Outpatient / APC 5313
APC 5313 · 923 hospitals · 38,262 services
Level 3 Lower GI Procedures
Hospital outpatient departments billed Medicare for 38,262 services in APC 5313 in 2024. They charged an average of $19,230; Medicare allowed $2,692 — a ratio of 7.1 to 1 — and paid $2,165 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $3,822 to $100,283 across hospitals.
- 1Average charge $19,230
- 2Medicare allowed $2,692
- 3Reporting hospitals 923
- 4Services 38,262
By state
The average charge for this service was highest in Florida ($31,766) and lowest in Rhode Island ($7,678). 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 | 2,652 | $31,766 | $2,506 |
| Nevada | 150 | $30,970 | $3,007 |
| Alabama | 428 | $24,754 | $2,272 |
| Alaska | 37 | $24,588 | $2,987 |
| Texas | 2,152 | $24,408 | $2,483 |
| California | 3,780 | $23,564 | $3,543 |
| Arizona | 612 | $22,554 | $2,732 |
| Virginia | 1,475 | $21,924 | $2,499 |
| Georgia | 981 | $21,564 | $2,446 |
| Pennsylvania | 1,923 | $21,098 | $2,585 |
| New Jersey | 1,311 | $20,698 | $2,981 |
| South Carolina | 1,078 | $20,405 | $2,349 |
| New York | 2,515 | $19,738 | $3,064 |
| Mississippi | 330 | $19,537 | $2,278 |
| Colorado | 465 | $19,380 | $2,663 |
| Illinois | 1,664 | $18,618 | $2,631 |
| Oklahoma | 518 | $18,135 | $2,379 |
| Kentucky | 616 | $17,615 | $2,394 |
| New Hampshire | 223 | $17,382 | $2,748 |
| Kansas | 447 | $16,774 | $2,411 |
| Louisiana | 464 | $16,675 | $2,310 |
| Tennessee | 723 | $16,648 | $2,318 |
| District of Columbia | 188 | $16,487 | $2,782 |
| Indiana | 859 | $16,418 | $2,532 |
| Delaware | 198 | $16,360 | $2,795 |
| Ohio | 1,402 | $15,868 | $2,362 |
| Nebraska | 250 | $15,767 | $2,465 |
| Arkansas | 376 | $15,305 | $2,430 |
| Wisconsin | 697 | $15,298 | $2,502 |
| North Carolina | 1,132 | $15,227 | $2,481 |
| Hawaii | 74 | $14,853 | $3,126 |
| Wyoming | 38 | $14,814 | $2,814 |
| Washington | 854 | $14,762 | $2,864 |
| New Mexico | 191 | $14,641 | $2,438 |
| Connecticut | 422 | $14,449 | $3,101 |
| Missouri | 857 | $14,384 | $2,444 |
| Oregon | 294 | $14,199 | $2,912 |
| Idaho | 135 | $13,369 | $2,551 |
| Michigan | 1,123 | $13,294 | $2,467 |
| West Virginia | 374 | $13,068 | $2,346 |
| South Dakota | 266 | $12,682 | $2,622 |
| North Dakota | 305 | $12,444 | $2,633 |
| Iowa | 466 | $11,979 | $2,414 |
| Utah | 188 | $11,872 | $2,431 |
| Maine | 248 | $11,749 | $2,569 |
| Vermont | 108 | $11,668 | $1,405 |
| Minnesota | 776 | $11,549 | $2,703 |
| Montana | 135 | $11,375 | $2,660 |
| Massachusetts | 1,684 | $10,355 | $2,976 |
| Rhode Island | 74 | $7,678 | $2,799 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Good Samaritan Hospital San Jose, CA | $100,283 | $3,743 |
| Adventhealth Heart of Florida Davenport, FL | $99,933 | $2,543 |
| HCA Florida Jfk Hospital Atlantis, FL | $99,045 | $2,399 |
| Adventhealth Ocala Ocala, FL | $78,574 | $2,544 |
| Grandview Medical Center Birmingham, AL | $76,713 | $2,335 |
| Henrico Doctors' Hospital Richmond, VA | $73,669 | $2,439 |
| Tricities Hospital Hopewell, VA | $73,386 | $2,443 |
| Cjw Medical Center Richmond, VA | $69,259 | $2,417 |
| HCA Florida Ocala Hospital Ocala, FL | $67,958 | $2,462 |
| Capital Health Medical Center - Hopewell Pennington, NJ | $63,793 | $2,939 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Camc Charleston Surgical Hospital Charleston, WV | $3,822 | $2,380 |
| Umass Memorial Health-Milford Regional Medical Ctr Milford, MA | $3,959 | $3,013 |
| South Shore Hospital South Weymouth, MA | $4,259 | $2,923 |
| Beth Israel Deaconess Hospital - Needham Needham, MA | $4,397 | $3,015 |
| Beth Israel Deaconess Hospital-Milton Inc Milton, MA | $4,923 | $2,943 |
| New England Baptist Hospital Boston, MA | $5,233 | $2,886 |
| St Elizabeth's Medical Center Brighton, MA | $5,789 | $2,898 |
| Boston Medical Center Corporation- Boston, MA | $5,802 | $3,015 |
| Black Hills Surgical Hospital LLC Rapid City, SD | $5,889 | $2,632 |
| Inova Mount Vernon Hospital Alexandria, VA | $5,978 | $2,632 |
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.