Outpatient / APC 5223
APC 5223 · 1,294 hospitals · 65,607 services
Level 3 Pacemaker and Similar Procedures
Hospital outpatient departments billed Medicare for 65,607 services in APC 5223 in 2024. They charged an average of $60,944; Medicare allowed $10,202 — a ratio of 6 to 1 — and paid $8,568 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $14,277 to $267,879 across hospitals.
- 1Average charge $60,944
- 2Medicare allowed $10,202
- 3Reporting hospitals 1,294
- 4Services 65,607
By state
The average charge for this service was highest in Nevada ($119,824) and lowest in Rhode Island ($31,840). 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 | 506 | $119,824 | $11,437 |
| Texas | 4,770 | $83,788 | $9,487 |
| Florida | 4,577 | $78,810 | $9,600 |
| California | 5,560 | $78,537 | $13,530 |
| Kentucky | 1,028 | $77,186 | $9,225 |
| South Carolina | 1,600 | $77,008 | $9,245 |
| Colorado | 847 | $76,650 | $10,188 |
| Alabama | 1,306 | $75,044 | $8,864 |
| New Mexico | 282 | $69,260 | $9,614 |
| New Jersey | 1,882 | $66,411 | $11,485 |
| Arizona | 1,307 | $66,331 | $10,495 |
| Pennsylvania | 2,808 | $66,180 | $10,061 |
| New York | 3,195 | $63,566 | $11,698 |
| Utah | 552 | $62,821 | $9,628 |
| Tennessee | 1,999 | $60,319 | $8,981 |
| Louisiana | 973 | $59,474 | $8,928 |
| Virginia | 2,206 | $58,863 | $9,587 |
| Indiana | 1,611 | $58,522 | $9,666 |
| Georgia | 1,912 | $56,827 | $9,514 |
| Alaska | 96 | $56,456 | $11,220 |
| South Dakota | 589 | $55,012 | $10,046 |
| Illinois | 2,543 | $54,840 | $10,036 |
| District of Columbia | 188 | $54,007 | $10,914 |
| Maine | 239 | $53,953 | $9,769 |
| Mississippi | 948 | $53,299 | $8,950 |
| New Hampshire | 365 | $51,922 | $10,474 |
| Oklahoma | 1,042 | $49,703 | $9,174 |
| North Carolina | 2,077 | $49,042 | $9,568 |
| West Virginia | 478 | $48,474 | $9,111 |
| Missouri | 1,567 | $47,867 | $9,340 |
| Michigan | 1,550 | $47,119 | $9,562 |
| Kansas | 1,003 | $46,924 | $9,319 |
| Minnesota | 1,160 | $46,687 | $10,371 |
| Idaho | 562 | $46,408 | $9,869 |
| Wyoming | 91 | $46,265 | $10,684 |
| Oregon | 672 | $44,613 | $11,501 |
| Delaware | 349 | $42,902 | $10,656 |
| Wisconsin | 1,062 | $42,044 | $9,832 |
| North Dakota | 299 | $41,666 | $10,210 |
| Ohio | 2,306 | $41,331 | $9,102 |
| Vermont | 147 | $41,199 | $4,344 |
| Washington | 1,426 | $40,511 | $10,975 |
| Iowa | 899 | $39,884 | $9,369 |
| Nebraska | 823 | $39,548 | $9,589 |
| Massachusetts | 1,594 | $38,274 | $11,445 |
| Montana | 454 | $37,786 | $10,172 |
| Connecticut | 641 | $36,015 | $11,923 |
| Arkansas | 1,204 | $34,937 | $9,187 |
| Hawaii | 200 | $32,406 | $12,192 |
| Rhode Island | 112 | $31,840 | $10,745 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Good Samaritan Hospital San Jose, CA | $267,879 | $15,008 |
| Grandview Medical Center Birmingham, AL | $221,508 | $8,814 |
| Trident Medical Center Charleston, SC | $220,923 | $9,208 |
| Physicians Regional Medical Center - Pine Ridge Naples, FL | $209,110 | $9,666 |
| Hospital of Univ of Pennsylvania Philadelphia, PA | $204,976 | $10,747 |
| Los Robles Hospital & Medical Center Thousand Oaks, CA | $202,655 | $13,108 |
| Summerlin Hospital Medical Center Las Vegas, NV | $201,912 | $11,423 |
| Delray Medical Center Delray Beach, FL | $195,665 | $8,393 |
| Capital Health Regional Medical Center Trenton, NJ | $190,958 | $11,166 |
| Flowers Hospital Dothan, AL | $190,111 | $8,575 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Crouse Hospital Syracuse, NY | $14,277 | $11,083 |
| Anna Jaques Hospital Newburyport, MA | $15,599 | $11,454 |
| CHI Saint Joseph East Lexington, KY | $16,580 | $9,242 |
| Trinity Medical Ctr East &trinity Medical Ctr West Steubenville, OH | $16,965 | $9,082 |
| Cookeville Regional Medical Center Cookeville, TN | $17,047 | $9,788 |
| Taylor Regional Hospital Campbellsville, KY | $17,635 | $8,955 |
| Cooley Dickinson Hospital Inc,the Northampton, MA | $17,745 | $11,454 |
| Nmc Health Newton, KS | $17,900 | $9,112 |
| Sibley Memorial Hospital Washington, DC | $18,420 | $10,914 |
| Prov Sacred Hrt Med Ctr & Childs Hosp. Spokane, WA | $19,195 | $10,629 |
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.