Outpatient / APC 5231
APC 5231 · 135 hospitals · 6,336 services
Level 1 ICD and Similar Procedures
Hospital outpatient departments billed Medicare for 6,336 services in APC 5231 in 2024. They charged an average of $122,086; Medicare allowed $22,388 — a ratio of 5.5 to 1 — and paid $20,752 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $42,079 to $528,404 across hospitals.
- 1Average charge $122,086
- 2Medicare allowed $22,388
- 3Reporting hospitals 135
- 4Services 6,336
By state
The average charge for this service was highest in Nevada ($192,110) and lowest in Hawaii ($68,303). 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 | 42 | $192,110 | $25,184 |
| California | 536 | $170,637 | $29,727 |
| Texas | 402 | $169,046 | $20,635 |
| Louisiana | 87 | $165,705 | $19,007 |
| Colorado | 74 | $163,627 | $22,468 |
| South Carolina | 151 | $151,118 | $20,193 |
| Kentucky | 89 | $144,958 | $20,287 |
| Florida | 467 | $144,455 | $20,870 |
| New Jersey | 214 | $142,970 | $24,937 |
| Alabama | 100 | $136,538 | $19,323 |
| Pennsylvania | 351 | $135,649 | $22,010 |
| New Mexico | 27 | $133,908 | $21,416 |
| Virginia | 171 | $126,924 | $20,863 |
| Arizona | 85 | $126,763 | $23,459 |
| New York | 441 | $122,406 | $25,701 |
| New Hampshire | 34 | $114,394 | $22,578 |
| Tennessee | 180 | $113,343 | $19,679 |
| Illinois | 264 | $113,109 | $21,971 |
| Michigan | 182 | $112,586 | $20,819 |
| Oklahoma | 122 | $111,853 | $19,306 |
| Wyoming | 13 | $110,269 | $23,570 |
| Maine | 20 | $106,953 | $21,363 |
| Georgia | 148 | $104,255 | $20,983 |
| Delaware | 37 | $103,134 | $23,562 |
| Indiana | 175 | $100,537 | $21,373 |
| Utah | 31 | $100,051 | $21,110 |
| Oregon | 63 | $99,654 | $24,437 |
| Mississippi | 97 | $95,882 | $19,519 |
| North Carolina | 209 | $95,847 | $20,801 |
| South Dakota | 23 | $93,937 | $22,524 |
| Missouri | 147 | $91,377 | $20,136 |
| Washington | 110 | $90,842 | $23,912 |
| Idaho | 31 | $89,674 | $21,778 |
| Minnesota | 86 | $89,107 | $22,866 |
| Wisconsin | 87 | $88,618 | $21,231 |
| Rhode Island | 22 | $87,950 | $23,857 |
| Nebraska | 51 | $87,329 | $21,199 |
| West Virginia | 44 | $86,303 | $18,928 |
| Ohio | 295 | $86,216 | $19,855 |
| Kansas | 71 | $83,103 | $20,462 |
| North Dakota | 20 | $82,698 | $22,433 |
| Montana | 29 | $79,810 | $22,312 |
| Iowa | 94 | $75,508 | $20,830 |
| Massachusetts | 201 | $74,505 | $24,906 |
| Connecticut | 72 | $71,859 | $26,009 |
| Arkansas | 98 | $71,004 | $19,875 |
| Vermont | 13 | $70,585 | $8,223 |
| Hawaii | 19 | $68,303 | $23,591 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Cedars-Sinai Medical Center Los Angeles, CA | $528,404 | $28,895 |
| Englewood Hospital Englewood, NJ | $435,191 | $26,746 |
| St David's Medical Center Austin, TX | $307,850 | $20,695 |
| Stanford Health Care Stanford, CA | $273,510 | $33,090 |
| Hendrick Medical Center Abilene, TX | $262,255 | $22,067 |
| NYU Langone Hospitals New York, NY | $259,231 | $26,461 |
| Lehigh Valley Hospital Allentown, PA | $244,152 | $22,111 |
| Hospital of Univ of Pennsylvania Philadelphia, PA | $235,937 | $23,684 |
| UPMC Presbyterian Shadyside Pittsburgh, PA | $234,118 | $21,000 |
| Virtua Our Lady of Lourdes Hospital Camden, NJ | $229,111 | $24,609 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Mercyone North Iowa Medical Center Mason City, IA | $42,079 | $22,788 |
| Beth Israel Deaconess Medical Center Boston, MA | $42,704 | $25,244 |
| Kaleida Health Buffalo, NY | $44,532 | $24,922 |
| Rex Hospital Raleigh, NC | $46,662 | $21,168 |
| St Peter's Hospital Albany, NY | $48,038 | $24,922 |
| Memorial Healthcare System, Inc Chattanooga, TN | $49,599 | $20,039 |
| Brigham and Women's Hospital Boston, MA | $51,896 | $25,244 |
| Massachusetts General Hospital Boston, MA | $52,557 | $25,244 |
| Memorial Hermann Hospital System Houston, TX | $54,289 | $19,967 |
| University of Iowa Health Care Medical Center Iowa City, IA | $54,696 | $20,984 |
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.