Outpatient / APC 5331
APC 5331 · 512 hospitals · 24,425 services
Complex GI Procedures
Hospital outpatient departments billed Medicare for 24,425 services in APC 5331 in 2024. They charged an average of $35,087; Medicare allowed $5,370 — a ratio of 6.5 to 1 — and paid $4,268 of it, the patient's coinsurance making up most of the rest. Average charges ranged from $7,712 to $177,195 across hospitals.
- 1Average charge $35,087
- 2Medicare allowed $5,370
- 3Reporting hospitals 512
- 4Services 24,425
By state
The average charge for this service was highest in Nevada ($58,450) and lowest in District of Columbia ($20,685). 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 | 99 | $58,450 | $6,170 |
| California | 2,469 | $48,866 | $7,171 |
| Alabama | 268 | $48,401 | $4,619 |
| Colorado | 521 | $48,250 | $5,379 |
| Florida | 1,327 | $48,098 | $5,090 |
| Oklahoma | 318 | $48,036 | $4,803 |
| Pennsylvania | 1,048 | $45,356 | $5,201 |
| Texas | 1,596 | $42,315 | $5,010 |
| Mississippi | 140 | $39,645 | $4,756 |
| Alaska | 36 | $39,315 | $6,057 |
| Virginia | 682 | $39,290 | $4,933 |
| Indiana | 606 | $38,329 | $5,042 |
| New Mexico | 60 | $37,439 | $5,138 |
| Georgia | 556 | $36,153 | $4,946 |
| New Jersey | 673 | $35,432 | $5,925 |
| South Carolina | 589 | $34,411 | $4,646 |
| New Hampshire | 108 | $33,439 | $5,588 |
| Iowa | 274 | $32,585 | $4,813 |
| Illinois | 1,180 | $32,441 | $5,082 |
| New York | 1,270 | $31,741 | $6,177 |
| Louisiana | 252 | $31,683 | $4,778 |
| Washington | 640 | $30,741 | $5,716 |
| Tennessee | 355 | $30,398 | $4,778 |
| Arizona | 930 | $29,560 | $5,016 |
| Oregon | 233 | $29,473 | $5,837 |
| North Carolina | 741 | $29,308 | $4,897 |
| Kentucky | 447 | $29,263 | $4,208 |
| Wisconsin | 379 | $28,858 | $5,248 |
| Nebraska | 208 | $28,422 | $5,049 |
| North Dakota | 137 | $28,245 | $5,346 |
| Maine | 117 | $28,051 | $5,112 |
| Kansas | 323 | $27,257 | $4,762 |
| South Dakota | 165 | $26,939 | $5,270 |
| Ohio | 816 | $26,760 | $4,761 |
| Michigan | 682 | $26,708 | $4,854 |
| West Virginia | 210 | $26,054 | $4,663 |
| Wyoming | 18 | $25,558 | $5,696 |
| Vermont | 30 | $25,322 | $2,769 |
| Minnesota | 844 | $25,236 | $5,394 |
| Hawaii | 84 | $24,729 | $6,322 |
| Massachusetts | 826 | $24,225 | $5,959 |
| Delaware | 54 | $24,141 | $5,342 |
| Connecticut | 335 | $24,114 | $6,272 |
| Montana | 112 | $23,702 | $5,353 |
| Arkansas | 212 | $22,715 | $4,796 |
| Missouri | 769 | $22,341 | $4,516 |
| Rhode Island | 60 | $22,132 | $5,784 |
| Idaho | 130 | $22,045 | $5,205 |
| Utah | 251 | $21,610 | $4,383 |
| District of Columbia | 245 | $20,685 | $5,714 |
Highest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Good Samaritan Hospital San Jose, CA | $177,195 | $8,025 |
| Cjw Medical Center Richmond, VA | $147,071 | $4,906 |
| Lewisgale Medical Center Salem, VA | $140,698 | $4,906 |
| Los Robles Hospital & Medical Center Thousand Oaks, CA | $128,490 | $7,007 |
| Medical City Plano Plano, TX | $112,542 | $4,934 |
| Grandview Medical Center Birmingham, AL | $110,240 | $4,573 |
| North Austin Medical Center Austin, TX | $100,710 | $5,016 |
| Englewood Hospital Englewood, NJ | $91,990 | $5,601 |
| OU Health University of Oklahoma Medical Center Oklahoma City, OK | $91,195 | $4,850 |
| HCA Healthone Presbyterian St Lukes Denver, CO | $89,064 | $5,425 |
Lowest average charges
| Hospital | Charge | Allowed |
|---|---|---|
| Kansas Medical Center LLC Andover, KS | $7,712 | $4,866 |
| Inova Fair Oaks Hospital Fairfax, VA | $10,027 | $4,401 |
| Silver Cross Hospital and Medical Centers New Lenox, IL | $11,060 | $5,221 |
| Advocate Christ Hospital & Medical Center Oak Lawn, IL | $11,663 | $4,717 |
| Inova Alexandria Hospital Alexandria, VA | $11,992 | $4,941 |
| Mercy Hospital South Saint Louis, MO | $12,313 | $4,831 |
| Inova Fairfax Hospital Falls Church, VA | $13,676 | $4,821 |
| Winchester Medical Center Winchester, VA | $13,784 | $5,605 |
| Confluence Health Hospital Wenatchee, WA | $13,904 | $5,349 |
| Presbyterian Hospital Albuquerque, NM | $13,920 | $5,044 |
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.