Outpatient (sample) |
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OP claims data are for the calendar year ending 12/31/2006.
These reports are consistent with CMS Data Release policies.
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Statistics for the Top 20 Medical Diagnoses
ICD-9 Diagnosis codes (formats: Word or PDF) / Definitions
| ICD-9 Code |
ICD-9 Description | Total Payment | Number Patient Claims | Average Charge | Average Cost | Average Payment | Total Outlier Amount |
National Average Charge |
|---|---|---|---|---|---|---|---|---|
| V5332 | FTNG AUTMTC DFIBRILLATOR | $973,821 | 64 | $33,364 | $12,610 | $15,215 | $123 | $16,407 |
| 41401 | CRNRY ATHRSCL NATVE VSSL | $915,630 | 500 | $8,447 | $1,740 | $1,831 | $7,355 | $6,309 |
| 3669 | CATARACT NOS | $605,479 | 536 | $7,038 | $2,122 | $1,129 | $1,924 | $3,835 |
| 78650 | CHEST PAIN NOS | $583,606 | 886 | $4,023 | $836 | $658 | $16,419 | $2,014 |
| 4280 | CHF NOS | $479,700 | 209 | $7,315 | $2,440 | $2,295 | $5,117 | $1,605 |
| 99673 | COMP-REN DIALYS DEV/GRFT | $460,416 | 347 | $6,898 | $2,127 | $1,326 | $10,695 | $6,150 |
| 78659 | CHEST PAIN NEC | $422,507 | 382 | $6,106 | $1,308 | $1,106 | $5,272 | $2,882 |
| 42781 | SINOATRIAL NODE DYSFUNCT | $411,666 | 62 | $21,833 | $7,618 | $6,639 | $6,468 | $2,779 |
| V5331 | FTNG CARDIAC PACEMAKER | $401,272 | 81 | $14,710 | $5,067 | $4,953 | $652 | $2,449 |
| 36616 | SENILE NUCLEAR CATARACT | $375,087 | 332 | $6,946 | $2,104 | $1,129 | $451 | $3,354 |
| 4271 | PAROX VENTRIC TACHYCARD | $356,407 | 34 | $25,085 | $9,073 | $10,482 | $284 | $5,586 |
| 4148 | CHR ISCHEMIC HRT DIS NEC | $332,391 | 29 | $28,878 | $10,459 | $11,461 | $347 | $3,623 |
| V6709 | FOLLOW-UP SURGERY NEC | $251,412 | 250 | $7,082 | $1,348 | $1,005 | $47,043 | $1,028 |
| 78900 | ABDMNAL PAIN UNSPCF SITE | $243,887 | 585 | $2,277 | $453 | $416 | $2,240 | $1,427 |
| V7283 | OTH SPCF PREOP EXAM | $240,072 | 1,719 | $920 | $166 | $139 | $5,884 | $575 |
| 7242 | LUMBAGO | $228,748 | 528 | $1,920 | $463 | $433 | $4,632 | $894 |
| 72252 | LUMB/LUMBOSAC DISC DEGEN | $221,609 | 353 | $3,195 | $808 | $627 | $10,096 | $1,331 |
| 3540 | CARPAL TUNNEL SYNDROME | $190,758 | 179 | $6,214 | $1,806 | $1,065 | $1,656 | $2,295 |
| 1629 | MAL NEO BRONCH/LUNG NOS | $177,165 | 349 | $2,427 | $493 | $507 | $979 | $2,616 |
| 40391 | HYP RENAL NOS W REN FAIL | $176,240 | 150 | $7,528 | $2,334 | $1,174 | $5,950 | $4,565 |
| All Other | $15,099,437 | 27,490 | - | - | - | - | - | |
| Unclassified Services | $61,884 | 67 | - | - | - | - | - | |
| TOTAL FOR ALL CLAIMS | $23,209,194 | 35,132 | - | - | - | - | - |
Statistics for the Top 20 Ambulatory Payment Classifications (APCs)
APCs descriptions (formats: Excel or PDF) / Definitions
| APC Number |
APC Description | Total Payment | Number Patient Claims |
Units of Service | Average Charge |
Average Cost | Average Payment | National Average Charge |
|---|---|---|---|---|---|---|---|---|
| 0080 | Diagnostic Cardiac Catheterization | $1,340,320 | 800 | 800 | $4,185 | $590 | $1,675 | $3,688 |
| 0283 | Computerized Axial Tomography with Contrast Material | $1,028,130 | 4,648 | 4,668 | $1,139 | $139 | $220 | $1,233 |
| 0246 | Cataract Procedures with IOL Insert | $1,023,736 | 963 | 963 | $4,445 | $1,194 | $1,063 | $1,963 |
| 0108 | Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads | $930,154 | 43 | 43 | $5,978 | $1,605 | $21,631 | $7,088 |
| 0612 | High Level Emergency Visits | $875,845 | 4,130 | 4,134 | $755 | $270 | $211 | $563 |
| 0107 | Insertion of Cardioverter-Defibrillator | $847,918 | 54 | 54 | $2,841 | $763 | $15,702 | $4,779 |
| 0089 | Insertion/Replacement of Permanent Pacemaker and Electrodes | $536,893 | 91 | 91 | $4,651 | $1,249 | $5,899 | $4,103 |
| 0280 | Level III Angiography and Venography except Extremity | $495,155 | 678 | 691 | $1,334 | $256 | $716 | $1,623 |
| 0260 | Level I Plain Film Except Teeth | $484,889 | 12,388 | 12,941 | $265 | $50 | $37 | $171 |
| 0332 | Computerized Axial Tomography and Computerized Angiography without Contrast Material | $467,518 | 2,776 | 2,782 | $1,043 | $127 | $168 | $1,033 |
| 0286 | Myocardial Scans | $424,065 | 1,988 | 1,998 | $1,506 | $289 | $212 | $812 |
| 0336 | Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast | $419,115 | 1,286 | 1,303 | $1,827 | $350 | $321 | $1,516 |
| 0143 | Lower GI Endoscopy | $374,581 | 991 | 991 | $1,598 | $429 | $377 | $1,088 |
| 0333 | Computerized Axial Tomography and Computerized Angio w/o Contrast Material followed by Contrast | $365,757 | 1,371 | 1,376 | $1,778 | $218 | $265 | $1,484 |
| 0088 | Thrombectomy | $350,724 | 225 | 227 | $6,639 | $1,783 | $1,545 | $3,551 |
| 0090 | Insertion/Replacement of Pacemaker Pulse Generator | $342,925 | 77 | 77 | $3,611 | $970 | $4,453 | $3,493 |
| 0041 | Level I Arthroscopy | $322,558 | 322 | 324 | $3,935 | $1,057 | $995 | $2,020 |
| 0237 | Level III Posterior Segment Eye Procedures | $299,865 | 186 | 186 | $5,922 | $1,590 | $1,612 | $2,730 |
| 0222 | Implantation of Neurological Device | $298,259 | 29 | 29 | $5,504 | $1,478 | $10,284 | $2,595 |
| 0337 | MRI and Magnetic Resonance Angiography without Contrast Material followed by Contrast Material | $295,864 | 654 | 658 | $2,094 | $402 | $449 | $2,222 |
| TOTAL FOR TOP 20 | $11,524,271 | 33,700 | 34,336 | - | - | - | - | |
| SERVICE MIX INDEX = 5.041 |
Search for Other APCs
Enter APC desired and statistics will appear in a new window.
(Only APCs representing more than 10 patients are reported.)
Statistics for the Top 20 Procedures
HCPCS descriptions (formats:
Excel or PDF) /
Definitions
CPT descriptions are copyright AMA and can be ordered from the AMA
website.
Short CPT descriptions appear in Addendum B of the Federal Register as part of OPPS rulemaking
and on the
CMS website.
CPT ©2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use.
| HCPCS/CPT Code | HCPCS/CPT Description | Total Payment | Number Patient Claims | Units of Service | Average Charge | Average Cost | Average Payment | National Average Charge |
|---|---|---|---|---|---|---|---|---|
| 66984 | EXTRACAPSULAR CATARACT REMOVAL W/INSERTION, LENS PROSTHESIS (1 STAGE) | $1,000,994 | 936 | 936 | $4,493 | $1,206 | $1,069 | $1,965 |
| 93510 | LEFT HEART CATHETERIZATION, RETROGRADE, BRACHIAL/AXILLARY/FEMORAL ARTERY; PERCUTANEOUS | $949,742 | 566 | 566 | $4,216 | $595 | $1,677 | $3,590 |
| 33249 | INSERTION/REPOSITIONING ELECT LEAD SINGLE/DUAL CHAMBER PACING CARDIOVER-DEFIB, INSERT PULS GENERATR | $930,154 | 43 | 43 | $5,978 | $1,605 | $21,631 | $7,088 |
| 33240 | INSERTION, SINGLE/DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR | $847,918 | 54 | 54 | $2,841 | $763 | $15,702 | $4,779 |
| 99285 | EMERGENCY DEPT VISIT, 3 KEY COMPONENTS:COMPREHENSIVE HX; COMPREHENSIVE EXAM; MED DECISN HIGH COMPLEX | $482,745 | 2,278 | 2,280 | $919 | $329 | $211 | $751 |
| 33208 | INSERTION/REPLACEMENT, PERMANENT PACEMAKER W/TRANSVENOUS ELECTRODE(S); ATRIAL & VENTRICULAR | $405,367 | 67 | 67 | $4,926 | $1,323 | $6,050 | $4,205 |
| 99284 | EMERGENCY DEPT VISIT, 3 KEY COMPONENTS: DETAILED HX; DETAILED EXAM; MED DECISION MOD COMPLEXITY | $393,099 | 1,852 | 1,854 | $554 | $198 | $212 | $488 |
| 72193 | CT SCAN, PELVIS; W/CONTRAST | $366,462 | 1,657 | 1,665 | $787 | $96 | $220 | $1,218 |
| 93526 | COMBINED RIGHT HEART CATHETERIZATION & RETROGRADE LEFT HEART CATHETERIZATION | $352,795 | 212 | 212 | $4,190 | $591 | $1,664 | $4,515 |
| 74160 | CT SCAN, ABDOMEN; W/ CONTRAST | $339,439 | 1,531 | 1,543 | $1,227 | $150 | $219 | $1,269 |
| 99283 | EMERGENCY DEPT VISIT,3 KEY COMPONENTS:EXPAND PROB FOCUS HX;EXPAND PROB FOCUS EXAM;MED DEC MOD COMPLX | $291,190 | 2,381 | 2,385 | $301 | $107 | $122 | $299 |
| 33213 | INSERTION/REPLACEMENT, PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER | $255,163 | 57 | 57 | $3,861 | $1,037 | $4,476 | $3,544 |
| 63650 | PERCUTANEOUS IMPLANTATION, NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL | $248,795 | 28 | 41 | $3,470 | $932 | $6,068 | $2,913 |
| 71260 | CT SCAN, THORAX; W/CONTRAST MATL(S) | $239,252 | 1,082 | 1,082 | $1,515 | $185 | $221 | $1,232 |
| 78465 | MYOCARDIAL PERFUSION IMAGING; SPECT, MULTIPLE STUDIES, REST &/OR STRESS & REDISTRIBUTION | $235,399 | 733 | 736 | $2,935 | $563 | $319 | $1,516 |
| 62362 | IMPLANTATION/REPLACE, DEVICE, INTRATHECAL/EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP | $227,681 | 36 | 36 | $3,464 | $930 | $6,324 | $2,197 |
| 70450 | CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL | $209,575 | 1,239 | 1,242 | $1,141 | $139 | $168 | $996 |
| Q0081 | Infusion ther other than che | $191,601 | 1,823 | 1,921 | $135 | $36 | $99 | $212 |
| 71020 | RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL & LATERAL | $190,058 | 5,048 | 5,076 | $177 | $34 | $37 | $173 |
| 70553 | MRI, BRAIN; W/O CONTRAST, THEN W/CONTRAST & FURTHER SEQUENCES | $181,504 | 403 | 404 | $2,086 | $400 | $449 | $2,283 |
| TOTAL FOR TOP 20 | $8,338,933 | 22,026 | 22,200 | - | - | - | - |
Search for Other Procedures
Enter HCPCS/CPT code desired and statistics will appear in a new window.(Only procedures representing more than 10 patients are reported.)
Service Statistics
Services by Revenue Code / Definitions
| Service | Number Patient Claims | Units of Service | Average Charge | Average Cost | Average Payment | Service Mix Index - SMI |
|---|---|---|---|---|---|---|
| Pharmacy | 22,793 | 24,509 | $289 | $83 | $0 | 1.80 |
| IV Therapy | 1,823 | 1,921 | $135 | $36 | $100 | 3.10 |
| Medical Surgical Supplies | 19,166 | 20,451 | $907 | $373 | $3 | 4.61 |
| Laboratory | 68,723 | 85,259 | $63 | $9 | $9 | 0.39 |
| Laboratory - Pathological | 3,787 | 6,017 | $274 | $55 | $23 | 0.41 |
| Radiology - Diagnostic | 16,444 | 17,125 | $363 | $70 | $77 | 1.51 |
| Radiology - Therapeutic | 54 | 56 | $228 | $61 | $231 | 7.34 |
| Nuclear Medicine | 4,915 | 5,757 | $923 | $177 | $107 | 4.86 |
| CT Scan | 9,120 | 9,152 | $1,187 | $145 | $206 | 4.14 |
| Operating Room Services | 11,258 | 11,529 | $2,703 | $726 | $971 | 24.09 |
| Anesthesia | 1,363 | 3,969 | $92 | $25 | $0 | 0.00 |
| Blood Storage and Processing | 560 | 1,123 | $161 | $144 | $107 | 2.63 |
| Other Imaging Services | 2,252 | 2,270 | $678 | $130 | $171 | 3.58 |
| Respiratory Services | 854 | 3,914 | $106 | $48 | $36 | 0.65 |
| Physical Therapy | 180 | 483 | $113 | $36 | $30 | 0.74 |
| Occupational Therapy | 52 | 256 | $93 | $25 | $30 | 0.00 |
| Speech-Language Pathology | 167 | 264 | $262 | $106 | $51 | 1.01 |
| Emergency Room | 11,129 | 12,574 | $361 | $129 | $121 | 2.29 |
| Pulmonary Function | 3,102 | 3,108 | $70 | $19 | $20 | 1.28 |
| Cardiology | 4,308 | 4,334 | $507 | $136 | $166 | 4.80 |
| Cardiac Cath Lab | 4,416 | 4,424 | $1,419 | $200 | $376 | 34.41 |
| Clinic | 161 | 207 | $64 | $17 | $39 | 1.22 |
| Magnetic Resonance Technology (MRT) | 2,004 | 2,026 | $1,915 | $368 | $363 | 7.08 |
| Drugs Requiring Specific Identification | 7,369 | 52,155 | $33 | $10 | $7 | 0.34 |
| Recovery Room | 5,281 | 29,128 | $106 | $40 | $0 | 0.00 |
| EKG/ECG (Electrocardiogram) | 5,761 | 6,886 | $129 | $22 | $20 | 0.45 |
| EEG (Electroencephalogram) | 190 | 194 | $1,115 | $344 | $312 | 5.98 |
| Gastrointestinal Servuces | 47 | 48 | $991 | $266 | $147 | 2.84 |
| Observation Room | 1,946 | 48,133 | $30 | $8 | $2 | 6.90 |
| Psychiatric / Psychological Services | 28 | 153 | $251 | $92 | $89 | 1.10 |
| Other Diagnostic Services | 2,153 | 2,515 | $409 | $84 | $97 | 1.95 |
| Other Therapeutic - Cardiac Rehab | 150 | 1,045 | $123 | $33 | $30 | 0.62 |
| Unclassified | 499 | 556 | $588 | $495 | $208 | 0.30 |