Comprehensive APCs, Medicare's outpatient payment groups: submitted charge against what Medicare allowed, per service.
APC
Service
Services
Charge
Allowed
Billed ÷ allowed
5375
Level 5 Urology and Related Services
141
$44,815
$4,642
9.7×
5072
Level 2 Excision/ Biopsy/ Incision and Drainage
138
$13,450
$1,462
9.2×
5362
Level 2 Laparoscopy and Related Services
118
$78,371
$9,154
8.6×
5361
Level 1 Laparoscopy and Related Services
70
$48,134
$5,141
9.4×
5374
Level 4 Urology and Related Services
67
$28,637
$3,107
9.2×
5183
Level 3 Vascular Procedures
64
$36,192
$2,873
12.6×
5373
Level 3 Urology and Related Services
57
$13,324
$1,838
7.2×
5165
Level 5 ENT Procedures
49
$48,816
$5,280
9.2×
5073
Level 3 Excision/ Biopsy/ Incision and Drainage
49
$19,857
$2,565
7.7×
8011
Comprehensive Observation Services
48
$20,004
$2,431
8.2×
5191
Level 1 Endovascular Procedures
42
$47,942
$2,896
16.6×
5154
Level 4 Airway Endoscopy
35
$31,127
$3,379
9.2×
5091
Level 1 Breast/Lymphatic Surgery and Related Procedures
35
$27,938
$3,433
8.1×
5302
Level 2 Upper GI Procedures
33
$18,479
$1,675
11.0×
5092
Level 2 Breast/Lymphatic Surgery and Related Procedures
32
$51,566
$5,881
8.8×
5313
Level 3 Lower GI Procedures
29
$19,033
$2,467
7.7×
5213
Level 3 Electrophysiologic Procedures
27
$228,551
$21,367
10.7×
5116
Level 6 Musculoskeletal Procedures
27
$181,852
$16,773
10.8×
5414
Level 4 Gynecologic Procedures
24
$24,617
$2,818
8.7×
5465
Level 5 Neurostimulator and Related Procedures
22
$154,849
$27,954
5.5×
5182
Level 2 Vascular Procedures
21
$8,915
$1,444
6.2×
5376
Level 6 Urology and Related Services
21
$84,744
$8,301
10.2×
5378
Level 8 Urology and Related Services
20
$125,406
$18,152
6.9×
5114
Level 4 Musculoskeletal Procedures
18
$68,627
$6,458
10.6×
5193
Level 3 Endovascular Procedures
16
$104,466
$9,911
10.5×
5341
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures
13
$20,636
$3,118
6.6×
5372
Level 2 Urology and Related Services
13
$7,137
$617
11.6×
5303
Level 3 Upper GI Procedures
12
$22,959
$3,456
6.6×
5464
Level 4 Neurostimulator and Related Procedures
11
$116,731
$19,711
5.9×
5212
Level 2 Electrophysiologic Procedures
—
—
—
—
5153
Level 3 Airway Endoscopy
—
—
—
—
5164
Level 4 ENT Procedures
—
—
—
—
5415
Level 5 Gynecologic Procedures
—
—
—
—
5416
Level 6 Gynecologic Procedures
—
—
—
—
5163
Level 3 ENT Procedures
—
—
—
—
5461
Level 1 Neurostimulator and Related Procedures
—
—
—
—
5462
Level 2 Neurostimulator and Related Procedures
—
—
—
—
5155
Level 5 Airway Endoscopy
—
—
—
—
5504
Level 4 Extraocular, Repair, and Plastic Eye Procedures
—
—
—
—
5184
Level 4 Vascular Procedures
—
—
—
—
5115
Level 5 Musculoskeletal Procedures
—
—
—
—
5192
Level 2 Endovascular Procedures
—
—
—
—
5223
Level 3 Pacemaker and Similar Procedures
—
—
—
—
5224
Level 4 Pacemaker and Similar Procedures
—
—
—
—
5200
Implantation Wireless PA Pressure Monitor
—
—
—
—
5194
Level 4 Endovascular Procedures
—
—
—
—
5331
Complex GI Procedures
—
—
—
—
5112
Level 2 Musculoskeletal Procedures
—
—
—
—
5113
Level 3 Musculoskeletal Procedures
—
—
—
—
5094
Level 4 Breast/Lymphatic Surgery and Related Procedures
—
—
—
—
5222
Level 2 Pacemaker and Similar Procedures
—
—
—
—
5093
Level 3 Breast/Lymphatic Surgery and Related Procedures
—
—
—
—
5431
Level 1 Nerve Procedures
—
—
—
—