• Medicare OPPS claims data are for calendar year ending 12/31/2017 (Proposed rule OPPS).
  • These reports are consistent with CMS cell size suppression policy.
Sample Hospital
Louisville, KY  11111
CMS Certification Number: 000000

Sample Report | Order Information

Outpatient Utilization

Based on Medicare OPPS claims data

Drill down to more granular utilization statistics for ICD diagnoses and procedures
More Information | Sample Report

Statistics for the Top 20 Medical Diagnoses

ICD-10 Diagnosis Codes

ICD-10
Code
ICD-10 Description Total Payment Number Patient Claims Average Charge Average Cost Average Payment Total Outlier
Amount
National Average Charge
Z5111 Encounter for antineoplastic chemotherapy $13,630,891 2,785 $20,758 $3,897 $4,894 $29,176 $17,747
Z5112 Encounter for antineoplastic immunotherapy $11,877,244 1,293 $30,992 $6,098 $9,186 $0 $24,664
G35 Multiple sclerosis $4,154,081 911 $18,722 $3,548 $4,560 $83,641 $8,909
Z510 Encounter for antineoplastic radiation therapy $2,899,420 670 $18,867 $2,696 $4,327 $0 $14,141
T82858A Stenosis of other vascular prosth dev/grft, init $1,795,351 412 $19,990 $3,731 $4,358 $5,695 $21,159
T82868A Thrombosis due to vascular prosth dev/grft, init $1,705,175 200 $33,054 $6,283 $8,526 $7,724 $28,296
R079 Chest pain, unspecified $1,476,588 1,093 $11,626 $1,479 $1,351 $25,475 $6,871
G8929 Other chronic pain $1,313,135 1,992 $4,001 $714 $659 $0 $2,227
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,183,153 1,006 $9,167 $1,223 $1,176 $9,046 $5,842
C61 Malignant neoplasm of prostate $1,113,490 1,115 $5,415 $800 $999 $0 $4,148
Z1211 Encounter for screening for malignant neoplasm of colon $1,112,377 1,446 $4,428 $770 $769 $0 $4,850
R0789 Other chest pain $1,077,017 1,061 $8,854 $1,112 $1,015 $10,756 $8,064
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,030,533 161 $47,139 $6,159 $6,401 $16,926 $36,718
D839 Common variable immunodeficiency, unspecified $825,327 262 $17,557 $3,471 $3,150 $0 $13,069
I480 Paroxysmal atrial fibrillation $824,608 541 $12,136 $1,948 $1,524 $2,759 $3,870
R55 Syncope and collapse $761,454 683 $9,310 $1,082 $1,115 $2,877 $7,598
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $664,099 37 $93,897 $17,173 $17,949 $0 $20,351
Z45010 Encntr for checking and test of card pacemaker pulse gnrtr $658,346 71 $46,232 $8,411 $9,272 $0 $21,689
I255 Ischemic cardiomyopathy $611,512 83 $43,908 $7,932 $7,368 $0 $13,074
I739 Peripheral vascular disease, unspecified $583,605 386 $9,369 $1,678 $1,512 $3,522 $2,746
  All Other $74,550,375 99,816 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $123,847,781 116,024 - - - - -

Statistics for the Top 20 Ambulatory Payment Classifications (APCs)

APC
Number
APC Description Total Payment Number
Patient
Claims
Units of Service Average
Charge
Average Cost Average Payment National Average Charge
8011 Comprehensive Observation Services $5,073,447 2,524 2,524 $1,478 $335 $2,010 $2,214
5193 Level 3 Endovascular Procedures $4,245,645 477 477 $16,260 $2,287 $8,901 $21,129
5012 Clinic Visits and Related Services $2,612,144 22,046 26,863 $87 $50 $97 $173
5192 Level 2 Endovascular Procedures $2,108,704 483 483 $10,961 $1,907 $4,366 $12,420
5693 Level 3 Drug Administration $2,061,176 9,760 12,640 $413 $58 $163 $431
5024 Level 4 Type A ED Visits $2,041,475 6,774 6,780 $1,079 $245 $301 $1,611
5524 Level 4 Imaging without Contrast $2,032,130 4,985 4,991 $2,849 $408 $407 $2,435
5694 Level 4 Drug Administration $2,024,587 4,510 7,980 $481 $78 $254 $913
5593 Level 3 Nuclear Medicine and Related Services $2,012,565 1,949 1,949 $4,424 $575 $1,033 $4,505
5114 Level 4 Musculoskeletal Procedures $1,828,832 388 388 $6,054 $1,058 $4,713 $10,229
5232 Level 2 ICD and Similar Procedures $1,812,468 65 65 $16,785 $2,934 $27,884 $40,140
5194 Level 4 Endovascular Procedures $1,721,911 130 130 $20,432 $3,059 $13,245 $25,235
5594 Level 4 Nuclear Medicine and Related Services $1,544,275 1,286 1,286 $6,865 $892 $1,201 $6,990
5463 Level 3 Neurostimulator and Related Procedures $1,400,786 87 87 $2,960 $517 $16,101 $8,737
5213 Level 3 Electrophysiologic Procedures $1,383,040 92 92 $33,000 $3,095 $15,033 $34,837
5523 Level 3 Imaging without Contrast $1,374,862 6,561 6,701 $2,513 $152 $205 $2,627
5025 Level 5 Type A ED Visits $1,355,774 3,054 3,057 $1,520 $344 $443 $2,250
5191 Level 1 Endovascular Procedures $1,330,694 520 520 $18,647 $1,749 $2,559 $14,872
5572 Level 2 Imaging with Contrast $1,323,296 3,419 3,424 $4,009 $179 $386 $4,503
5182 Level 2 Vascular Procedures $1,290,331 595 624 $4,087 $696 $2,068 $6,849
  TOTAL FOR TOP 20 $40,578,142 69,705 81,061 - - - -
  SERVICE MIX INDEX = 5.562        

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Service Statistics

Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 23,841 75,099 $36 $7 $0 0.00
IV Therapy 33,047 58,604 $310 $44 $54 1.08
Medical Surgical Supplies 35,251 75,534 $1,217 $248 $10 59.16
Laboratory 244,997 318,555 $186 $15 $2 1.27
Laboratory - Pathological 10,716 29,065 $273 $22 $2 2.43
Radiology - Diagnostic 24,365 25,505 $504 $65 $48 1.47
Radiology - Therapeutic 12,038 26,118 $818 $115 $220 3.43
Nuclear Medicine 9,128 12,874 $1,245 $162 $189 11.33
CT Scan 23,287 23,392 $2,653 $87 $148 3.25
Operating Room Services 25,286 28,246 $2,993 $523 $1,273 23.01
Anesthesia 9,470 500,290 $23 $3 $0 0.00
Blood Storage and Processing 1,647 3,290 $899 $127 $238 3.55
Other Imaging Services 8,541 8,589 $1,594 $207 $232 5.92
Respiratory Services 3,686 10,835 $275 $47 $39 1.30
Physical Therapy 7,216 9,479 $125 $30 $10 0.00
Occupational Therapy 2,184 2,824 $120 $21 $12 0.00
Speech-Language Pathology 2,400 2,545 $165 $29 $19 4.70
Emergency Room 18,428 18,455 $1,061 $240 $508 7.89
Pulmonary Function 2,659 2,926 $378 $53 $39 2.85
Cardiology 10,626 10,633 $2,373 $334 $196 6.08
Cardiac Cath Lab 1,103 1,123 $19,187 $1,800 $4,327 85.75
Ambulatory Surgical Care 16 17 $310 $54 $432 21.35
Clinic 22,178 27,075 $88 $50 $97 1.43
Magnetic Resonance Technology (MRT) 8,133 8,190 $3,692 $181 $267 4.97
Drugs Requiring Specific Identification 161,794 5,644,713 $31 $6 $7 0.00
Recovery Room 9,996 776,482 $13 $3 $0 0.00
EKG/ECG (Electrocardiogram) 15,888 19,378 $318 $23 $7 0.96
EEG (Electroencephalogram) 423 442 $686 $164 $319 7.74
Gastrointestinal Services 21 21 $2,706 $381 $363 5.54
Observation Room 4,478 151,139 $57 $8 $0 0.00
Treatment Room 3,089 3,852 $360 $206 $99 3.00
Lithotripsy 157 158 $13,162 $1,853 $2,904 46.45
Other Diagnostic Services 7,256 7,427 $1,115 $149 $178 3.52
Other Therapeutic Services 159 925 $212 $36 $49 0.73
Other Therapeutic - Cardiac Rehab 754 5,256 $167 $96 $101 1.47
Unclassified 2,504 2,578 $149 $34 $41 0.66
Audiology 0 0 $0 $0 $0 0.00
Blood Products 0 0 $0 $0 $0 0.00
Cast Room 0 0 $0 $0 $0 0.00
Labor & Delivery 0 0 $0 $0 $0 0.00
Oncology 0 0 $0 $0 $0 0.00
Other Therapeutic - Education / Training 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Services 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Treatments 0 0 $0 $0 $0 0.00