Outpatient / APC 5164
APC 5164 · 378 hospitals · 15,436 services
Level 4 ENT Procedures
Hospital outpatient departments billed Medicare for 15,436 services in APC 5164 in 2024. They charged an average of $21,440; Medicare allowed $2,864 — a ratio of 7.5 to 1 — and paid $2,269 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $2,444 to $121,920 across hospitals.
- 1Average charge $21,440
- 2Medicare allowed $2,864
- 3Reporting hospitals 378
- 4Services 15,436
By state
The average charge for this service was highest in Florida ($40,670) and lowest in New Hampshire ($5,251). 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 |
|---|---|---|---|
| Florida | 760 | $40,670 | $2,845 |
| Colorado | 147 | $33,067 | $3,077 |
| California | 1,266 | $32,583 | $3,900 |
| South Carolina | 240 | $29,252 | $2,672 |
| Alabama | 196 | $29,219 | $2,672 |
| Texas | 964 | $29,035 | $2,864 |
| Nevada | 58 | $28,530 | $3,202 |
| District of Columbia | 40 | $27,649 | $3,189 |
| Georgia | 361 | $26,637 | $2,746 |
| Arizona | 205 | $25,995 | $3,065 |
| Virginia | 337 | $24,744 | $2,634 |
| Pennsylvania | 614 | $24,291 | $2,971 |
| Oklahoma | 299 | $23,191 | $2,723 |
| New Mexico | 84 | $22,619 | $2,916 |
| Indiana | 385 | $22,162 | $2,838 |
| Washington | 304 | $21,899 | $3,195 |
| New Jersey | 230 | $21,714 | $3,408 |
| Alaska | 28 | $21,500 | $3,270 |
| Ohio | 821 | $21,318 | $2,606 |
| Connecticut | 166 | $20,277 | $3,560 |
| Kansas | 208 | $20,244 | $2,662 |
| North Carolina | 415 | $19,899 | $2,611 |
| Illinois | 649 | $19,809 | $2,586 |
| Tennessee | 309 | $19,720 | $2,597 |
| West Virginia | 142 | $19,658 | $2,681 |
| Michigan | 508 | $18,751 | $2,847 |
| Louisiana | 308 | $18,746 | $2,659 |
| Kentucky | 204 | $18,164 | $2,574 |
| Hawaii | 33 | $17,432 | $3,610 |
| Oregon | 188 | $17,336 | $3,390 |
| Wisconsin | 344 | $16,537 | $2,921 |
| New York | 881 | $16,158 | $3,134 |
| Minnesota | 354 | $15,973 | $2,938 |
| South Dakota | 247 | $15,455 | $3,014 |
| Missouri | 383 | $15,438 | $2,681 |
| Delaware | 39 | $15,030 | $3,227 |
| Idaho | 151 | $14,987 | $2,727 |
| Arkansas | 160 | $13,769 | $2,756 |
| Maine | 105 | $13,600 | $2,852 |
| Nebraska | 143 | $13,526 | $2,724 |
| Iowa | 266 | $13,126 | $2,778 |
| Wyoming | 37 | $12,247 | $3,208 |
| Montana | 91 | $12,070 | $3,080 |
| Utah | 162 | $11,781 | $2,866 |
| North Dakota | 67 | $10,984 | $3,037 |
| Mississippi | 198 | $10,606 | $1,424 |
| Massachusetts | 751 | $10,390 | $3,066 |
| Rhode Island | 27 | $10,159 | $3,268 |
| Vermont | 46 | $8,134 | $1,625 |
| New Hampshire | 514 | $5,251 | $1,007 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| HCA Florida Fort Walton-Destin Hospital Fort Walton Beach, FL | $121,920 | $2,916 |
| Cedars-Sinai Medical Center Los Angeles, CA | $105,388 | $3,958 |
| Grandview Medical Center Birmingham, AL | $81,941 | $2,680 |
| Cjw Medical Center Richmond, VA | $80,742 | $2,772 |
| Tampa General Hospital Tampa, FL | $75,132 | $2,916 |
| Wesley Medical Center Wichita, KS | $64,333 | $2,749 |
| Stanford Health Care Stanford, CA | $63,271 | $3,573 |
| Memorial Hermann Texas Medical Center Houston, TX | $61,729 | $2,985 |
| Trident Medical Center Charleston, SC | $60,681 | $2,778 |
| Loma Linda University Medical Center Loma Linda, CA | $58,168 | $3,959 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Clifton Springs Hospital and Clinic Clifton Springs, NY | $2,444 | $853 |
| Unity Health White County Medical Center Searcy, AR | $2,590 | $2,931 |
| Mary Hitchcock Memorial Hospital Lebanon, NH | $3,452 | $760 |
| Boston Medical Center Corporation- Boston, MA | $4,088 | $1,763 |
| University of Mississippi Med Center Jackson, MS | $4,132 | $583 |
| The Carle Foundation Hospital Urbana, IL | $4,511 | $658 |
| Northwestern Medical Center Inc Saint Albans, VT | $4,744 | $1,524 |
| Broadlawns Medical Center Des Moines, IA | $5,199 | $2,763 |
| Rochester General Hospital Rochester, NY | $5,625 | $1,870 |
| Emerson Hospital - W Concord, MA | $6,808 | $3,228 |
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.