Outpatient / APC 5165
APC 5165 · 744 hospitals · 37,605 services
Level 5 ENT Procedures
Hospital outpatient departments billed Medicare for 37,605 services in APC 5165 in 2024. They charged an average of $41,209; Medicare allowed $5,580 — a ratio of 7.4 to 1 — and paid $4,432 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $5,493 to $178,993 across hospitals.
- 1Average charge $41,209
- 2Medicare allowed $5,580
- 3Reporting hospitals 744
- 4Services 37,605
By state
The average charge for this service was highest in Nevada ($70,556) and lowest in Rhode Island ($15,821). 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 | 164 | $70,556 | $6,169 |
| Florida | 2,917 | $62,599 | $5,174 |
| California | 3,498 | $61,617 | $7,421 |
| Colorado | 651 | $51,460 | $5,580 |
| South Carolina | 817 | $49,955 | $4,997 |
| Pennsylvania | 1,839 | $49,388 | $5,301 |
| District of Columbia | 257 | $48,396 | $5,922 |
| Alaska | 46 | $46,158 | $5,881 |
| Texas | 2,437 | $43,401 | $5,185 |
| Illinois | 1,358 | $43,138 | $5,493 |
| Arizona | 890 | $43,010 | $5,713 |
| Georgia | 961 | $42,909 | $5,140 |
| Indiana | 732 | $42,537 | $5,290 |
| Virginia | 872 | $41,550 | $5,191 |
| Alabama | 618 | $40,392 | $4,790 |
| Oklahoma | 639 | $38,824 | $4,983 |
| New Hampshire | 294 | $38,785 | $5,879 |
| Washington | 856 | $37,364 | $5,945 |
| Ohio | 1,660 | $37,299 | $4,915 |
| Louisiana | 531 | $37,194 | $4,810 |
| New Mexico | 220 | $36,660 | $5,283 |
| New York | 2,080 | $36,086 | $6,423 |
| Kentucky | 553 | $34,683 | $4,982 |
| Tennessee | 894 | $34,481 | $4,844 |
| New Jersey | 721 | $33,872 | $6,290 |
| West Virginia | 229 | $33,254 | $4,933 |
| Kansas | 459 | $32,523 | $5,062 |
| South Dakota | 370 | $32,414 | $5,566 |
| Oregon | 402 | $32,103 | $6,221 |
| Wisconsin | 835 | $31,611 | $5,375 |
| Connecticut | 346 | $30,755 | $6,486 |
| Missouri | 906 | $30,575 | $4,742 |
| Michigan | 1,150 | $30,012 | $5,172 |
| North Carolina | 1,061 | $29,802 | $5,211 |
| Iowa | 424 | $29,532 | $5,130 |
| Hawaii | 121 | $29,153 | $6,580 |
| Maine | 184 | $27,738 | $5,316 |
| Minnesota | 808 | $27,534 | $5,716 |
| Nebraska | 520 | $26,364 | $5,131 |
| Idaho | 244 | $26,357 | $5,318 |
| Mississippi | 294 | $26,192 | $4,575 |
| Massachusetts | 1,276 | $25,774 | $6,255 |
| Delaware | 143 | $24,729 | $5,765 |
| Utah | 403 | $24,602 | $5,302 |
| Wyoming | 47 | $24,039 | $5,868 |
| Arkansas | 371 | $23,655 | $5,031 |
| Montana | 215 | $23,064 | $5,514 |
| Vermont | 53 | $21,887 | $3,238 |
| North Dakota | 162 | $21,570 | $5,539 |
| Rhode Island | 77 | $15,821 | $5,943 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| HCA Florida Fort Walton-Destin Hospital Fort Walton Beach, FL | $178,993 | $5,305 |
| Manatee Memorial Hospital Bradenton, FL | $134,975 | $5,305 |
| Grandview Medical Center Birmingham, AL | $132,673 | $4,873 |
| Providence Santa Rosa Memorial Hospital Santa Rosa, CA | $131,773 | $8,201 |
| Los Robles Hospital & Medical Center Thousand Oaks, CA | $128,723 | $7,200 |
| Summerlin Hospital Medical Center Las Vegas, NV | $126,644 | $6,061 |
| Stanford Health Care Stanford, CA | $121,432 | $7,946 |
| Sunrise Hospital and Medical Center Las Vegas, NV | $120,410 | $5,972 |
| Riverside Community Hospital Riverside, CA | $113,843 | $7,200 |
| HCA Houston Healthcare Clear Lake Webster, TX | $112,493 | $5,430 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Camc Charleston Surgical Hospital Charleston, WV | $5,493 | $4,964 |
| Beloit Memorial Hospital Beloit, WI | $5,884 | $5,696 |
| St Bernards Medical Center Jonesboro, AR | $9,814 | $4,940 |
| Parkwest Medical Center Knoxville, TN | $10,432 | $4,830 |
| Beth Israel Deaconess Hospital - Needham Needham, MA | $10,470 | $6,289 |
| Beverly Hospital Corporation Beverly, MA | $10,650 | $6,289 |
| Salina Surgical Hospital Salina, KS | $10,868 | $5,000 |
| Mercy Hospital Fort Smith Fort Smith, AR | $11,558 | $4,879 |
| Thomas Hospital Fairhope, AL | $11,912 | $4,416 |
| Lawrence General Hospital Lawrence, MA | $12,993 | $6,289 |
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.