Outpatient / APC 5163
APC 5163 · 177 hospitals · 8,456 services
Level 3 ENT Procedures
Hospital outpatient departments billed Medicare for 8,456 services in APC 5163 in 2024. They charged an average of $9,715; Medicare allowed $1,404 — a ratio of 6.9 to 1 — and paid $1,111 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $173 to $42,525 across hospitals.
- 1Average charge $9,715
- 2Medicare allowed $1,404
- 3Reporting hospitals 177
- 4Services 8,456
By state
The average charge for this service was highest in Nevada ($25,690) and lowest in Montana ($2,956). 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 | 19 | $25,690 | $1,664 |
| Alabama | 111 | $18,869 | $1,250 |
| Florida | 347 | $18,453 | $1,346 |
| Colorado | 83 | $17,551 | $1,444 |
| South Carolina | 149 | $14,262 | $1,278 |
| Georgia | 159 | $14,251 | $1,309 |
| Indiana | 205 | $13,593 | $1,370 |
| Oklahoma | 172 | $13,590 | $1,297 |
| Texas | 338 | $13,492 | $1,366 |
| Louisiana | 204 | $12,718 | $1,210 |
| New Jersey | 110 | $12,718 | $1,608 |
| Kentucky | 136 | $12,326 | $1,272 |
| Hawaii | 21 | $11,957 | $1,600 |
| District of Columbia | 17 | $11,725 | $1,487 |
| Arizona | 74 | $11,691 | $1,130 |
| Mississippi | 86 | $11,331 | $1,162 |
| Pennsylvania | 508 | $11,265 | $1,344 |
| California | 765 | $11,186 | $1,925 |
| Virginia | 164 | $10,753 | $1,274 |
| New York | 344 | $10,209 | $1,637 |
| Connecticut | 49 | $10,112 | $1,681 |
| Tennessee | 188 | $9,769 | $1,224 |
| Illinois | 359 | $9,157 | $1,311 |
| Missouri | 166 | $8,962 | $1,334 |
| Kansas | 114 | $8,499 | $1,031 |
| Oregon | 71 | $8,342 | $1,616 |
| North Carolina | 205 | $8,323 | $1,324 |
| Wyoming | 16 | $7,710 | $1,529 |
| Ohio | 585 | $7,665 | $1,244 |
| Utah | 47 | $7,422 | $1,330 |
| Delaware | 34 | $7,394 | $1,531 |
| Michigan | 379 | $7,303 | $1,323 |
| Arkansas | 68 | $7,243 | $1,321 |
| Washington | 172 | $6,925 | $1,486 |
| West Virginia | 131 | $6,284 | $1,241 |
| Iowa | 136 | $6,238 | $1,345 |
| New Mexico | 91 | $5,765 | $1,350 |
| Maine | 81 | $5,548 | $1,414 |
| Minnesota | 150 | $5,535 | $1,434 |
| Massachusetts | 512 | $5,479 | $1,620 |
| Wisconsin | 253 | $5,456 | $1,389 |
| Nebraska | 63 | $5,175 | $1,048 |
| South Dakota | 113 | $4,118 | $1,460 |
| Idaho | 68 | $3,616 | $1,331 |
| Vermont | 83 | $3,600 | $704 |
| New Hampshire | 137 | $3,595 | $1,166 |
| North Dakota | 71 | $2,986 | $1,451 |
| Montana | 82 | $2,956 | $1,433 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Trident Medical Center Charleston, SC | $42,525 | $1,316 |
| Northwest Health-La Porte La Porte, IN | $35,009 | $1,360 |
| Temple University Hospital Philadelphia, PA | $26,511 | $999 |
| OU Health University of Oklahoma Medical Center Oklahoma City, OK | $25,751 | $1,051 |
| Adventhealth Orlando Orlando, FL | $22,885 | $1,382 |
| Stanford Health Care Stanford, CA | $19,543 | $2,118 |
| Piedmont Newnan Hospital, Inc Newnan, GA | $18,319 | $1,415 |
| NYU Langone Hospitals New York, NY | $18,100 | $1,718 |
| Baptist Health Paducah Paducah, KY | $18,016 | $1,395 |
| Geisinger Medical Center Danville, PA | $17,231 | $1,362 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Community Memorial Hospital - Ventura Ventura, CA | $173 | $1,875 |
| Henry Ford Health West Bloomfield Hospital West Bloomfield, MI | $600 | $798 |
| Sanford Medical Center Bismarck Bismarck, ND | $705 | $1,430 |
| Mountain View Hospital Idaho Falls, ID | $1,171 | $1,148 |
| Cheshire Medical Center Keene, NH | $1,219 | $1,462 |
| Henry Ford Health Hospital Detroit, MI | $1,554 | $1,317 |
| Billings Clinic Hospital Billings, MT | $1,679 | $1,326 |
| Concord Hospital Concord, NH | $1,775 | $637 |
| Northwest Specialty Hospital Post Falls, ID | $1,782 | $1,397 |
| Sanford Fargo, ND | $1,808 | $1,430 |
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.