422 |
| Kentucky | 682 | $43,111 | $5,630 |
| West Virginia | 313 | $42,361 | $5,496 |
| Oklahoma | 759 | $41,576 | $5,559 |
| New York | 2,727 | $41,111 | $7,191 |
| Mississippi | 554 | $39,436 | $5,383 |
| Idaho | 300 | $37,388 | $6,065 |
| Wisconsin | 968 | $37,119 | $6,007 |
| Hawaii | 174 | $37,046 | $7,491 |
| North Carolina | 1,590 | $36,391 | $5,788 |
| Connecticut | 468 | $35,956 | $7,220 |
| Nebraska | 468 | $35,490 | $5,887 |
| Oregon | 572 | $35,419 | $6,929 |
| Missouri | 1,070 | $35,147 | $5,627 |
| Kansas | 764 | $35,116 | $5,684 |
| Tennessee | 1,198 | $34,686 | $5,486 |
| South Dakota | 403 | $34,391 | $6,123 |
| Iowa | 624 | $32,825 | $5,663 |
| Michigan | 1,227 | $32,746 | $5,846 |
| Maine | 214 | $30,995 | $6,017 |
| Montana | 309 | $30,209 | $6,219 |
| Wyoming | 108 | $29,884 | $6,470 |
| Massachusetts | 1,531 | $29,880 | $6,952 |
| Delaware | 273 | $29,759 | $6,506 |
| Minnesota | 945 | $28,625 | $6,325 |
| Arkansas | 527 | $28,126 | $5,566 |
| Utah | 484 | $27,509 | $5,843 |
| Vermont | 139 | $25,477 | $3,964 |
| North Dakota | 272 | $24,673 | $6,227 |
| Rhode Island | 121 | $23,575 | $6,574 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| HCA Florida Fawcett Hospital Port Charlotte, FL | $272,432 | $5,907 |
| Northbay Medical Center Fairfield, CA | $247,337 | $9,377 |
| The Hospitals of Providence Memorial Campus El Paso, TX | $202,190 | $5,658 |
| HCA Florida St Petersburg Hospital Saint Petersburg, FL | $183,223 | $5,907 |
| Grandview Medical Center Birmingham, AL | $182,105 | $5,438 |
| HCA Florida Fort Walton-Destin Hospital Fort Walton Beach, FL | $175,625 | $5,907 |
| HCA Healthone Rose Denver, CO | $172,438 | $6,208 |
| Good Samaritan Hospital San Jose, CA | $169,896 | $9,178 |
| Desert Regional Medical Center Palm Springs, CA | $166,331 | $8,018 |
| HCA Florida Trinity Hospital Trinity, FL | $164,299 | $5,907 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Arkansas Surgical Hospital No Little Rock, AR | $8,387 | $5,521 |
| Parkwest Medical Center Knoxville, TN | $10,839 | $5,179 |
| Morristown Hamblen Hospital Association Morristown, TN | $12,479 | $5,378 |
| Providence Hospital Mobile, AL | $12,738 | $5,407 |
| Kansas Surgery & Recovery Center Wichita, KS | $13,314 | $5,513 |
| Salina Surgical Hospital Salina, KS | $13,322 | $5,567 |
| Fort Sanders Regional Medical Center Knoxville, TN | $13,429 | $5,378 |
| South Central Reg Med Ctr Laurel, MS | $13,444 | $5,703 |
| Thomas Hospital Fairhope, AL | $13,453 | $5,409 |
| Billings Clinic Hospital Billings, MT | $13,597 | $5,877 |
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.