Outpatient / APC 5303
APC 5303 · 589 hospitals · 24,416 services
Level 3 Upper GI Procedures
Hospital outpatient departments billed Medicare for 24,416 services in APC 5303 in 2024. They charged an average of $24,790; Medicare allowed $3,638 — a ratio of 6.8 to 1 — and paid $2,891 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $1,481 to $154,831 across hospitals.
- 1Average charge $24,790
- 2Medicare allowed $3,638
- 3Reporting hospitals 589
- 4Services 24,416
By state
The average charge for this service was highest in Nevada ($44,829) and lowest in Wyoming ($13,669). 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 | 117 | $44,829 | $4,077 |
| Alabama | 279 | $35,594 | $3,125 |
| Florida | 1,663 | $34,233 | $3,419 |
| California | 2,476 | $32,853 | $4,790 |
| Alaska | 32 | $32,361 | $3,960 |
| Mississippi | 145 | $32,084 | $3,205 |
| Texas | 1,583 | $31,669 | $3,405 |
| Pennsylvania | 941 | $30,604 | $3,503 |
| Colorado | 517 | $29,229 | $3,542 |
| Oklahoma | 267 | $29,079 | $3,279 |
| New Hampshire | 118 | $28,989 | $3,767 |
| Georgia | 483 | $28,284 | $3,386 |
| South Carolina | 512 | $26,666 | $3,276 |
| New Jersey | 745 | $26,201 | $4,078 |
| Virginia | 679 | $26,017 | $3,386 |
| Louisiana | 289 | $25,834 | $3,238 |
| Indiana | 580 | $24,946 | $3,418 |
| Vermont | 20 | $24,265 | $3,014 |
| New York | 1,480 | $23,456 | $4,190 |
| Kentucky | 417 | $23,306 | $3,314 |
| New Mexico | 110 | $22,946 | $3,464 |
| Illinois | 1,210 | $22,941 | $3,593 |
| Arizona | 675 | $22,896 | $3,630 |
| Kansas | 313 | $21,744 | $3,295 |
| Wisconsin | 438 | $20,802 | $3,518 |
| Washington | 523 | $20,766 | $3,878 |
| Iowa | 255 | $20,763 | $3,318 |
| Nebraska | 193 | $20,589 | $3,362 |
| North Carolina | 815 | $20,427 | $3,391 |
| Tennessee | 442 | $20,014 | $3,207 |
| Connecticut | 268 | $19,644 | $4,112 |
| Delaware | 93 | $19,349 | $3,839 |
| South Dakota | 173 | $18,223 | $3,613 |
| Montana | 113 | $18,053 | $3,673 |
| Oregon | 217 | $17,956 | $3,982 |
| North Dakota | 136 | $17,851 | $3,602 |
| Massachusetts | 768 | $17,768 | $4,089 |
| Hawaii | 89 | $17,751 | $4,424 |
| Utah | 172 | $17,734 | $3,412 |
| Michigan | 538 | $17,709 | $3,410 |
| Missouri | 770 | $17,645 | $3,310 |
| Idaho | 171 | $16,315 | $3,477 |
| West Virginia | 207 | $15,842 | $3,247 |
| Minnesota | 524 | $15,744 | $3,507 |
| Rhode Island | 66 | $15,532 | $3,840 |
| Ohio | 1,269 | $15,121 | $2,557 |
| Arkansas | 219 | $15,071 | $3,257 |
| Maine | 100 | $14,881 | $3,545 |
| District of Columbia | 187 | $14,072 | $3,902 |
| Wyoming | 17 | $13,669 | $3,826 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Good Samaritan Hospital San Jose, CA | $154,831 | $5,393 |
| Cjw Medical Center Richmond, VA | $100,776 | $3,297 |
| Lewisgale Medical Center Salem, VA | $83,404 | $3,297 |
| Adventist Health Lodi Memorial Lodi, CA | $82,893 | $4,810 |
| Poplar Bluff Regional Medical Center Poplar Bluff, MO | $82,613 | $3,449 |
| HCA Florida Largo Hospital Largo, FL | $81,074 | $3,469 |
| Flowers Hospital Dothan, AL | $80,103 | $3,289 |
| Medical City Plano Plano, TX | $75,991 | $3,447 |
| Los Robles Hospital & Medical Center Thousand Oaks, CA | $75,509 | $4,708 |
| Southern Hills Hospital and Medical Center Las Vegas, NV | $72,019 | $4,102 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Bethesda North Cincinnati, OH | $1,481 | $353 |
| Methodist Medical Center of Oak Ridge Oak Ridge, TN | $5,173 | $3,158 |
| Inova Fairfax Hospital Falls Church, VA | $6,278 | $3,289 |
| Winchester Medical Center Winchester, VA | $6,424 | $3,766 |
| Parkwest Medical Center Knoxville, TN | $6,585 | $3,159 |
| Kansas Medical Center LLC Andover, KS | $6,909 | $3,270 |
| Inova Fair Oaks Hospital Fairfax, VA | $7,686 | $3,591 |
| Silver Cross Hospital and Medical Centers New Lenox, IL | $7,710 | $3,542 |
| Inova Alexandria Hospital Alexandria, VA | $7,789 | $3,435 |
| Mercy Hospital South Saint Louis, MO | $7,818 | $3,408 |
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.