Outpatient / APC 5094
APC 5094 · 47 hospitals · 3,138 services
Level 4 Breast/Lymphatic Surgery and Related Procedures
Hospital outpatient departments billed Medicare for 3,138 services in APC 5094 in 2024. They charged an average of $117,441; Medicare allowed $16,978 — a ratio of 6.9 to 1 — and paid $15,345 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $42,809 to $264,517 across hospitals.
- 1Average charge $117,441
- 2Medicare allowed $16,978
- 3Reporting hospitals 47
- 4Services 3,138
By state
The average charge for this service was highest in Colorado ($166,434) and lowest in North Dakota ($52,742). 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 |
|---|---|---|---|
| Colorado | 48 | $166,434 | $16,913 |
| Nevada | 26 | $161,274 | $18,829 |
| California | 323 | $160,857 | $22,136 |
| Texas | 294 | $155,519 | $15,607 |
| Kentucky | 42 | $144,334 | $14,648 |
| Florida | 242 | $139,865 | $15,930 |
| Arizona | 80 | $136,844 | $16,873 |
| Pennsylvania | 98 | $133,935 | $16,308 |
| Alabama | 32 | $133,852 | $13,579 |
| New Jersey | 128 | $127,259 | $18,958 |
| Indiana | 65 | $123,049 | $15,418 |
| Utah | 31 | $123,011 | $14,879 |
| South Carolina | 78 | $122,307 | $14,999 |
| Washington | 46 | $121,923 | $17,692 |
| Georgia | 136 | $114,344 | $15,397 |
| Arkansas | 31 | $112,612 | $14,573 |
| North Carolina | 67 | $110,071 | $15,873 |
| Oregon | 24 | $105,899 | $18,623 |
| Iowa | 22 | $103,032 | $15,244 |
| Oklahoma | 46 | $102,859 | $14,793 |
| Virginia | 98 | $102,365 | $15,669 |
| Tennessee | 81 | $100,679 | $14,894 |
| Ohio | 95 | $97,017 | $15,258 |
| New York | 237 | $95,664 | $19,590 |
| Wisconsin | 53 | $94,673 | $15,739 |
| Kansas | 56 | $93,890 | $15,509 |
| Illinois | 117 | $93,812 | $16,768 |
| South Dakota | 21 | $90,322 | $16,512 |
| Louisiana | 50 | $83,625 | $14,579 |
| Mississippi | 14 | $82,579 | $14,756 |
| Delaware | 20 | $82,378 | $17,648 |
| Nebraska | 29 | $77,898 | $15,438 |
| District of Columbia | 17 | $75,655 | $17,989 |
| Connecticut | 26 | $71,443 | $19,746 |
| Michigan | 52 | $66,527 | $15,928 |
| Minnesota | 76 | $65,917 | $16,750 |
| Missouri | 68 | $63,553 | $14,030 |
| Massachusetts | 84 | $62,104 | $18,676 |
| North Dakota | 11 | $52,742 | $16,805 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Cedars-Sinai Medical Center Los Angeles, CA | $264,517 | $21,610 |
| Orlando Health Orlando Regional Medical Center Orlando, FL | $236,254 | $15,930 |
| Scripps Memorial Hospital La Jolla La Jolla, CA | $198,575 | $21,610 |
| Honorhealth Scottsdale Shea Medical Center Scottsdale, AZ | $183,850 | $15,953 |
| Jupiter Medical Center Jupiter, FL | $172,471 | $15,930 |
| NYU Langone Hospitals New York, NY | $169,336 | $19,793 |
| Norton Hospital / Norton Healthcare Pavilion / Nor Louisville, KY | $151,920 | $14,052 |
| Adventhealth Orlando Orlando, FL | $141,084 | $15,930 |
| Riverview Medical Center Red Bank, NJ | $133,379 | $18,636 |
| Baylor Regional Medical Center at Plano Plano, TX | $130,615 | $15,826 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Cox Medical Centers Springfield, MO | $42,809 | $13,594 |
| Park Nicollet Methodist Hospital Saint Louis Park, MN | $44,809 | $16,809 |
| Cooper University Hospital Camden, NJ | $45,631 | $18,406 |
| University of Michigan Health Ann Arbor, MI | $50,733 | $16,268 |
| Memorial Hospital for Cancer and Allied Diseases New York, NY | $56,396 | $20,004 |
| University of Texas M D Anderson Cancer Center Houston, TX | $58,339 | $15,817 |
| Womans Hospital Baton Rouge, LA | $62,474 | $14,872 |
| Brigham and Women's Faulkner Hospital Boston, MA | $64,361 | $18,881 |
| Northshore University Healthsystem Evanston Hosp Evanston, IL | $64,826 | $16,359 |
| New York-Presbyterian Hospital New York, NY | $65,109 | $20,003 |
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.