Outpatient / APC 5116
APC 5116 · 1,481 hospitals · 77,366 services
Level 6 Musculoskeletal Procedures
Hospital outpatient departments billed Medicare for 77,366 services in APC 5116 in 2024. They charged an average of $98,060; Medicare allowed $17,397 — a ratio of 5.6 to 1 — and paid $15,767 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $10,515 to $546,110 across hospitals.
- 1Average charge $98,060
- 2Medicare allowed $17,397
- 3Reporting hospitals 1,481
- 4Services 77,366
By state
The average charge for this service was highest in Alaska ($290,422) and lowest in Rhode Island ($44,809). 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 |
|---|---|---|---|
| Alaska | 187 | $290,422 | $19,390 |
| Florida | 5,369 | $140,120 | $16,631 |
| Kentucky | 1,497 | $133,069 | $16,013 |
| California | 4,672 | $132,087 | $23,368 |
| Texas | 5,544 | $129,107 | $16,369 |
| Nevada | 663 | $127,461 | $19,909 |
| Mississippi | 732 | $117,295 | $15,412 |
| Colorado | 2,177 | $114,973 | $17,742 |
| Georgia | 2,027 | $114,461 | $16,390 |
| Virginia | 2,494 | $113,861 | $16,332 |
| Arizona | 2,406 | $113,386 | $18,232 |
| South Carolina | 2,002 | $112,181 | $15,902 |
| Indiana | 2,123 | $105,302 | $16,593 |
| District of Columbia | 200 | $104,834 | $18,849 |
| Alabama | 1,300 | $103,075 | $15,180 |
| New Mexico | 341 | $102,122 | $17,014 |
| New Hampshire | 404 | $99,652 | $18,184 |
| New Jersey | 1,778 | $99,110 | $19,840 |
| Illinois | 2,589 | $95,905 | $17,395 |
| Louisiana | 1,196 | $93,814 | $15,543 |
| Pennsylvania | 3,331 | $91,090 | $17,332 |
| Tennessee | 2,155 | $89,455 | $15,327 |
| Washington | 1,682 | $88,002 | $19,053 |
| North Carolina | 2,726 | $87,442 | $16,482 |
| New York | 2,190 | $82,540 | $19,950 |
| Maine | 328 | $80,898 | $17,184 |
| Iowa | 1,357 | $80,446 | $16,103 |
| Oklahoma | 1,398 | $78,738 | $15,833 |
| Ohio | 3,191 | $78,314 | $15,982 |
| Connecticut | 808 | $76,777 | $20,749 |
| Delaware | 461 | $74,820 | $18,543 |
| South Dakota | 804 | $74,112 | $17,486 |
| Oregon | 978 | $72,195 | $19,861 |
| Utah | 1,128 | $72,133 | $15,266 |
| Kansas | 1,308 | $71,231 | $16,023 |
| Idaho | 756 | $70,217 | $16,897 |
| Hawaii | 106 | $69,636 | $20,771 |
| Missouri | 1,874 | $69,327 | $16,122 |
| Wisconsin | 1,469 | $68,804 | $16,906 |
| Vermont | 130 | $67,501 | $8,376 |
| Wyoming | 298 | $66,506 | $18,170 |
| Michigan | 1,919 | $64,761 | $16,377 |
| Arkansas | 1,247 | $63,670 | $15,893 |
| West Virginia | 604 | $61,647 | $15,715 |
| Nebraska | 1,039 | $60,712 | $16,771 |
| Montana | 520 | $58,492 | $17,614 |
| North Dakota | 437 | $56,531 | $17,467 |
| Minnesota | 1,456 | $54,102 | $18,099 |
| Massachusetts | 1,756 | $52,806 | $19,884 |
| Rhode Island | 175 | $44,809 | $18,679 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Medical City Lewisville Lewisville, TX | $546,110 | $16,789 |
| Good Samaritan Hospital San Jose, CA | $513,187 | $24,635 |
| Medical City Plano Plano, TX | $490,937 | $16,735 |
| Tricities Hospital Hopewell, VA | $478,676 | $16,182 |
| Cjw Medical Center Richmond, VA | $462,582 | $16,011 |
| Henrico Doctors' Hospital Richmond, VA | $411,745 | $15,984 |
| Medical City Denton Denton, TX | $390,049 | $16,789 |
| HCA Houston Healthcare Tomball Tomball, TX | $382,944 | $17,243 |
| Woodland Heights Medical Center Lufkin, TX | $380,510 | $16,137 |
| Medical City Alliance Fort Worth, TX | $378,122 | $16,789 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Mckay-Dee Hospital Ogden, UT | $10,515 | $2,990 |
| West Calcasieu Cameron Hospital Sulphur, LA | $20,242 | $15,624 |
| East Alabama Medical Center Opelika, AL | $22,212 | $15,185 |
| St Bernards Medical Center Jonesboro, AR | $25,533 | $15,688 |
| Rochester General Hospital Rochester, NY | $30,729 | $17,808 |
| Mercy Hospital Fort Smith Fort Smith, AR | $31,561 | $15,523 |
| Mount Auburn Hospital Cambridge, MA | $31,690 | $19,966 |
| Kell West Regional Hospital Wichita Falls, TX | $31,691 | $15,896 |
| Lahey Hospital & Medical Center, Burlington Burlington, MA | $31,825 | $19,966 |
| Cape Cod Hospital Hyannis, MA | $31,993 | $19,966 |
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.