# Patent

## Title
Medical practice pattern tool

## Abstract

The invention is a business process embodied in a software algorithm that determines difference in practice patterns among physicians for the main cost components of given conditions.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims priority from U.S. Provisional Patent Application Ser. No. 60/731,917, filed Oct. 31, 2005.


FIELD OF THE INVENTION
This invention relates to computer-implemented processes for the analysis of medical practice.
BACKGROUND OF THE INVENTION
Conventional systems, such as the Episode Treatment Group (ETG) software by Symmetry Health Data System, Inc, various risk adjusters, and other measures of physician service use allow managed care organizations to find rates of utilization of given services, determine relative costs of physician care, and bucket costs into categories such as office visits, pharmacy, and facility use. The conventional systems thus might show that there are differences between medical providers, such as one might be more expensive than another; however, they do not take the necessary steps to address what a managed care organization should work on in order to decrease costs of medical care and improve quality. The conventional systems do not identify what the specific cost drivers are that cause differences between the medical providers. Further, the conventional systems do not present data in a way that is clinically relevant and easy to present in graphic form to facilitate the discussion of medical appropriateness and allow clinical judgment as to whether the service is under utilized, over utilized, or mis-used, based on medical evidence for or against the service in question. In other words, the conventional systems do not connect cost containment to quality improvement.
The conventional approaches therefore require a priori hypotheses about cost drivers and then extensive drilldowns and other data analysis to discover the cost drivers. The user must ask specific questions, hypothesizing which services might be cost drivers, for example: “Find out if lab testing is a factor in hypertension care, and then find which tests and who is using them.” Such analyses typically take a number of hundred person-hours of work, develop over a time frame of weeks to months, and may lead down dead ends. For example, an analysis of hypertension cost drivers took approximately four weeks in real time to complete, and found that pharmacy was the only factor differentiating costs of care among physicians. A comprehensive analysis investigating the cost drivers for a plurality of conditions in a number of different specialties would be quite cumbersome using the conventional methods and the results would likely be out of date when the analysis is completed.
Several references are related to the evaluation and comparison of healthcare providers according to costs, quality of care, and effectiveness. Some of the references are related to determining the proper treatment for a patient. For instance, PCT publication number WO 96/00423 A1 by MEDICODE, INC. compares individual medical practitioners or a group of medical practitioners against a statistical norm or trend. The comparison is made by converting medical providers billing data into a historical database. The application also discusses the determination of episodes of care and providing reports on the results. The application does not compare the services performed by the medical providers to determine what services stand out as the cause for the differences between the medical providers or the groups of medical providers.
U.S. Application publication No. 2002/0111826 A1 by Potter, et al. compares actual costs of episodes of care against budgeted costs to evaluate medical practitioners and to manage health care costs. Potter, et al. does not teach a timely and comprehensive analysis investigating the underlying cost drivers for a plurality of conditions in a number of different specialties.
U.S. Pat. No. 5,845,254, issued to Lockwood, et al., teaches a process of determining cost effectiveness of physicians in a group and the qualitative performance level of the group by adjusting the episodes of care by severity. Lockwood, et al. does not identify the cost drivers that cause differences between medical providers.
PCT Publication number WO 91/17510 A1 by HEALTHCHEX, INC. describes a means for processing health care services information relative to certain clinical variables, including age, gender, and diagnosis, and then ranking the data into orders of clinical complexity. The system then determines systematic relationships between medical services rendered to patients, clinical complexity, and cost. The system does not determine what the specific cost drivers are that cause differences between medical providers, nor does it address what an managed care organization should do to decrease costs of medical care and improve quality.
A family of U.S. applications and patents and a PCT application based on U.S. Pat. No. 5,835,897, issued to Dennis K. Dang teaches computer-implemented processes of determining the cost-efficiency and service quality of health care providers. The references in the family discuss episode treatment groups (ETGs) and the ETG grouper software. The application does not compare the services performed by the health care providers to determine what services stand out as the cause for the differences between the health care providers or the groups of health care providers.
U.S. application publication No. 2004/0111291 A1 by Dust, et al. teaches a process of identifying patients likely to generate high cost health care and sending patients to proper health care providers to meet certain requirements set by an employer that provides health care benefits. The method does not identify cost drivers for a plurality of conditions in a number of different specialties.
PCT publication number WO 95/19604 A3 by INFORMED ACCESS SYSTEMS, INC. teaches a process for selecting the appropriate treatment for a patient. The publication does not require a diagnosis; the process sorts potential patients into those that do not need professional medical care and those that do. The level and type of care is then determined for those that need treatment. The process does not compare the costs associated with treatments it recommends to determine the differences between groups of medical providers. Further, the publication does not teach a process for recommending particular services for treating a patient with a particular diagnosis.
PCT publication number WO 99/41653 A2 by IAMETER, INCORPORATED and associated U.S. Pat. No. 6,061,657 teach a process for treating a particular patient for a particular illness including the estimation of charges for the treatment and keeping the actual cost of the treatment close to the estimate. The publication does not teach the identification of specific cost drivers that cause differences between medical providers. The publication also does not provide a medical practice blueprint that includes a timely analysis of several conditions in several specialties that can be used to provide recommendations regarding certain practice patterns.
U.S. Pat. No. 6,223,164, issued to Seare, et al., teaches a system for analyzing historical medical provider billings to statistically establish a normative utilization profile wherein a medical provider's utilization profile is compared with a normative profile. Seare creates a model of the cost of a specific medical episode based on historical treatment patterns and a fee schedule and compares various treatment patterns for a particular diagnosis to the model to determine an allegedly cost-effective treatment approach. Seare also identifies medical providers who provide treatment that does not fall within the statistically established treatment patterns or profiles. Seare does not find the general practice patterns and does not describe the specific differences between the treatment patterns and the models.
Therefore, what is needed is a medical practice analysis tool that efficiently uncovers the true underlying cost drivers. Further what is needed is a tool that can provide a timely analysis of several conditions in several specialties to develop a medical practice blueprint, recommending certain practice patterns over others for the several conditions and specialties.
SUMMARY OF THE INVENTION
The invention comprises, in one form thereof, an algorithm that allows the discovery of the medical practice pattern of physicians or other practitioners stratified according to predefined criteria. For example, the practitioners are stratified according to those who are low, medium, and high users of resources for a given condition. Its input is episodes of care generated by episode grouping software, such as the Episode Treatment GrouperTM of Symmetry Health Data System, Inc. Its output is a series of tables and graphs showing the cost drivers for each stratum of practitioners (e.g. by low to high cost quintiles) and their variation from stratum to stratum.
The invention sifts through the costs at the service level and then shows which services are the significant factors for the condition of interest. The invention readily discovers those while conventional systems require testing of multiple hypotheses and potentially could miss the true cost drivers unless the appropriate questions were asked in the first place. Using conventional systems, a typical analysis of a single condition takes weeks, as noted above. A full analysis using the present invention could be produced in less than 30 minutes with automated formatting of the output data.
The inputs and outputs of the invention are clinically relevant and easy to present in graphic form. This facilitates the discussion of medical appropriateness and allows clinical judgment as to whether the service is under utilized, over utilized, or misused, based on medical evidence for or against the service in question. Therefore the invention allows the connection of cost containment to quality improvement.
The invention includes a method of practice pattern analysis for medical professionals. The method comprises the steps of defining a plurality of episodes of care from any database of medical services organized into episodes of care for a plurality of medical professionals, assigning the medical professionals into strata according to a given characteristic for the defined episodes, recording all medical services provided for each of the episodes of care, normalizing the number of medical services provided and costs by the number of episodes of care in the plurality of episodes, removing all the services having a particular value under a threshold to remove anomalous data, and generating a report of the actual medical services and costs versus a set of expected medical services and costs for each stratum of medical professionals, wherein the report is normalized to the number of episodes of care in the stratum.
More particularly, the invention includes a method of managing medical care performed by a group of medical practitioners. The method comprises the steps of compiling a plurality of episodes of care comprising a plurality of services provided by each practitioner in the group of practitioners; sorting the medical practitioners into strata according to a predefined criterion; and listing the services associated with the medical practitioners in each stratum with a selected service value being included with each of the services. An additional step comprises one of the following: assembling a list of services having a threshold parameter above a threshold defined such that only services that have a significant impact on the selected service value are preserved or comparing an actual selected service value to an expected selected service value for each of the services in each stratum. For the purposes of this description, the selected service value is defined as either the service cost total for all the episodes in each stratum or the service utilization total for all the episodes in each stratum. Other service values may be used in alternative embodiments. The threshold parameter is related to the selected service value. For example, the threshold parameter is equal to the selected service value or a normalized selected service value. The medical practitioners are associated with all the services in the episodes that the practitioner had a significant role for a total role analysis. The step of assembling services includes the steps of determining the threshold parameter for each service by dividing the selected service value in each stratum by the number of episodes in that stratum; setting the minimum threshold for the threshold parameter; and storing the services having a threshold parameter above the threshold in a potential cost drivers table. The step of assembling services may also include the steps of determining an expected selected service value for each of the services in each of the episodes of care; evaluating a threshold parameter by subtracting the selected service values in each stratum from the expected selected service value and dividing the difference by the number of episodes in that stratum; setting the minimum threshold for the threshold parameter; and storing the services having a per episode service value difference above the threshold in a potential cost drivers table.
The threshold parameter may also be evaluated by setting it equal to the selected service value for each service in each stratum, e.g.: the threshold parameter would equal the total cost of a service in each stratum or the total utilization of a service in each stratum. Alternatively, the threshold parameter is determined for each service in each stratum by dividing the service cost total for all the episodes in that stratum by the service utilization total for all the episodes in that stratum. In a further alternative, the threshold parameter is evaluated by subtracting the selected service values in each stratum from the expected selected service value.
The method may further comprise the steps of generating a report comparing among the strata the selected service values for the services in the potential cost drivers table; identifying the service that differentiates the strata; and providing the medical practitioners with a description of how to reduce the difference between the strata. The expected selected service value determination step may include the steps of totaling the selected service value for each service for all the episodes in the analysis to provide an analysis total of the selected service value; determining an analysis average for the selected service value of each service by dividing the analysis total of the selected service value by the sum of the episodes in the analysis; and multiplying the analysis average of the selected service value by the number of episodes in each stratum for each service to provide the expected selected service value. The step of compiling a plurality of episodes may include tracking each service by episodes of care performed by a group of medical practitioners; aggregating the medical services according to given characteristics; and sorting the episodes of care into predefined conditions. Particularly, the episodes of care may be formed using the Symmetry ETG grouper software. The condition analyzed in the method may be a complete ETG, a combination of ETGs, a subset of an ETG, or a combination of subsets of a plurality of ETGs.
The medical practitioners may be separated into strata according to several criteria including, but not limited to, cost, the number of services performed, performance in another condition, geographic region, specialty, type of practice, and size of practice. Medical practitioners having an anomalous selected service value may be removed from the analysis group. The practitioners may be attributed to the episodes according to a number of attribution rules. For example, the practitioner attributed to an episode may be the practitioner with the highest percentage of professional costs of the episode, the practitioner with the highest percentage of generated costs of the episode, all practitioners in the episode who contributed more than a preset percentage of the cost to the episode, a primary care physician associated with the episode, all practitioners with any involvement in the episode, the practitioner that performed a significant procedure in the episode, the practitioner that had the most face-to-face encounters with a patient associated with the episode, or combinations thereof.
An additional analysis includes the further step of analyzing the practice pattern of an individual practitioner in a total role drilldown analysis of a single medical condition. Similarly, the analysis may include the further step of analyzing the practice pattern of an individual practitioner in a total role MPPT meta-drilldown analysis including data from a plurality of medical conditions.
Further, the invention includes a method for providing a group of medical providers with guidelines for decreasing underuse, overuse, or misuse of medical services. The method comprises the steps of identifying a number of medical conditions performed by the group of medical providers; performing a medical practice pattern analysis; analyzing the results of the medical practice pattern analysis to identify a number of cost drivers that differentiate the strata in each condition; and providing the medical practitioners with a description of how to reduce the difference in the cost drivers between the strata in each condition. The step of performing a medical practice pattern analysis includes the further steps of identifying a plurality of episodes of care for the medical providers for a given condition and a plurality of medical services utilized in each episode of care; calculating a total episode cost for each episode of care; organizing the episodes of care into conditions with given characteristics; separating the medical providers for each conditions into strata by a given characteristic; executing a normalizing algorithm in each stratum for each condition with a threshold to identify and remove anomalous services in the episode of care; and producing a report showing a plurality of cost drivers and comparing the main cost drivers between the strata for each episode grouping.
Even further, the invention includes a medical practice pattern analysis report, comprising tables and graphs of a selected service value for a service for a plurality of strata, wherein the selected service value is greater than a threshold set to remove a plurality of other services having a less significant effect on a particular difference between the strata. The selected service value may include, but is not limited to, an absolute cost per episode of the service, an absolute service utilization per episode, a cost difference per episode, a service utilization difference per episode, and a service cost per utilization. A plurality of medical practitioners are attributed to a plurality of episodes including the services, and the strata are defined by a criterion that may include the average cost, average service utilization, performance in another condition, geographic region, specialty, type of practice, and size of practice of the medical practitioners responsible for the services. The graph may display a service that drives the difference between the strata as well as the selected service values for a plurality of services, wherein the selected service values are greater than the threshold.
Still further, the invention includes a medical method blueprint, comprising a plurality of cells, each describing a treatment recommendation for a particular type of episode of care, wherein the recommendation is based on a medical practice pattern analysis that revealed a service as a driver for a difference between a plurality of stratified medical practitioners. The cells may be grouped by specialty. The medical practitioners are stratified by a criterion that may include the average cost, average service utilization, geographic region, specialty, type of practice, and size of practice of the medical practitioners responsible for the services.
The advantages of the algorithm are therefore manifold: first, it uncovers the true underlying cost drivers, and second it does so quickly. Utilization of the algorithm would allow analysis of the top 20 conditions of the 20 largest specialties (400 analyses) in a few hundred person-hours. Conventional methods have been too cumbersome to allow such a systematic analysis. A similar analysis with current techniques could take years, by which time the results would be outdated. Lastly, because of its process of database set up at the front end, the algorithm is not limited to a single episode grouping. Rather, the analysis can be carried out across multiple episode groupings, and even across combinations of episode groupings and subsets of episode groupings.



BRIEF DESCRIPTION OF THE DRAWINGS
The present invention is disclosed with reference to the accompanying drawings, wherein:
FIG. 1 is a flow diagram of the general process of the present invention;
FIGS. 2A and 2B include a more detailed flow diagram of the medical practice pattern tool of the present invention;
FIG. 3 is a blueprint cell according to the present invention;
FIG. 4 is a portion of the medical management blueprint of the present invention;
FIGS. 5, 6A, and 6B are bar graph outputs of the medical practice pattern tool according to Example A; and
FIGS. 7 and 8 are the bar graph outputs of the medical practice pattern tool according to Example B.



Corresponding reference characters indicate corresponding parts throughout the several views. The examples set out herein illustrate several embodiments of the invention but should not be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTION
Referring to FIG. 1, there is shown a flow diagram of the medical practice pattern tool of the present invention. The medical practice pattern tool 100 includes the steps of inputting the services 102 performed by a plurality of medical practitioners into a grouping protocol 104, which identifies episodes of care comprised of the services and groups them into the episodes of care according to a medical services database. The grouping protocol 104 outputs several groups of episodes of care 106 and step 108 assigns medical practitioners into strata by cost or by the number of services performed. Step 110 lists the medical services performed in each episode of care within each stratum. Step 112 analyzes the services by generating an average cost and utilization per stratum, calculating the average cost and utilization per episode across all strata, generating expected cost and utilization for each service according to that average number and the total number of episodes in the service's stratum, generating total cost and utilization differences per episode for each service in each stratum, and removing all services where costs and/or utilization absolute values or differences from expected are below a threshold. In step 114, a report is generated showing the key cost drivers and differences from expected values, which are services having a total cost or utilization absolute value or difference per episode that is greater than or equal to a threshold value. In one embodiment, the reports are output in tables and bar graphs.
More particularly, the medical practice pattern tool 100 tracks services performed by medical practitioners in a given region, specialty, or combination thereof in steps 102 and 104. A medical practitioner is defined as any person that provides care to a patient, including but not limited to physicians, doctors, anesthesiologists, nurse practitioners, nurses, technicians such as radiology technicians, and therapists. In an alternative embodiment, medical practitioner is expanded to medical providers, which may include medical facilities such as clinics and hospitals. The services provided include any care provided to a patient, such as office visits, radiology, pharmaceuticals, and vaccinations. Step 104 assigns the services to episodes of care and determines the responsibility for each episode of care and sorts the episodes of care by predefined conditions. An episode of care is defined as all management, ancillary (including lab and radiology), pharmacy, inpatient facility, and surgical (i.e.: professional) services for one patient over a defined time period.
Step 104 may be carried out by any grouping protocol, such as, for example, the ETG grouper software by Symmetry Health Data System, Inc. This should not be construed to exclude other ETG groupers. The Symmetry ETG grouper is described in the family of patents based on U.S. Pat. No. 5,835,897 by Dennis K. Dang, which is herein incorporated by reference. According to Dang, an episode treatment group (ETG) is a clinically homogenous and statistically stable group of similar illness etiology and therapeutic treatment. The ETG grouper method uses service or segment-level claim data as input data and assigns each service to an appropriate episode of care. The Episode Treatment GrouperTM collects these services into an episode and assigns the episode to one of approximately 900 clinically homogeneous conditions or Episode Treatment GroupsTM (ETGsTM). Examples of ETGs include, for example, benign skin lesions (ETG 0682), allergic rhinitis (ETG 0332), benign hypertension without co-morbidity (ETG 0281), and joint derangement with surgery—knee and lower leg (ETG 0742.02).
ETGs gather all in-patient, ambulatory and ancillary claims into mutually exclusive treatment episodes (otherwise known as episodes of care), regardless of treatment duration, then use clinical algorithms to identify both concurrent and recurrent episodes. The ETG grouper continues to collect information until an absence of treatment is detected for a predetermined period of time commensurate with the episode. For example, a bronchitis episode will have a sixty day window, while a myocardial infarction may have a one year window. Subsequent records of the same nature within the window reset the window for an additional period of time until the patient is asymptomatic for the pre-determined time period.
ETGs can identify a change in the patient's condition and shift the patient's episode from the initially defined ETG to the ETG which includes the change in condition. ETGs identify all providers treating a single illness episode.
Medical claim data is input as data records by data entry into a computer storage device, such as a hard disk drive. The ETG grouper may reside in any of a number of computer system architectures, i.e., it may be run from a stand-alone computer or exist in a client-server system, for example a local area network (LAN) or wide area network (WAN). The ETG grouper and the medical practice pattern tool may be provided in a single software package and installed on a single workstation or server. Alternatively, the grouper and the medical practice pattern tool are separate modules. The grouper output, which is the medical practice pattern tool input, may even be provided by a third party.
Once relevant medical claim data is input, claims data is processed by loading the computer program into the computer system memory. During set-up of the program onto the computer system, the computer program will have previously set pointers to the physical location of the data files and look-up tables written to the computer storage device. Upon initialization of the computer program, the user is prompted to enter an identifier for a first patient. The program then checks for open episodes for the identified patient, sets flags to identify the open episodes and closes any episodes based upon a predetermined time duration from date of episode to current date. After all open episodes for a patient are identified, the new claims data records are read to memory and validated for type of provider, CPT code and ICD-9 (dx) code, then identified as a management, surgery, facility, ancillary, drug or other record. The CPT code is the American Medical Association's list of the Current Procedural Terminology; CPT-4 is the fourth version of this list. The ICD is the International Classification of Diseases published by the World Health Organization. ICD-9 is the ninth revision of this publication.
As used herein, “Management records” are defined as claims which represent a service by a provider engaging in the direct evaluation, management, or treatment of a patient. Examples of management records include office visits and therapeutic services. Management records serve as anchor records because they represent focal points in the patient treatment as well as for related ancillary services. “Ancillary records” are claims which represent services which are incidental to the direct evaluation, management and treatment of the patient. Examples of ancillary records include X-ray and laboratory tests. “Surgery records” are specific surgical professional fee claims. Surgery records also serve as anchor records. “Facility records” are claims for medical care facility usage. Examples of facility records include hospital room charges or outpatient surgical room charges. “Drug records” are specific for pharmaceutical prescription claims. “Other records” are those medical claim records that are not management, surgery, ancillary, facility or drug records.
Invalid records are flagged and logged to an error output file for the user. Valid records are then processed by an ETG Assignor Sub-routine and, based upon diagnosis code, are either matched to existing open episodes for the patient or serve to create new episodes.
Management and surgery records serve as “anchor records.” An “anchor record” is a record that originates a diagnosis or a definitive treatment for a given medical condition. Management and surgery records serve as base reference records for facility, ancillary, and drug claim records relating to the diagnosis or treatment that is the subject of the management or surgery record. Only management and surgery records can serve to start a given episode.
If the record is a management record or a surgery record, the diagnosis code in the claim record is compared with prior related open episodes in an existing look-up table for a possible ETG match. If more than one open episode exists, the program selects the most recent open episode. A positive match signifies that the current episode is related to an existing open episode. After the match is determined, the time window is reset for an additional period of time corresponding to the episode. A loop shifts the originally assigned ETG based on the additional or subsequent diagnoses. If any of the additional or subsequent diagnoses is a defined co-morbidity diagnosis, the patient's co-morbidity file is updated. If no match between the first diagnosis code and an open episode is found, a new episode is created.
Grouping prescription drug records requires two tables, a NDC (National Drug Code) by GDC (Generic Drug Code) table and a GDC by ETG table. Because the NDC table has approximately 200,000 entries, it has been found impracticable to directly construct an NDC by ETG table. For this reason the NDC by GDC table serves as a translation table to translate NDCs to GDCs and construct a smaller table based upon GDCs. Reading, then from these tables, the NDC code in the claim data record is read and translated to a GDC code. The program then identifies all valid ETGs for the GDC codes in the claim data record then matches those valid ETGs with active episodes.
The output of the ETG grouper is one or more episode treatment groups, each comprising a list of all the episodes of care in the group. The services that make up the episodes and the practitioners responsible for the services are included in a table. Although the medical practice pattern tool 100 is described using the ETGs defined by Symmetry's ETG grouper, any grouper protocol may be used, such as the Medstat Episode Grouper by Thomson Medstat and the Cave Grouper by the Cave Consulting Group.
Referring to FIGS. 2A and 2B, the user selects the episodes according to certain general characteristics such as completeness or outlier status in step 202. Complete episodes are episodes in which the predetermined time window described above has passed. Outlier episodes are episodes which exceed given criteria for cost or service level. In the current embodiment, only complete episodes are used. Alternatively a user could choose to examine incomplete episodes or both complete and incomplete episodes. Similarly, in the current embodiment only non-outlier episodes are used. However, a user of the invention could choose to analyze high-cost outlier episodes, for example, in order to find the cost drivers in those episodes (i.e. to determine what made them outliers).
In step 203, the user performs data cleansing as necessary. For example, anesthesia services that are measured in minutes in one institution and in occurrences in another institution could all be converted to occurrences. In another example, outpatient surgery facility fees, which might vary from institution to institution, could be converted into uniform fees to better allow comparison based on utilization rather than particular contracting arrangements.
In step 204, the user performs high level service groupings. For example, the episode grouper may already have grouped services into ancillary costs, management fees, inpatient facility costs, pharmacy, and surgical professional fees. In the current embodiment, the invention assigns services so as to create the additional high level categories of radiology services, physical therapy services, and allergy services (production and administration of vaccine, commonly known as “allergy shots”). The output of step 204 is the service group file 205.
In step 206 the system finds all managing practitioners in the specialty or specialties of interest and creates a list of practitioner IDs. Alternatively a list of practitioners can be provided or created by other means such as by user input. A provider ID list produced by other commercial data processes also may be used for this step. It should be noted that a number of different specialties or practitioners from different specialties may be combined at the user's discretion in order to capture all the practitioners of interest. For example, there may be practitioners in different specialties that perform similar services. The percentage of involvement for each practitioner is calculated for each episode by cycling through each episode, finding and storing all practitioners associated with the episode, calculating and storing each practitioner's percentage of the total of the episode, and outputting a practitioner episode percentage table reporting the roles of the practitioners in each episode. The percentage of involvement is calculated by the total cost that the practitioner contributed to the episode or by the number of services the practitioner ordered in the episode. Alternatively to percentages, other measures of involvement may be used. Any attribution rule may be used to assign episodes to practitioners; however, it should be noted that a practitioner that is deemed to have had a significant role in an episode is assigned all the services in that episode regardless of whether that practitioner was responsible for the service, according to the current embodiment.
A number of alternative attribution rules are described in a white paper from Bridges to Excellence and The Leapfrog Group, “Measuring Provider Efficiency, Version 1.0” [online], Dec. 31, 2004 [retrieved on Jan. 17, 2006]. Retrieved from the Internet: <http://bridgestoexcellence.org/bte/pdf/Measuring_Provider_Efficiency_Versionl—12-31-20041.pdf> pages 38-41. The first method described in the white paper attributes an episode to the one practitioner with the highest percentage of the cost of the episode. This method will generally result in only one practitioner being attributed to an episode even when there are many treating practitioners. Further, the attributed practitioner may not have been responsible for the decisions that led to the costs of the episode. A second method in the white paper is similar to the first method with a minimum threshold for the percentage of the costs of the episode. Particularly, the episode is attributed to the practitioner with the highest percentage of the cost of the episode only if that percentage is over the threshold. This eliminates episodes with highly fragmented care. In a third method described in the white paper, the attribution rule assigns the episodes to the patient's primary care provider regardless of the primary care provider's role in the episode. This method is only applicable when the patients are required to select a primary care provider. The fourth method described in the white paper infers a primary care provider for patients that are not required to select one. The primary care provider is identified by review of the patient's visits to providers for a predefined period, such as 12 months, before the episode. The fifth attribution method described by the white paper assigns all the practitioners involved in an episode to the episode regardless of the percentage of the practitioner's involvement. The white paper's sixth method attributes an episode to the practitioner that performed a significant procedure in the episode. This method only applies to surgical episode types. The seventh method described by the white paper assigns the episode to the practitioner with the most face-to-face encounters with the patient. The attribution is thus not based on dollars. The white paper also describes a method that attributes an episode to the practitioners that had professional fees above a threshold percentage of the cost of the episode. The attribution rule is not to be limited to the above-described attribution methods.
The system then selects all services for all episodes attributed to each practitioner in step 207. A variety of rules may be used for assigning episodes to practitioners, such as, for example, those practitioners who have generated a certain percentage of services at least 25% of the total costs of the episode. The definition of a significant role may be varied to include more or less practitioners as needed for the particular analysis.
The medical practice pattern tool 100 now produces a file 208 comprising all services in all episodes attributed to each practitioner, for each practitioner of interest. The file includes all services with an additional field identifying the practitioner to whom was attributed the episode containing the service. Where an episode has been attributed to more than one practitioner, for example, where two practitioners shared management of the patient, the episode's services are copied and, in the second instance of the episode, the added field has the second practitioner's identifier. It should be noted that multiple practitioners may be assigned the same total role services.
The episodes specific to a condition of interest are then defined by the user of the medical practice pattern tool 100 in step 209. This step may be performed several times to provide analysis on several different groups of episodes of interest using the data compiled in the previous steps. It should be noted that by preserving in file 208 all episodes across all conditions for the entire group of practitioners, great flexibility is retained for analyses, because, at this step, conditions can be created by selecting episodes according to specific criteria not limited by the definitions of the original episode grouper.
The user employs clinical judgment to produce an operational definition of a group of episodes of interest, which may be from one or more ETGs output by the grouper. For example, in the specialty of allergists, the episodes of interest may be related to Allergic Rhinitis in the ETG 0332. A further example in the specialty of orthopedists, the episodes of interest may be Carpal Tunnel Syndrome with and without surgery, combining the ETGs 0174 and 1075. Alternatively, the episodes of interest may be a subset of an ETG defined by ICD-9 or by CPT. For example, in the specialty of dermatologists, benign neoplasm of skin (ETG 0682) could be analyzed without episodes containing the diagnosis of actinic keratoses, which would normally be included in ETG 0682. A further example in the specialty of orthopedics, knee derangement with or without surgery (ETGs 0742.02 and 0743.02), but including only episodes containing arthroscopy. In a further alternative, episodes of interest are defined to include multiple ETGs with multiple limitations. For example, an analysis in the specialty of dermatologists may include dermatitis in ETG 0678, minor inflammation of skin, episodes with diagnoses 690-693 plus ETG 0692, dermatological signs and symptoms, episodes with diagnosis 782.1, rash.
In step 210, the medical practice pattern tool 100 selects the services for the episodes of interest identified in step 209 and outputs a pre-analysis service set file 211 listing the services in the episodes of interest with identifiers for all practitioners to whom those episodes were attributed.
In step 212, the medical practice pattern tool 100 counts the number of episodes and their costs for all practitioners in the analysis and outputs a file 213 showing the episode counts and average cost by practitioner. In step 214, the user then optionally applies a volume threshold and/or other criteria to select a final list of practitioners to analyze. For example, the user may decide that practitioners who see fewer than 5 cases per year have atypical practices and should be excluded from analysis.
In step 215, the user assigns the practitioners into strata. The strata may be defined in numerous ways, such as by the total episode cost (the total cost of the episode regardless of the practitioner's contribution), responsible cost, by specialty, by geographic location (e.g. urban, suburban, rural), by type of practice (e.g. by group size), etc. For example, the physicians are ranked according to cost and separated into percentile groups (quartiles, quintiles, etc). The strata may be divided evenly, or the boundaries between strata may be selected using the user's judgment, for example at natural breaks in the data. In a particular embodiment, the strata are defined for the episodes of interest using the pre-analysis service table, by ranking all the relevant physicians from highest to lowest volume in terms of number of episodes, choosing a lower limit for number of episodes, re-sorting all physicians with greater than or equal to the minimum number of episodes by the average total cost per episode, lowest to highest. Physicians having an average total cost per episode that is unexpectedly high or low compared to the rest of the group of episodes of interest may be removed from the group. Similarly, physicians having a number of episodes that does not fit with the rest of the group are removed. The physicians are then divided into strata, such as cost quintiles. The medical practice pattern tool 100 outputs a practitioner stratum table that lists the practitioners in their respective strata and includes the total role episode count, the responsible role expense, the total role expense, the responsible role average cost per episode, and the total role expense per episode (see Table A4 in the example). The result is step 216, which outputs the practitioner stratum table 217. The medical practice pattern tool 100 also outputs a table 218 of episode count by stratum, which is a table of the number of episodes in each stratum.
In step 219, the medical practice pattern tool 100 then uses the final practitioner stratum table 216 and the pre-analysis service set 211 and selects episodes' services for only those practitioners in the final table 216. Each service is labeled with its attributed practitioner's stratum number. The result is file 220, the analysis service set.
In step 221, the medical practice pattern tool 100 then counts the beginning diagnosis for each episode in the analysis service set and produces a count of diagnoses by stratum, outputting the diagnosis list 222. This list can be used in conjunction with other outputs of the medical practice pattern tool 100 to perform additional analyses, such as determining whether the pattern of medical conditions by specific diagnosis had an effect on costs.
The medical practice pattern tool 100 then in step 223 finds the average cost and utilization for every service across all episodes in the entire analysis. To achieve this, the cost and service utilizations are totaled across all the episodes in the entire group of episodes of interest, which may be known as the analysis total. Each cost and service utilization is normalized by dividing by the total number of episodes in the group of episodes of interest to generate the cost per episode average and the service utilization per episode average across all the episodes in the analysis, which may be known as the analysis average. The number of episodes in the entire group of episodes of interest is the sum of the stratum episode counts in the table 218. The medical practice pattern tool 100 outputs a table of the costs and service utilizations per episode for all episodes of interest, resulting in file 224, the cost-service per episode file.
The medical practice pattern tool 100 then in step 225 determines the expected cost and expected service utilization for each service in each stratum from step 223. For each service, the system multiplies the number of episodes in the current stratum times the service cost per episode and service utilization per episode from the table 224 of costs and services per episode in the entire analysis. The result is the “expected” costs and service utilizations for each service in the current stratum (i.e.: as if the average cost and service utilization across all practitioners of interest had been delivered for the number of episodes in that stratum). In other words, the expected cost and expected utilization for every service in each stratum equals the average cost or utilization for a service across all episodes times that stratum's number of episodes from the stratum episode count table 218.
The medical practice pattern tool 100 then also in step 225 finds the difference between the actual and expected service cost or utilization for each service in each stratum. The expected cost and service utilization are subtracted, respectively, from the actual cost and service utilization of each service to find a cost and utilization difference per service. It should be noted that the actual service cost is defined herein as the sum of the cost of that service over every time the service occurred in a stratum. For example, if a service is consistently $200 and it occurred 100 times in a particular stratum, the total service cost is $20,000 for that stratum. It should be further noted that the service utilization is defined herein as the number of times a service was performed for the episodes in a given stratum. In the above example, the service utilization is 100.
The medical practice pattern tool 100 then generates a list of all the services attributed to the practitioners in the practitioner stratum table and then sorts and normalizes all the resultant services. For each service the tool shows the actual total cost and utilization, the expected cost and utilization, and the differences between the actual and expected costs (and optionally, utilizations). The tool then applies a normalization within each stratum by dividing both the total costs and utilizations and their differences from expected by the number of episodes in that stratum. The resulting output is a table 226, the MPPT file, sorted by stratum, high level category, and then service within each category from highest to lowest difference from expected cost or utilization.
In steps 227 and 230, the user may identify potential cost drivers and generate a report comparing the absolute values of the services. In step 227, the user applies a minimum threshold for the total cost for each service in each stratum or the service utilization for each service in each stratum. The threshold therefore may be, for example, a total cost of $10 per episode or a service utilization of 0.1 per episode. Any service that has a cost or service utilization above the threshold is stored in a potential cost drivers table. Thus, anomalous data are removed. The total service cost or service utilization for each of these potential cost drivers may be displayed in a graph, such as a bar graph, in step 229.
It often makes sense to group certain services together in the graph, for example, pharmaceutical claims. The user may use clinical judgment while examining the services to apply appropriate groupings, e.g.: complex radiology within radiology, antibiotics within pharmacy, consultations within examination and management, etc. Therefore it is beneficial to group the services by type within the strata formed in step 215. Further, in the steps following step 215, it is convenient to calculate the totals for each type of service as if the service type was an individual service. For example, the system calculates the total cost difference per episode for all antibiotics within pharmacy, as well as for the individual services within the pharmacy type.
The important cost differences are determined by setting a threshold for the cost difference per episode and removing the services that are below that threshold in step 230. For example, a cost difference per episode that is less than $2 may be considered to an insignificant difference and services below that threshold would be removed from the list. Thus, anomalous data are removed. The resulting output list, which indicates the total cost difference per quintile episode, groups similar services together within each stratum as discussed in step 227. For example, in allergic rhinitis allergy vaccines (“allergy shots”) appear within the ETG category of management costs while other management costs and evaluation are grouped separately. Likewise, all physical therapy services would be grouped together and all anesthesia services would be grouped together. The service group differences from expected can then be displayed as a graph 232 showing the variation from average of each service group for each stratum.
In alternative embodiments, the threshold step may be applied to other values. For instance, the utilization difference may be calculated similarly to the cost difference and the threshold may be applied to the utilization difference or the utilization difference divided by the number of episodes in the stratum. Alternatively, the threshold may be applied to the total cost or utilization. In a further alternative, the threshold is applied to the total cost of a service within a stratum divided by the total utilization of that service in that stratum. So the threshold may be applied to the total cost, the total utilization, the cost per episode, the utilization per episode, the cost difference, the utilization difference, the cost difference per episode, the utilization difference per episode, the cost per utilization, or variations and combinations thereof.
The final output of the medical practice pattern tool 100 comprises a report consisting of tables or graphs, such as bar graphs (outputs 229 and 232), comparing the cost drivers. The graph 232 displays the cost per episode of the cost drivers above and below the expected value for each stratum. The graph readily shows the differences between the strata. Thus step 116 (FIG. 1) is reviewing the table(s) and graph(s) and determining the services that drive the differences between the strata. For example, physicians in the first quintile may use less of service A than the average of the group of episodes of interest, thus showing a negative cost difference per episode for service A, and more of service B than the average of the group of episodes of interest, thus showing a positive cost difference per episode for service B. If the practitioners in the fifth quintile have a positive cost difference per episode for service A and a negative cost difference per episode for service B, and the first quintile is the least expensive quintile, then it stands to reason that physicians that choose to use more of service B and less of service A will have less expensive episodes of care for that group of episodes of interest on average.
It is possible to collect all of the results from several analyses of separate groups of episodes of interest and form a medical management blueprint for practitioners to follow. The blueprint provided in step 118 (FIG. 1) has a separate cell, such as the one shown in FIG. 3, for each analysis performed using the medical practice pattern tool 100. Each cell has a brief description of the episodes of interest, a list of two or three cost drivers, and a recommendation for treatment within that specialty. The description of the episodes of interest will indicate whether a single ETG, a combination of ETGs, or a subset of ETGs was used. The cells are placed in rows according to specialty, as shown by example in FIG. 4. Therefore, after making a diagnosis, a practitioner may consult the blueprint or a listing or guideline derived from the blueprint to determine what services for treating this diagnosis are favored. If the preferred services of the practitioner are not cost drivers in the analysis, then she proceeds according to her discretion. However, if the services are addressed in the blueprint, the practitioner is recommended to use the services utilized by the lower cost quintiles and to not use services that are not utilized by the lower cost quintiles. In addition or alternatively to providing recommendations to the practitioners, the blueprint may recommend that a practitioner or an organization renegotiate a contract with a service provider. For example, the medical practice pattern tool 100 may show that the inpatient physical therapy costs are exceedingly high for a particular hospital and the recommendation is for the managed care organization to renegotiate the costs for the therapy. In a general sense, an organization can use the blueprint to organize its efforts to manage costs.
An advantage of the medical practice pattern tool is that it reveals what services less expensive practitioners use and what services they do not use. It does not simply report which practitioners are expensive and which are inexpensive. Further, the medical practice pattern tool may have counterintuitive results. In particular, the recommendation may be to use a more expensive service over a less expensive service. This may be because the less expensive service is less effective than the more expensive service, or because the less expensive service is used much more frequently, causing higher total costs. For example, for the condition allergic rhinitis it has been found that physicians in the less expensive quintiles use less vaccine (“allergy shots”) and more pharmaceuticals to treat allergies while those in the expensive quintiles use more vaccinations and less pharmaceuticals. This result is counterintuitive because pharmaceuticals tend to drive expenses in other conditions.
It is possible for the results of an analysis to be skewed by certain factors. Patient severity could be systematically different from one stratum to another. ETGs are already constructed so as to be cost homogenous, and those that are clinically homogenous minimize the concerns further (e.g. ETG for HTN without complications).
Certain episode groupers include severity adjustment, or severity could be judged by separate analyses (e.g. through one of several standard severity adjustment methods such as age-gender, ERG, DCG, etc). The differences in physician practice patterns are usually apparent and larger than severity differences, due to the construction of ETGs. However, one could group episodes by patient-severity strata and then evaluate the differences in practice according to patient severity.
The invention has a major competitive edge over other analytic tools in the market. First, it discovers the general characteristics of practice patterns, rather than requiring multiple a priori hypotheses and analyses. A key goal of managed care organizations is identifying and defining “best practices.”
In addition, the inputs and outputs of the algorithm are clinically relevant and easy to present in graphic form. This facilitates the discussion of medical appropriateness and allows clinical judgment as to whether the service is under utilized, over utilized, or mis-used, based on medical evidence for or against the service in question. Therefore the invention allows the connection of cost containment to quality improvement.
Application of the algorithm shows potential savings of $250,000 to $1,250,000 among conditions in three specialties that have been examined. The potential cost savings for a medium-sized regional insurance plan are $10,000,000 to $30,000,000 per year (2 conditions×20 specialties×$250,000 average at the low end, 3×20×$500,000 average at the high end).
As described, the medical practice pattern tool focuses on the total role rather than the responsible role of a particular medical practitioner. For the purposes of this description, the total role comprises the total cost or utilization of the care of a particular patient, as opposed to the contribution of a single physician of interest, which is the responsible role. The advantage that the total role has over the responsible role is that the total role analysis captures all services in an episode while the responsible role analysis only considers services for which the practitioner of interest is responsible. Thus, if a particular practitioner does not typically order a particular service for a given ETG, and another practitioner typically does order that service, the first practitioner looks less expensive and the service at issue looks like a cost driver. A total role analysis may show that this is an incorrect result. For example, a first general practitioner may typically order an MRI for episodes in a particular ETG prior to sending the patients to a specialist. A second general practitioner may typically send the patients directly to the specialist for episodes in the same ETG, in which case, the specialist is responsible for the MRI. In a responsible role comparison of the two general practitioners, the first general practitioner looks more expensive and the MRI appears to be a cost driver, all else being equal. A total role analysis shows, however, that the MRI was ordered in all episodes regardless of whether the general practitioner or the specialist ordered it, and the MRI is eliminated as a potential cost driver. A responsible role analysis may be desirable in certain circumstances, and one skilled in the art will be able to modify the medical practice pattern tool described to provide such an analysis. Thus, the medical practice pattern tool with a responsible role focus is considered to be within the scope of the invention.
Further to the main MPPT analysis, an individual practitioner's practice pattern is discerned by a total role drilldown and a total role MPPT meta-drilldown. The total role drilldown for a practitioner lists all the services from the episodes in which this practitioner had a significant role. The episodes are from a single condition corresponding to an MPPT analysis, such as a modified ETG. The services are organized by high level category and, within each category, the services are ranked according to the total cost difference (i.e. the expected cost subtracted from the total cost).
The total role MPPT meta-drilldown lists all the services from the episodes in which the physician had a significant role for all the conditions analyzed. In other words, the MPPT analysis may be carried out for several conditions and an individual practitioner may have a significant role in episodes of a plurality of these conditions. The MPPT meta-drilldown combines all the episodes from all the conditions considered. Similarly to the total role drilldown for an individual condition, the services in the MPPT meta-drilldown are organized by high level category and within each category the services are ranked according to the total cost difference (i.e. the expected cost subtracted from the total cost). The expected cost and utilization for each service in the MPPT meta-drilldown is calculated by multiplying the average cost and utilization for the service in each condition (from step 223) times the number of episodes in which the physician had a significant role in that condition, then summing the result over all the conditions considered. This provides a case-mixed service cost and utilization, by service.
The organization and ranking of the services in the total role drilldown and the total role MPPT meta-drilldown thus readily show the physician's variation in one condition and across multiple conditions, respectively. The services that really make a difference to the cost of the physician's practice are revealed by normalizing by the number of episodes, as described in the main MPPT analysis. Most of the physician's services have a cost difference per service of close to $0, while services that truly affect costs have a non-zero cost difference per episode.
EXAMPLE A
In an example, a number of episodes of care for the condition benign neoplasm of the skin, ETG 0682, are analyzed using the medical practice pattern tool. In this example, the medical practitioners are physicians in the specialty of dermatology associated with a medium sized regional managed care organization. The claims data input to the ETG grouper was from a period of two years.
The user chose to analyze complete episodes of care that were not cost outliers. In the data cleansing step the user had substituted uniform fees for outpatient hospital services. In choosing the top-level of groupings the user kept the Symmetry Grouper categories (ancillary, facility, management, pharmacy, and surgery) but split radiology costs out of ancillary to form a separate category. A sample of the resulting service group file 205 is shown in Table A1. Note that the data at this point contains all episodes from all ETGs for the specialty of dermatology.
In the example, the user had previously compiled a list of all dermatologists in the managed care organization and used that list as input 206. The user then found all episodes that were to be attributed to each dermatologist according to the user's chosen attribution rule, and inserted the attributed practitioner's identification number as the final field in the file 208, “total role all practitioners services details all episode,” sample shown in Table A2. Note that more than one practitioner could have been attributed in a given episode, and in that case the medical practice pattern tool would have made one or more additional copies of all the services in that episode and appended the second (and third and fourth, and so on as the case might be) practitioner identifier to the copied episode's services. For example, the services with claim IDs 56 through 60 in Table A2, which belong to episode number 1067490, were attributed to physician number CCP010000009 and CCP010000032. Thus, the services for this episode are listed twice with one set attributed to CCP010000009 and the other attributed to CCP010000032.
The user knew from prior experience that ETG 0682 contains episodes of actinic keratosis removal as well as non-actinic keratosis skin lesion removal. Because this mixed two medical conditions, the user, in step 209, specified that the condition of interest was those ETG 0682 episodes that did not contain a diagnosis of actinic keratoses (ICD9 702.xy where x is any fourth digit and y is any fifth digit). The medical practice pattern tool therefore at this step selected only episodes of 0683 without actinic keratosis diagnoses, producing the pre-analysis service set 211. Of the episodes shown in Tables A1 and A2, the episode with claim IDs 66 through 70 included a diagnosis of actinic keratoses and therefore were removed from the analysis.
The medical practice pattern tool at this point counts the episodes and their costs for all practitioners in the pre-analysis service set, producing the file 213, “practitioner zero or more episodes.” A sample of the file 213 is shown in Table A3. Note that the practitioners are ordered by volume so that the user can apply optional threshold and other criteria in step 214. In this case the user did not choose to apply any criteria. However, in this step there might have been a volume threshold, for example a minimum of 100 episodes, which would have removed seven practitioners. The user also could have removed any practitioners with an atypical practice, for example, anyone known to specialize in treatment of skin cancers, who might therefore a priori be considered to have more difficult patients referred for care.
In step 215 the decision was made to stratify the practitioners into quartiles according to average total episode cost. Other stratification schemes could have been applied, such as cost quintiles or urban/suburban/rural practice locations. The result was file 217, “practitioner stratum table,” as shown in Table A4 The MPPT counted the episodes in each stratum producing the stratum episode count table 218 as shown in Table A5. It is seen that there were a total of 22,358 episodes across all four quartiles, with 6,455 episodes in Quartile 1, 4,443 episodes in Quartile 2, 7,788 episodes in Quartile 3, and 3,672 episodes in Quartile 4.
The MPPT in step 219 would have selected only those services in the pre analysis service set 211 that were in episodes attributed to the physicians in the final practitioner stratum table, producing the analysis service set. In this example, since no physician was eliminated in step 214, the analysis service set was identical to the pre-analysis service set. The MPPT produced a count of diagnoses by stratum, output 222 “diagnosis list”, as shown in Table A6.
The MPPT then in step 223 found the costs and service count (utilization) per episode for every service in the analysis service set. A portion of the resulting “cost-service per episode” file 224 is shown in Table A7. Taking as an example service 11400, which is the CPT-4 identifier code for the procedure “excise, benign skin lesion, including margins, except skin tag, trunk/arms/legs,” it is seen that the service was performed 512 times in the entire analysis (that is, across the 22,358 episodes of all four quartiles). The total cost was $47,710. Therefore the average cost per episode for all dermatologists of interest (in this case, the entire specialty in the region of the managed care organization) was $47,710 divided by 22,358, or $2.13 per episode and the average utilization per episode was 512 divided by 22,358, or 0.0229 per episode. The other columns in Table A7 simply track the number of episodes in which the service occurred, the average cost of the service per episode in which it actually occurred, and the average number of times the service was ordered per episode in which it actually occurred. If fewer dermatologists were analyzed (e.g. if some were excluded in step 214 for small numbers of episodes or atypical practices), the denominator of 22,358 would have been smaller.
The MPPT then performs the step 225 consisting of listing the services by stratum, top-level category, and then service, counting the actual costs per service and occurrence (utilization) per service within each stratum, generating the expected costs and occurrences, generating the differences between actual and expected, and normalizing those by the number of episodes in the stratum. A portion of the output 226, the MPPT file, is shown in table A8. Continuing the example of service 11400, it is seen that for quartile 1 the service occurred 94 times in 6,455 episodes at a total cost of $10,400. If the service had occurred at the average rate of all analyzed practitioners of 0.0229 per episode, it would have occurred 147.82 times, the expected number of occurrences (0.0229 times 6,455). Similar calculations lead to an expected cost of $13,774 ($2.13 time 6,455), showing that in quartile 1 the service occurred at a lower rate than expected and a lower cost than expected. The cost difference between actual and expected was $3,734. The MPPT then normalized the actual cost and cost difference to the number of episodes in the quartile, yielding an actual cost per quartile episode of $1.55 (rounded in the table to $2) and a cost difference of $0.58 per episode below expected (rounded to −$1.00).
By similar calculations and reasoning it can be seen that in quartile 1 the service 17000, destruction of premalignant lesion, occurs more often than expected, at an actual cost per quartile episode of $13.37 (rounded to $13) and a cost difference of $1.03 per episode above expected (rounded to $1).
By similar calculations and reasoning it can be seen that in contrast to the lowest cost quartile, the service 11400 in quartile 4 is used at $4 per episode ($2 per episode above expected) and the service 17000 is used at $10 per episode ($3 per episode below average).
The user now applies thresholds to determine significant drivers of cost and variation. In this example a cost driver threshold of $2 (rounded) per episode was used and all services with costs below that threshold were removed. The medical practice pattern tool in this step removes (for example) all pharmacy and radiology services, showing that they were not significant cost drivers as defined by the user in setting that threshold. An alternative threshold of services per episode could have been used. A portion of the resulting report (file 228) is shown in table A9 and the corresponding graph shown in FIG. 5, which shows the absolute cost per the number of episodes in each stratum for the significant cost drivers. This report shows that the important cost drivers in the condition benign skin lesions are pathology costs, management costs, and procedure costs. Particularly, FIG. 5 shows that Quartile 1 spends much less on office visits and procedures than the more expensive quartiles.
Similarly the user could remove all cost differences under a threshold such as $1 to show that those services were not significant drivers of the variation in care among quartiles. An alternative threshold of service utilization difference could be used. In this example, the user also choose to use a separate cost difference threshold to select all services with a per episode cost difference of over $0.30 (absolute value). FIG. 6A shows the difference between the actual cost and the expected cost per the number of episodes in each stratum for the significant cost drivers. FIG. 6B shows the significant cost drivers within the procedure group of cost drivers: biopsy, shave excision, excision, destruction, and other. The graphs clearly show that Quartile 1 spends much less on office visits and procedures than the more expensive quartiles. More specifically, Quartile 1 spends less on excision procedures and more on destruction than the other quartiles.
It will be noted that in this example under surgical procedures there are several natural groupings of services, such as all excisions, all lesion destructions, etc. The user has sorted and subtotaled the costs for those groupings of services.
The resultant tables and corresponding graphs thus teach that the practice pattern of the lower quartile dermatologists consists of lower pathology costs, office visit costs, and procedure costs compared to those of the higher cost dermatologists, and further that the procedure costs are represented in general by higher excision-type procedures in the highest quartile dermatologists.
Therefore the medical practice pattern tool has uncovered a pattern of variation in care among cost quartiles in the use of office visits and lesion excision versus lesion destruction. This teaches that the practice pattern of the lower cost physicians is to do lesion destruction rather than lesion excision, and further that medical costs can be decreased by a medical guideline that suggests to practitioners to perform lesion destruction instead of excision as often as possible consistent with good medical practice.
One will note that Tables A8 and A9 include several columns that track data that were not necessarily used in the analysis. This data may be useful, however, for additional analysis and for providing context to the recipients of the medical practice pattern tool analysis. Particularly, the “stratum” column lists the stratum designation; for example: S1 is used for stratum 1 and Q1 is used for Quartile or Quintile 1. The “category” column lists the cost category, such as Ancillary (A), which includes labs, other testing, outpatient facility fees, etc., Evaluation and Management (M), which includes office visits, etc., Pharmacy (P), Radiology (R), Inpatient Facility (F), Physical Therapy (T), among others. The “service” column lists the service group designator, e.g. the CPT code, the medication group label, the DRG code, etc. The “procedure description” column simply lists the text description of the service group designator. The “total services” column lists the stratum service usage, which is the total number of times that service was provided for all episodes in the current stratum. The “your services” column lists the number of units of that service provided for all episodes in that stratum performed by the physicians with a significant role. This value is obtained by examining each episode and counting the services generated or ordered by the index physician, for those physicians with a significant role. The “other's services” column lists the number of that service provided for all episodes, obtained by examining each episode and counting the services generated or ordered by practitioners who were not in the significant role relative to the index practitioner.
The “expected services” column lists the number of services that would be expected if performed in this stratum at the average rate of services per episode in the entire analysis (i.e. across all strata). More particularly, the expected services is defined by the service usage for the entire analysis divided by the number of episodes in the analysis and multiplied by the number of episodes in the current stratum. The “stratum (or quartile or quintile) episodes” column lists the number of episodes in that stratum. The “total costs” column lists the actual total costs for all of that service in that stratum. The “your costs” column lists the actual costs for that service in that stratum for the physicians with significant roles. This is the costs for the services usage listed in the “your services” column. The “other costs” column lists the actual costs for all of that service in the current stratum for the other physicians without a significant role. This is the costs for the services usage listed in the “other services” column. The “expected costs” column lists the expected costs for that service, generated in the same manner as the expected services. Particularly, the expected cost is defined by the service cost for the entire analysis divided by the number of episodes in the analysis and multiplied by the number of episodes in the current stratum. The “total cost difference” column lists the total costs minus the expected costs and the “total costs per stratum episode” column lists the total costs divided by the number of episodes in the stratum.
The total cost “difference per stratum episodes” column lists the total costs divided by the number of episodes in the stratum. The “your costs per service” column lists the costs for physicians with a significant role (from the “your costs” column) divided by their number of services (from the “your services” column). The “other costs per svc” column lists the costs of the physicians who were not the significant role physicians for the episodes (from the “other's costs” column) divided by their number of services (from the “other's services” column). The “spec costs per svc” column lists the specialty costs per service, which is the sum of costs of all the physicians in the analysis (from the “total costs” column) divided by the number of that service in the entire analysis (from the “total services” column). The “episodes this service occurred” column lists the total number of episodes in the stratum in which the service was found. Tracking this additional data allows the user to perform additional analyses once the key cost drivers and the expensive practitioners are discovered. For example, the user may perform analyses related to the percentage use of a service by stratum episode, or the cost per service when service was actually used.
When reporting to an individual practitioner in the analysis, further analyses focused on the individual may be carried out. These include the total role drilldown and the total role MPPT meta-drilldown. The total role drilldown for physician #CCP010000014, who was assigned to the fourth quartile in the MPPT analysis, is shown in Table A10, wherein all the services from the episodes in which this physician had a significant role are listed. The episodes are from a single condition corresponding to an MPPT analysis, in this case the benign neoplasm of the skin, without actinic keratoses ETG 0682 of the present example. The services are organized by high level category and, within each category, the services are ranked according to the total cost difference (i.e. the expected cost subtracted from the total cost).
The total role MPPT meta-drilldown is shown by Table A11, which lists all the services from the episodes in which the physician had a significant role for all the conditions analyzed. In other words, the MPPT analysis may be carried out for several conditions (e.g.: ETGs or modified ETGs) and the present physician may have a significant role in episodes of a plurality of these conditions. The MPPT meta-drilldown combines all the episodes from all the conditions considered. Similarly to the total role drilldown, the services in the MPPT meta-drilldown are organized by high level category and within each category the services are ranked according to the total cost difference (i.e. the expected cost subtracted from the total cost). The expected cost and utilization for each service in the MPPT meta-drilldown is calculated by multiplying the average cost and utilization for the service in each condition (from step 223) times the number of episodes in which the physician had a significant role in that condition, then summing the result over all the conditions considered. This provides a case-mixed service cost and utilization, by service.
The organization and ranking of the services in the total role drilldown and the total role MPPT meta-drilldown thus readily show the physician's variation in one condition and across multiple conditions, respectively. The services that really make a difference to the cost of the physician's practice are revealed by normalizing by the number of episodes, as described in the main MPPT analysis. Most of the physician's services have a cost difference per service of close to $0, though services that truly affect costs have a non-zero cost difference per episode. Upon review of Tables A10 and A11, one will note that this physician is high in service number 11400 (excision) and low in service number 17000 (leasion destruction). This is in parallel to the MPPT part of the present example in which the fourth quartile was high in excision and low in lesion destruction, while the lower cost first quartile was low in excision and high in lesion destruction. Further, this physician tends to do more level 3 consults and office visits and fewer than expected level 2 of the same (see category “M” in Table A11).
Therefore, when reporting to the physician that the MPPT analysis indicates that higher quartile physicians tend to do more excisions than destruction, the user may also provide the physician's pattern in the same condition and across all conditions. In this case, the physician follows the fourth quartile pattern for the benign neoplasm of the skin without actinic keratoses condition and across all conditions. Further, the present physician codes much higher for office visits. Thus, the user may provide two concrete actions to lower the physician's costs.
For physicians in the lower quartiles, there may still be areas where they can lower costs and the total role drilldown and the MPPT meta-drilldown may reveal these areas in the physician's pattern. Thus the drilldowns may be valuable for all physicians in the analysis.
EXAMPLE B
In further example, a number of episodes of care for the condition Allergic Rhinitis, ETG 0332, are analyzed using the medical practice pattern tool. In this example, the medical practitioners are physicians in the specialty of allergy associated with a medium sized regional managed care organization. The claims data input to the ETG grouper was from a period of two years. The system develops the practitioner episode percentage table using the output of the ETG grouper, which provides the list of physicians associated with episodes of care in ETG 0332. For each episode, the system calculates the percentage of involvement of each physician by dividing the sum of the costs of the services the physician is responsible for in that episode by the total cost of the episode. The system then calculates and stores the number of episodes for which each physician contributed to at least 25% of the cost; though, it should be noted that other attribution rules may be used. Now the system ranks the physicians and divides them into strata, in this case cost quintiles, as shown in Table B1. As one can see, the physicians are ranked according to the average cost of the episodes in which that physician had a significant role. The quintiles are evenly divided except that physician 10's total role expense per episode fit better in the fourth quintile than the third.
Referring to Table B1, physician 1 has a significant role in 181 episodes in ETG 0332 and the total cost of those episodes is $115,782, translating to about $640 per episode. This places physician 1 in the lowest cost quintile, Q1. Physician 12, on the other hand, has a total cost per episode of about $753, which results in physician 12's placement in a higher cost quintile, Q4. The responsible cost data is also included in Table B1.
The system now calculates the expected cost and service utilization (number of times a service is ordered) for each service in each quintile. The system totals the cost of each service for the entire ETG 0332 and then totals the service utilization for that service over ETG 0332. For instance, service reference number 95004 has an ETG total cost of $84,806 and an ETG total service utilization of 21,600. Each of these totals is then divided by the total number of episodes in the ETG, which is 2506 in the case of ETG 0332. This results in the cost per episode average of $33.84 and the service utilization per episode average of 8.62 for service reference number 95004. The cost per episode average is multiplied times the number of episodes in each quintile to calculate the expected cost of the service for that quintile. For instance, there are 472 episodes in quintile Q1, multiplied times the cost per episode average of 33.84 results in an expected cost of $15,973 for service 95004 in Q1. Similarly, the service utilization per episode average is multiplied times the number of episodes in each quintile to calculate the expected service utilization of the service for that quintile. Thus the expected service utilization for service 95004 in Q1 is 4068.32.
The expected cost and service utilization are reported in Table B2, which lists the services organized by quintile and by type. The services are grouped by type in each quintile with subtotals in Table B2 so that services may be easily grouped in the final analysis. For example, pharmaceuticals in general may be a cost driver and there may be less interest in the details of the specific pharmaceuticals. For each service, the system subtracts the expected cost from the actual cost also reported in Table B2 to calculate the total cost difference. This is divided by the number of episodes in the quintile to result in the total cost difference per quintile episode. For service 95004, the total cost difference is $4,703 and the total cost difference per quintile episode is $10, as reported in Table B2. A negative total cost difference per quintile episode, such as ($1) for service 95015 indicates that the actual cost was lower than the expected cost.
Once the total cost difference per quintile episode is calculated for every service in every quintile, a cost driver threshold is set. In this case, any service with a total cost difference per quintile episode having an absolute value of $2 or greater, is reported in Table B3, still organized by quintile and by type within each quintile.
FIG. 7 shows the bar graph of the potential cost drivers from Table B3. The user employs clinical judgment to combine certain services and produce a meaningful graph. For example, if pharmacy is a cost driver in general, a separate graph of the components of the pharmacy group is generated to compare the cost difference per episode of the components. In this example, allergy test services, which were previously grouped and the cost difference per episode totaled in Tables B2 and B3, are graphed in a group; and pharmacy services, which were similarly grouped in Tables B2 and B3, are graphed in a group. Evaluation and management (E&M) services and vaccine services were grouped together in Tables B2 and B3; however, it now makes sense to graph these separately. The cost difference per episode for E&M services, such as service reference numbers 99244, 99214, 99243, and 99213 in quintile Q1, are totaled and graphed. Similarly, the cost difference per episode for vaccine services, such as service reference numbers 95147, 95115, 95165, and 95117 in quintile Q1, are totaled and graphed. Illustrating that even a portion of Table B3 may be graphed to compare the cost difference per episode of certain services, FIG. 8 shows the bar graph of the cost difference per episode of nasal steroid services, leukotriene receptor antagonist (LTA) services, and antihistamines, which are components of the pharmacy group of services.
The results of the medical practice pattern tool analysis of ETG 0332, Allergic Rhinitis, reveals that among allergists the main cost drivers are vaccine costs (the manufacture and administration of “allergy shots”), and to a much lesser extent allergy tests and E&M visits. The lowest cost physicians use much less vaccine but the most medications. They have slightly higher allergy test and office visit costs per episode than other quintiles. The highest cost physicians test and consult less but treat with both vaccines and medications far more. The middle quintile uses more vaccine and less pharmacy, but that quintile is dominated by one physician with that practice pattern.
In pharmacy, nasal steroid costs are the main driver, followed by prescription antihistamines. Leukotriene receptor antagonists (LTAs) were a smaller factor. The lowest cost physicians use the most nasal steroids and LTAs. They use prescription antihistamines moderately. They may be recommending over-the-counter loratadine, which would not appear in claims data. This would be an important question to ask physicians in that quintile.
Other factors besides physician practice choices could be in play. The most obvious would be patient severity. If patients in quintile five were the most severely ill they might need both vaccine and medication. However quintiles 1 and 2 (the lowest cost quintiles) contain two national-level and one international-level expert in allergy and immunology. A priori one would expect them to attract and treat the most severe patients. In addition, the largest allergy group in analysis region has members in all five quintiles, with two of the most senior members in quintiles 1 and 2, and the third senior member in quintile 5.
In summary, the results of the medical practice pattern tool analysis suggest that the most cost-effective allergists test and counsel somewhat more, and use nasal steroids (and perhaps OTC Loratadine) in preference to vaccines. The potential savings, if all physicians followed the quintile 1 practice pattern, are $160,000 per year.
It should be noted that because the service utilization and expected service utilization for each service is included in Table B2, the service utilization difference per episode may be calculated and the analysis may be completed comparing the service utilization difference per episode.
In an alternative embodiment, the analysis is carried out for a set of medical practitioners except that the strata are set up so that each stratum is one practitioner. The result is a comparison of the practice patterns of individuals rather than a comparison of a group of low cost practitioners and higher cost practitioners as described in the previous embodiment.
In a further alternative embodiment, all the conditions of a specialty (e.g. all the ETGs related to dermatology) are combined. In other words, the group of episodes of interest comprises all the episodes in all the dermatology ETGs. The strata are divided such that each stratum includes only one practitioner. The result is the general tendency of a given practitioner, revealing that a particular practitioner uses more or less E&M, procedures, etc. than expected for his specialty.
In an even further embodiment, the stratification of one condition (e.g. a particular ETG) is based on the characteristics of a separate condition. The analysis is then carried out on the cost variation in one condition as it relates to the other condition. For example, one carpal tunnel syndrome (CTS)-related ETG includes surgery and another is without surgery. If the two ETGs are combined, episodes of carpal tunnel treatment with surgery will overshadow episodes without surgery. In other words, the episodes with surgery are much more expensive than episodes without surgery; therefore, the episodes without surgery will very rarely have a sufficient effect to be included in the cost driver analysis and a driver that prevents surgery will likely be missed.
To reveal these cost drivers, the MPPT analysis 100 is carried out on each of the two CTS ETGs separately through step 216 to result in the practitioner stratum tables (output 217) for both ETGs. The system then compares the practitioner stratum tables to reveal each practitioner's rate of carpal tunnel treatment with surgery episodes versus treatment without surgery. The analysis is completed on the ETG for carpal tunnel without surgery by stratifying the practitioners by this surgery rate. The resulting cost differences may reveal a way to avoid surgery, such as steroid injections. The differences may also reveal that a service is a waste of money, for example if steroid injections had no effect on lowering the surgery rate.
There is a similar issue with the treatment of bronchitis. The episodes that start with bronchitis but lead to pneumonia will only appear in the pneumonia episodes. Therefore, similarly to the carpal tunnel example, an alternative stratification method is needed. In this case, the practitioners for the bronchitis ETG are separated into two strata: one with episodes that led to pneumonia and one with episodes that did not lead to pneumonia. The MPPT analysis is then carried out comparing the two strata and potentially revealing a service that reduces the likelihood that a bronchitis episode will result in pneumonia.
While the invention has been described with reference to particular embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the scope of the invention. Therefore, it is intended that the invention not be limited to the particular embodiments disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope and spirit of the appended claims.

















TABLE A1







CLAIM_ID
MEM_ID
SVC_PV
service date
SVC_EXP1
SVC_EXP2
CPT
CPT_MOD
DX_1
DX_2
PV_TYPE





56
855VM1YAM 00
CCP010000009
06-Oct-2003
$66
$66
17110

238.2
078.10
MD


57
855VM1YAM 00
CCP010000009
06-Oct-2003
$130
$130
99243
25
238.2
078.10
MD


58
855VM1YAM 00
CCP010000000
12-Sep-2003
$56
$56
99213

216.9
244.9
MD


59
855VM1YAM 00
CCP010000032
11-Nov-2003
$140
$140
11440

238.2

MD


60
855VM1YAM 00
CCP010000000
11-Nov-2003
$31
$31
88305
90
216.9

IL


61
8RO29B9A4 02
CCP010000023
25-Sep-2003
$77
$77
11402
51
216.9

MD


62
8RO29B9A4 02
CCP010000023
25-Sep-2003
$77
$77
11402
51
216.9

MD


63
8RO29B9A4 02
CCP010000023
25-Sep-2003
$165
$165
11403

216.9

MD


64
8RO29B9A4 02
CCP010000000
25-Sep-2003
$92
$92
88305
90
238.2

IL


65
8RO29B9A4 02
CCP010000023
02-Sep-2003
$86
$86
99242

216.9

MD


66
94PY71739 01
CCP010000023
21-Mar-2003
$84
$84
11311

702.11

MD


67
94PY71739 01
CCP010000023
07-Mar-2003
$58
$58
17110

702.11

MD


68
94PY71739 01
CCP010000000
21-Mar-2003
$31
$31
88305
90
216.3

IL


69
94PY71739 01
CCP010000023
25-Apr-2003
$20
$20
99211

216.9

MD


70
94PY71739 01
CCP010000023
07-Mar-2003
$86
$86
99242
25
702.11

MD

























Responsible






Episode


CLAIM_ID
etgno
epino
REC_TYPE
Flag
SVC_EXP3
quantity
visit_type
runid
servicein2
PV_ID
DATEFROM





56
0682
1067490
S
.0000
$66
1

2.0000
X1700
P010000009
12-Sep-2003


57
0682
1067490
M
.0000
$130
1
C
2.0000
99243
P010000009
12-Sep-2003


58
0682
1067490
M
.0000
$56
1
F
2.0000
99213
P010000000
12-Sep-2003


59
0682
1067490
S
.0000
$140
1

2.0000
11440
P010000032
12-Sep-2003


60
0682
1067490
A
1.0000
$31
1

2.0000
88305
P010000032
12-Sep-2003


61
0682
4631697
S
.0000
$77
1

4.0000
11402
P010000023
02-Sep-2003


62
0682
4631697
S
.0000
$77
1

4.0000
11402
P010000023
02-Sep-2003


63
0682
4631697
S
.0000
$165
1

4.0000
11403
P010000023
02-Sep-2003


64
0682
4631697
A
1.0000
$31
3

4.0000
88305
P010000023
02-Sep-2003


65
0682
4631697
M
.0000
$86
1
C
4.0000
99242
P010000023
02-Sep-2003


66
0682
6782814
S
.0000
$84
1

5.0000
11311
P010000023
07-Mar-2003


67
0682
6782814
S
.0000
$58
1

5.0000
X1700
P010000023
07-Mar-2003


68
0682
6782814
A
1.0000
$31
1

5.0000
88305
P010000023
07-Mar-2003


69
0682
6782814
M
.0000
$20
1
F
5.0000
99211
P010000023
07-Mar-2003


70
0682
6782814
M
.0000
$86
1
C
5.0000
99242
P010000023
07-Mar-2003



















Episode








CLAIM_ID
DATETHRU
DX_BEGIN
TOT_COST
CPT_ORIG
SVC_GRP
SVC_SET






56
11-Nov-2003
216.9
$423
X1700
17110
17110



57
11-Nov-2003
216.9
$423
99243
99243
99243



58
11-Nov-2003
216.9
$423
99213
99213
99213



59
11-Nov-2003
216.9
$423
11440
11440
11440



60
11-Nov-2003
216.9
$423
88305
88305
88305



61
25-Sep-2003
216.9
$497
11402
11402
11402



62
25-Sep-2003
216.9
$497
11402
11402
11402



63
25-Sep-2003
216.9
$497
11403
11403
11403



64
25-Sep-2003
216.9
$497
88305
88305
88305



65
25-Sep-2003
216.9
$497
99242
99242
99242



66
25-Apr-2003
702.11
$279
11311
11311
11311



67
25-Apr-2003
702.11
$279
X1700
17110
17110



68
25-Apr-2003
702.11
$279
88305
88305
88305



69
25-Apr-2003
702.11
$279
99211
99211
99211



70
25-Apr-2003
702.11
$279
99242
99242
99242


























TABLE A2







CLAIM_ID
MEM_ID
SVC_PV
from date
SVC_EXP1
SVC_EXP2
CPT
CPT_MOD
DX_1
DX_2
PV_TYPE





56
855VM1YAM 00
CCP010000009
06-Oct-2003
$66
$66
17110

238.2
078.10
MD


57
855VM1YAM 00
CCP010000009
06-Oct-2003
$130
$130
99243
25
238.2
078.10
MD


58
855VM1YAM 00
CCP010000000
12-Sep-2003
$56
$56
99213

216.9
244.9
MD


59
855VM1YAM 00
CCP010000032
11-Nov-2003
$140
$140
11440

238.2

MD


60
855VM1YAM 00
CCP010000000
11-Nov-2003
$31
$31
88305
90
216.9

IL


56
855VM1YAM 00
CCP010000009
06-Oct-2003
$66
$66
17110

238.2
078.10
MD


57
855VM1YAM 00
CCP010000009
06-Oct-2003
$130
$130
99243
25
238.2
078.10
MD


58
855VM1YAM 00
CCP010000000
12-Sep-2003
$56
$56
99213

216.9
244.9
MD


59
855VM1YAM 00
CCP010000032
11-Nov-2003
$140
$140
11440

238.2

MD


60
855VM1YAM 00
CCP010000000
11-Nov-2003
$31
$31
88305
90
216.9

IL


61
8RO29B9A4 02
CCP010000023
25-Sep-2003
$77
$77
11402
51
216.9

MD


62
8RO29B9A4 02
CCP010000023
25-Sep-2003
$77
$77
11402
51
216.9

MD


63
8RO29B9A4 02
CCP010000023
25-Sep-2003
$165
$165
11403

216.9

MD


64
8RO29B9A4 02
CCP010000000
25-Sep-2003
$92
$92
88305
90
238.2

IL


65
8RO29B9A4 02
CCP010000023
02-Sep-2003
$86
$86
99242

216.9

MD


66
94PY71739 01
CCP010000023
21-Mar-2003
$84
$84
11311

702.11

MD


67
94PY71739 01
CCP010000023
07-Mar-2003
$58
$58
17110

702.11

MD


68
94PY71739 01
CCP010000000
21-Mar-2003
$31
$31
88305
90
216.3

IL


69
94PY71739 01
CCP010000023
25-Apr-2003
$20
$20
99211

216.9

MD


70
94PY71739 01
CCP010000023
07-Mar-2003
$86
$86
99242
25
702.11

MD





















CLAIM_ID
etgno
epino
REC_TYPE
RESPFLAG
SVC_EXP3
quantity
visit_type
runid
servicein2
PV_ID
DATEFROM





56
0682
1067490
S
.0000
$66
1

2.0000
X1700
P010000009
12-Sep-2003


57
0682
1067490
M
.0000
$130
1
C
2.0000
99243
P010000009
12-Sep-2003


58
0682
1067490
M
.0000
$56
1
F
2.0000
99213
P010000000
12-Sep-2003


59
0682
1067490
S
.0000
$140
1

2.0000
11440
P010000032
12-Sep-2003


60
0682
1067490
A
1.0000
$31
1

2.0000
88305
P010000032
12-Sep-2003


56
0682
1067490
S
.0000
$66
1

2.0000
X1700
P010000009
12-Sep-2003


57
0682
1067490
M
.0000
$130
1
C
2.0000
99243
P010000009
12-Sep-2003


58
0682
1067490
M
.0000
$56
1
F
2.0000
99213
P010000000
12-Sep-2003


59
0682
1067490
S
.0000
$140
1

2.0000
11440
P010000032
12-Sep-2003


60
0682
1067490
A
1.0000
$31
1

2.0000
88305
P010000032
12-Sep-2003


61
0682
4631697
S
.0000
$77
1

4.0000
11402
P010000023
02-Sep-2003


62
0682
4631697
S
.0000
$77
1

4.0000
11402
P010000023
02-Sep-2003


63
0682
4631697
S
.0000
$165
1

4.0000
11403
P010000023
02-Sep-2003


64
0682
4631697
A
1.0000
$31
3

4.0000
88305
P010000023
02-Sep-2003


65
0682
4631697
M
.0000
$86
1
C
4.0000
99242
P010000023
02-Sep-2003


66
0682
6782814
S
.0000
$84
1

5.0000
11311
P010000023
07-Mar-2003


67
0682
6782814
S
.0000
$58
1

5.0000
X1700
P010000023
07-Mar-2003


68
0682
6782814
A
1.0000
$31
1

5.0000
88305
P010000023
07-Mar-2003


69
0682
6782814
M
.0000
$20
1
F
5.0000
99211
P010000023
07-Mar-2003


70
0682
6782814
M
.0000
$86
1
C
5.0000
99242
P010000023
07-Mar-2003



















CLAIM_ID
DATETHRU
DX_BEGIN
TOT_COST
CPT_ORIG
SVC_GRP
SVC_SET
TOTAL_ROLE_ID






56
11-Nov-2003
216.9
$423
X1700
17110
17110
CCP010000009



57
11-Nov-2003
216.9
$423
99243
99243
99243
CCP010000009



58
11-Nov-2003
216.9
$423
99213
99213
99213
CCP010000009



59
11-Nov-2003
216.9
$423
11440
11440
11440
CCP010000009



60
11-Nov-2003
216.9
$423
88305
88305
88305
CCP010000009



56
11-Nov-2003
216.9
$423
X1700
17110
17110
CCP010000032



57
11-Nov-2003
216.9
$423
99243
99243
99243
CCP010000032



58
11-Nov-2003
216.9
$423
99213
99213
99213
CCP010000032



59
11-Nov-2003
216.9
$423
11440
11440
11440
CCP010000032



60
11-Nov-2003
216.9
$423
88305
88305
88305
CCP010000032



61
25-Sep-2003
216.9
$497
11402
11402
11402
CCP010000023



62
25-Sep-2003
216.9
$497
11402
11402
11402
CCP010000023



63
25-Sep-2003
216.9
$497
11403
11403
11403
CCP010000023



64
25-Sep-2003
216.9
$497
88305
88305
88305
CCP010000023



65
25-Sep-2003
216.9
$497
99242
99242
99242
CCP010000023



66
25-Apr-2003
702.11
$279
11311
11311
11311
CCP010000023



67
25-Apr-2003
702.11
$279
X1700
17110
17110
CCP010000023



68
25-Apr-2003
702.11
$279
88305
88305
88305
CCP010000023



69
25-Apr-2003
702.11
$279
99211
99211
99211
CCP010000023



70
25-Apr-2003
702.11
$279
99242
99242
99242
CCP010000023
















TABLE A3







Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic keratoses diagnosis 702.xx


etg 0682



















etg of
total

etg of interest








interest
episodes
percent of
doctor
etg of interest
responsible
total episode





episode
across all
total
responsible
doctor total
dollars per
dollars per


Doctor

total role id
count
etg's
episodes
dollars
episode dollars
episode
episode



















NAME
28
CCP010000028
11
136
8.1%
$1,202
$1,416
$109
$129


NAME
34
CCP010000034
13
111
11.7%
$1,534
$1,801
$118
$139


NAME
20
CCP010000020
16
104
15.4%
$2,114
$2,759
$132
$172


NAME
33
CCP010000033
17
41
41.5%
$3,461
$4,229
$204
$249


NAME
31
CCP010000031
18
119
15.1%
$2,210
$2,714
$123
$151


NAME
8
CCP010000008
48
194
24.7%
$8,918
$11,901
$186
$248


NAME
22
CCP010000022
53
343
15.5%
$6,029
$7,665
$114
$145


NAME
37
CCP010000037
114
468
24.4%
$13,755
$16,936
$121
$149


NAME
1
CCP010000001
124
548
22.6%
$12,875
$15,931
$104
$128


NAME
35
CCP010000035
164
534
30.7%
$23,619
$26,740
$144
$163


NAME
6
CCP010000006
196
1,159
16.9%
$23,183
$28,251
$118
$144


NAME
36
CCP010000036
239
1,277
18.7%
$26,827
$33,072
$112
$138


NAME
2
CCP010000002
252
745
33.8%
$24,030
$25,788
$95
$102


NAME
27
CCP010000027
282
1,497
18.8%
$42,615
$45,645
$151
$162


NAME
7
CCP010000007
285
1,342
21.2%
$57,853
$59,968
$203
$210


NAME
24
CCP010000024
357
1,638
21.8%
$51,656
$55,213
$145
$155


NAME
26
CCP010000026
441
2,643
16.7%
$52,503
$59,788
$119
$136


NAME
4
CCP010000004
448
1,328
33.7%
$51,131
$53,399
$114
$119


NAME
13
CCP010000013
478
2,878
16.6%
$89,603
$99,854
$187
$209


NAME
5
CCP010000005
512
2,728
18.8%
$72,851
$81,939
$142
$160


NAME
30
CCP010000030
516
1,685
30.6%
$72,469
$82,939
$140
$161


NAME
23
CCP010000023
541
2,063
26.2%
$109,318
$112,946
$202
$209


NAME
3
CCP010000003
597
1,184
50.4%
$55,838
$59,244
$94
$99


NAME
32
CCP010000032
617
2,590
23.8%
$107,442
$121,776
$174
$197


NAME
29
CCP010000029
711
2,416
29.4%
$88,267
$99,224
$124
$140


NAME
25
CCP010000025
731
2,348
31.1%
$120,207
$125,768
$164
$172


NAME
19
CCP010000019
817
3,774
21.6%
$117,096
$122,392
$143
$150


NAME
11
CCP010000011
843
2,237
37.7%
$85,965
$94,409
$102
$112


NAME
16
CCP010000016
855
2,318
36.9%
$124,612
$132,612
$146
$155


NAME
18
CCP010000018
881
4,108
21.4%
$105,119
$116,862
$119
$133


NAME
14
CCP010000014
939
2,540
37.0%
$165,757
$173,593
$177
$185


NAME
21
CCP010000021
1,162
2,689
43.2%
$116,606
$124,819
$100
$107


NAME
15
CCP010000015
1,280
3,141
40.8%
$100,439
$110,545
$78
$86


NAME
9
CCP010000009
1,692
4,870
34.7%
$224,567
$255,154
$133
$151


NAME
12
CCP010000012
1,738
4,776
36.4%
$181,431
$190,528
$104
$110


NAME
10
CCP010000010
1,795
5,045
35.6%
$255,935
$264,955
$143
$148


NAME
17
CCP010000017
2,575
5,796
44.4%
$376,755
$387,526
$146
$150
















TABLE A4







Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic keratoses diagnosis 702.xx


etg 0682



















etg of











interest
etg of interest
etg of interest
responsible
total episode







episode
doctor responsible
doctor total episode
dollars per
dollars per
cost



Doctor

total role id
count
dollars
dollars
episode
episode
rank
quartile



















NAME
15
CCP010000015
1,280
$100,439
$110,545
$78
$86
1
Q1


NAME
3
CCP010000003
597
$55,838
$59,244
$94
$99
2
Q1


NAME
2
CCP010000002
252
$24,030
$25,788
$95
$102
3
Q1


NAME
21
CCP010000021
1,162
$116,606
$124,819
$100
$107
4
Q1


NAME
12
CCP010000012
1,738
$181,431
$190,528
$104
$110
5
Q1


NAME
11
CCP010000011
843
$85,965
$94,409
$102
$112
6
Q1


NAME
4
CCP010000004
448
$51,131
$53,399
$114
$119
7
Q1


NAME
1
CCP010000001
124
$12,875
$15,931
$104
$128
8
Q1


NAME
28
CCP010000028
11
$1,202
$1,416
$109
$129
9
Q1









Q1 Count 9
















NAME
18
CCP010000018
881
$105,119
$116,862
$119
$133
10
Q2


NAME
26
CCP010000026
441
$52,503
$59,788
$119
$136
11
Q2


NAME
36
CCP010000036
239
$26,827
$33,072
$112
$138
12
Q2


NAME
34
CCP010000034
13
$1,534
$1,801
$118
$139
13
Q2


NAME
29
CCP010000029
711
$88,267
$99,224
$124
$140
14
Q2


NAME
6
CCP010000006
196
$23,183
$28,251
$118
$144
15
Q2


NAME
22
CCP010000022
53
$6,029
$7,665
$114
$145
16
Q2


NAME
10
CCP010000010
1,795
$255,935
$264,955
$143
$148
17
Q2


NAME
37
CCP010000037
114
$13,755
$16,936
$121
$149
18
Q2









Q2 Count 9
















NAME
19
CCP010000019
817
$117,096
$122,392
$143
$150
19
Q3


NAME
17
CCP010000017
2,575
$376,755
$387,526
$146
$150
20
Q3


NAME
31
CCP010000031
18
$2,210
$2,714
$123
$151
21
Q3


NAME
9
CCP010000009
1,692
$224,567
$255,154
$133
$151
22
Q3


NAME
24
CCP010000024
357
$51,656
$55,213
$145
$155
23
Q3


NAME
16
CCP010000016
855
$124,612
$132,612
$146
$155
24
Q3


NAME
5
CCP010000005
512
$72,851
$81,939
$142
$160
25
Q3


NAME
30
CCP010000030
516
$72,469
$82,939
$140
$161
26
Q3


NAME
27
CCP010000027
282
$42,615
$45,645
$151
$162
27
Q3


NAME
35
CCP010000035
164
$23,619
$26,740
$144
$163
28
Q3









Q3 Count 10
















NAME
25
CCP010000025
731
$120,207
$125,768
$164
$172
29
Q4


NAME
20
CCP010000020
16
$2,114
$2,759
$132
$172
30
Q4


NAME
14
CCP010000014
939
$165,757
$173,593
$177
$185
31
Q4


NAME
32
CCP010000032
617
$107,442
$121,776
$174
$197
32
Q4


NAME
23
CCP010000023
541
$109,318
$112,946
$202
$209
33
Q4


NAME
13
CCP010000013
478
$89,603
$99,854
$187
$209
34
Q4


NAME
7
CCP010000007
285
$57,853
$59,968
$203
$210
35
Q4


NAME
8
CCP010000008
48
$8,918
$11,901
$186
$248
36
Q4


NAME
33
CCP010000033
17
$3,461
$4,229
$204
$249
37
Q4











22,358

Q4 Count 9





Grand Count 37
















TABLE A5







Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic


keratoses diagnosis 702.xx etg 0682


(5 or more episodes)











quartile




episode


Quartile
etg brief name
count












Q1
benign_lesions_without_actinic keratoses
6,455


Q2
benign_lesions_without_actinic keratoses
4,443


Q3
benign_lesions_without_actinic keratoses
7,788


Q4
benign_lesions_without_actinic keratoses
3,672










Total of quartile, doctor, episode level
22,358
















TABLE A6







Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic keratoses diagnosis 702.xx


etg 0682













begin






quar-
diag-
episode
diagnosis




tile
nosis
count
expense
medium
long















Q1
214.1
1
$387
LIPOMA OTH SKIN/SUBQ TISSUE
LIPOMA OF OTHER SKIN AND SUBCUTANEOUS TISSUE


Q1
214.9
2
$480
LIPOMA UNS SITE
LIPOMA UNSPECIFIED SITE


Q1
215.9
1
$76
OTH BENIGN NEO CONNEC SOFT TISS
OTHER BENIGN NEOPLASM OF CONNECTIVE AND






UNS
OTHER SOFT TISSUE SITE


Q1
216.0
17
$2,650
BENIGN NEO SKIN LIP
BENIGN NEOPLASM OF SKIN OF LIP


Q1
216.1
22
$3,492
BENIGN NEO EYELID INC CANTHUS
BENIGN NEOPLASM OF EYELID INCLUDING CANTHUS


Q1
216.2
16
$2,131
BENIGN NEO EAR SKIN
BENIGN NEOPLASM OF EAR AND EXTERNAL







AUDITORY CANAL


Q1
216.3
260
$35,232
BENIGN NEO SKIN OTH/UNS PARTS
BENIGN NEOPLASM OF SKIN OF OTHER AND






FACE
UNSPECIFIED PARTS OF FACE


Q1
216.4
177
$21,392
BENIGN NEO SCALP/SKIN NECK
BENIGN NEOPLASM OF SCALP AND SKIN OF NECK


Q1
216.5
565
$78,097
BENIGN NEO SKIN TRUNK EX SCROTUM
BENIGN NEOPLASM OF SKIN OF







TRUNK EXCEPT SCROTUM


Q1
216.6
164
$23,016
BEN NEO SKIN UPPER LIMB
BENIGN NEOPLASM OF SKIN OF UPPER LIMB







INCLUDING SHOULDER


Q1
216.7
172
$22,699
BENIGN NEO SKIN LOWER LIMB INC HIP
BENIGN NEOPLASM OF SKIN OF LOWER







LIMB INCLUDING HIP


Q1
216.8
16
$2,917
BENIGN NEO OTHER SITES SKIN
BENIGN NEOPLASM OF OTHER SPECIFIED







SITES OF SKIN


Q1
216.9
652
$69,688
BENIGN NEO SKIN SITE UNS
BENIGN NEOPLASM OF SKIN SITE UNSPECIFIED


Q1
228.01
6
$884
HEMANGIOMA SKIN/SUBQ TISSUE
HEMANGIOMA OF SKIN AND SUBCUTANEOUS TISSUE


Q1
228.1
1
$130
LYMPHANGIOMA ANY SITE
LYMPHANGIOMA ANY SITE


Q1
238.2
4,334
$406,694
UNCERT BEHAVIOR NEO SKIN
NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN


Q1
239.2
1
$56
BONE/SKIN UNSP BEHAVIOR NEO
NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT







TISSUE AND SKIN


Q1
448.1
34
$6,058
NEVUS NON-NEOPLASTIC
NEVUS NON-NEOPLASTIC


Q2
214.0
2
$265
LIPOMA SKIN/SUBQ TISSUE FACE
LIPOMA OF SKIN AND SUBCUTANEOUS







TISSUE OF FACE


Q2
214.1
7
$1,148
LIPOMA OTH SKIN/SUBQ TISSUE
LIPOMA OF OTHER SKIN AND SUBCUTANEOUS TISSUE


Q2
215.8
3
$292
OTH BEN NEO CONNEC SOFT TISSUE OT
OTHER BENIGN NEOPLASM OF CONNECTIVE AND







OTHER SOFT TISSUE OF OTHER SPECIFIED SITES


Q2
215.9
1
$112
OTH BENIGN NEO CONNEC SOFT
OTHER BENIGN NEOPLASM OF CONNECTIVE AND






TISS UNS
OTHER SOFT TISSUE SITE UNSPECIFIED


Q2
216.0
14
$1,862
BENIGN NEO SKIN LIP
BENIGN NEOPLASM OF SKIN OF LIP


Q2
216.1
9
$1,653
BENIGN NEO EYELID INC CANTHUS
BENIGN NEOPLASM OF EYELID INCLUDING CANTHUS


Q2
216.2
4
$465
BENIGN NEO EAR SKIN
BENIGN NEOPLASM OF EAR AND EXTERNAL







AUDITORY CANAL


Q2
216.3
179
$26,569
BENIGN NEO SKIN OTH/UNS PARTS
BENIGN NEOPLASM OF SKIN OF OTHER AND






FACE
UNSPECIFIED PARTS OF FACE


Q2
216.4
123
$18,970
BENIGN NEO SCALP/SKIN NECK
BENIGN NEOPLASM OF SCALP AND SKIN OF NECK


Q2
216.5
284
$44,678
BENIGN NEO SKIN TRUNK EX SCROTUM
BENIGN NEOPLASM OF SKIN OF TRUNK







EXCEPT SCROTUM


Q2
216.6
107
$15,845
BEN NEO SKIN UPPER LIMB
BENIGN NEOPLASM OF SKIN OF UPPER LIMB







INCLUDING SHOULDER


Q2
216.7
103
$14,578
BENIGN NEO SKIN LOWER LIMB INC HIP
BENIGN NEOPLASM OF SKIN OF LOWER LIMB







INCLUDING HIP


Q2
216.8
56
$7,571
BENIGN NEO OTHER SITES SKIN
BENIGN NEOPLASM OF OTHER SPECIFIED







SITES OF SKIN


Q2
216.9
816
$115,075
BENIGN NEO SKIN SITE UNS
BENIGN NEOPLASM OF SKIN SITE UNSPECIFIED


Q2
228.01
37
$4,636
HEMANGIOMA SKIN/SUBQ TISSUE
HEMANGIOMA OF SKIN AND SUBCUTANEOUS TISSUE


Q2
228.1
1
$171
LYMPHANGIOMA ANY SITE
LYMPHANGIOMA ANY SITE


Q2
238.2
2,606
$360,120
UNCERT BEHAVIOR NEO SKIN
NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN


Q2
239.2
3
$837
BONE/SKIN UNSP BEHAVIOR NEO
NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT







TISSUE AND SKIN


Q2
448.1
72
$13,707
NEVUS NON-NEOPLASTIC
NEVUS NON-NEOPLASTIC


Q3
210.0
3
$486
BENIGN NEO LIP
BENIGN NEOPLASM OF LIP


Q3
214.0
5
$1,124
LIPOMA SKIN/SUBQ TISSUE FACE
LIPOMA OF SKIN AND SUBCUTANEOUS







TISSUE OF FACE


Q3
214.1
13
$2,875
LIPOMA OTH SKIN/SUBQ TISSUE
LIPOMA OF OTHER SKIN AND SUBCUTANEOUS TISSUE


Q3
214.8
2
$320
LIPOMA OTHER SITES
LIPOMA OF OTHER SPECIFIED SITES


Q3
214.9
9
$1,618
LIPOMA UNS SITE
LIPOMA UNSPECIFIED SITE


Q3
215.8
1
$71
OTH BEN NEO CONNEC SOFT TISSUE OT
OTHER BENIGN NEOPLASM OF CONNECTIVE AND







OTHER SOFT TISSUE OF OTHER SPECIFIED SITES


Q3
215.9
2
$180
OTH BENIGN NEO CONNEC SOFT TISS
OTHER BENIGN NEOPLASM OF CONNECTIVE AND






UNS
OTHER SOFT TISSUE SITE


Q3
216.
1
$372
BENIGN NEOPLASM OF SKIN
BENIGN NEOPLASM OF SKIN


Q3
216.0
9
$1,376
BENIGN NEO SKIN LIP
BENIGN NEOPLASM OF SKIN OF LIP


Q3
216.1
16
$3,892
BENIGN NEO EYELID INC CANTHUS
BENIGN NEOPLASM OF EYELID INCLUDING CANTHUS


Q3
216.2
13
$2,583
BENIGN NEO EAR SKIN
BENIGN NEOPLASM OF EAR AND EXTERNAL







AUDITORY CANAL


Q3
216.3
325
$50,703
BENIGN NEO SKIN OTH/UNS PARTS
BENIGN NEOPLASM OF SKIN OF OTHER AND






FACE
UNSPECIFIED PARTS OF FACE


Q3
216.4
111
$22,575
BENIGN NEO SCALP/SKIN NECK
BENIGN NEOPLASM OF SCALP AND SKIN OF NECK


Q3
216.5
438
$74,330
BENIGN NEO SKIN TRUNK EX SCROTUM
BENIGN NEOPLASM OF SKIN OF TRUNK







EXCEPT SCROTUM


Q3
216.6
73
$13,441
BEN NEO SKIN UPPER LIMB
BENIGN NEOPLASM OF SKIN OF UPPER LIMB







INCLUDING SHOULDER


Q3
216.7
99
$18,208
BENIGN NEO SKIN LOWER LIMB INC HIP
BENIGN NEOPLASM OF SKIN OF LOWER







LIMB INCLUDING HIP


Q3
216.8
28
$4,922
BENIGN NEO OTHER SITES SKIN
BENIGN NEOPLASM OF OTHER SPECIFIED







SITES OF SKIN


Q3
216.9
1,473
$218,510
BENIGN NEO SKIN SITE UNS
BENIGN NEOPLASM OF SKIN SITE UNSPECIFIED


Q3
228.01
96
$17,043
HEMANGIOMA SKIN/SUBQ TISSUE
HEMANGIOMA OF SKIN AND SUBCUTANEOUS TISSUE


Q3
228.1
1
$260
LYMPHANGIOMA ANY SITE
LYMPHANGIOMA ANY SITE


Q3
238.2
4,980
$741,410
UNCERT BEHAVIOR NEO SKIN
NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN


Q3
239.2
4
$783
BONE/SKIN UNSP BEHAVIOR NEO
NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT







TISSUE AND SKIN


Q3
448.1
80
$15,792
NEVUS NON-NEOPLASTIC
NEVUS NON-NEOPLASTIC


Q4
210.0
1
$129
BENIGN NEO LIP
BENIGN NEOPLASM OF LIP


Q4
214.0
2
$295
LIPOMA SKIN/SUBQ TISSUE FACE
LIPOMA OF SKIN AND SUBCUTANEOUS







TISSUE OF FACE


Q4
214.1
3
$620
LIPOMA OTH SKIN/SUBQ TISSUE
LIPOMA OF OTHER SKIN AND SUBCUTANEOUS TISSUE


Q4
214.9
2
$473
LIPOMA UNS SITE
LIPOMA UNSPECIFIED SITE


Q4
215.8
8
$1,739
OTH BEN NEO CONNEC SOFT TISSUE OT
OTHER BENIGN NEOPLASM OF CONNECTIVE AND







OTHER SOFT TISSUE OF OTHER SPECIFIED SITES


Q4
215.9
7
$1,477
OTH BENIGN NEO CONNEC SOFT TISS
OTHER BENIGN NEOPLASM OF CONNECTIVE AND






UNS
OTHER SOFT TISSUE SITE


Q4
216.0
6
$1,310
BENIGN NEO SKIN LIP
BENIGN NEOPLASM OF SKIN OF LIP


Q4
216.1
10
$2,452
BENIGN NEO EYELID INC CANTHUS
BENIGN NEOPLASM OF EYELID INCLUDING CANTHUS


Q4
216.2
10
$1,757
BENIGN NEO EAR SKIN
BENIGN NEOPLASM OF EAR AND EXTERNAL







AUDITORY CANAL


Q4
216.3
106
$25,030
BENIGN NEO SKIN OTH/UNS PARTS
BENIGN NEOPLASM OF SKIN OF OTHER AND






FACE
UNSPECIFIED PARTS OF FACE


Q4
216.4
60
$13,613
BENIGN NEO SCALP/SKIN NECK
BENIGN NEOPLASM OF SCALP AND SKIN OF NECK


Q4
216.5
382
$74,703
BENIGN NEO SKIN TRUNK EX SCROTUM
BENIGN NEOPLASM OF SKIN OF TRUNK







EXCEPT SCROTUM


Q4
216.6
58
$10,812
BEN NEO SKIN UPPER LIMB
BENIGN NEOPLASM OF SKIN OF UPPER LIMB







INCLUDING SHOULDER


Q4
216.7
59
$11,764
BENIGN NEO SKIN LOWER LIMB INC HIP
BENIGN NEOPLASM OF SKIN OF LOWER LIMB







INCLUDING HIP


Q4
216.8
82
$17,728
BENIGN NEO OTHER SITES SKIN
BENIGN NEOPLASM OF OTHER SPECIFIED







SITES OF SKIN


Q4
216.9
1,246
$244,793
BENIGN NEO SKIN SITE UNS
BENIGN NEOPLASM OF SKIN SITE UNSPECIFIED


Q4
228.01
89
$15,747
HEMANGIOMA SKIN/SUBQ TISSUE
HEMANGIOMA OF SKIN AND SUBCUTANEOUS TISSUE


Q4
228.1
3
$977
LYMPHANGIOMA ANY SITE
LYMPHANGIOMA ANY SITE


Q4
238.2
1,403
$259,521
UNCERT BEHAVIOR NEO SKIN
NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN


Q4
239.2
3
$554
BONE/SKIN UNSP BEHAVIOR NEO
NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT







TISSUE AND SKIN


Q4
448.1
128
$27,300
NEVUS NON-NEOPLASTIC
NEVUS NON-NEOPLASTIC

























TABLE A7







specialty





total role
total role




total role
specialty
specialty


strata
expected
expected




episode
total role
total role
specialty
specialty
sum
expense
services



service
occurred in
average
average
total role
total role
episode
per
per


PAIRED_ETGNO
group
count
expense
services
expense
services
count
episode
episode
























benign_lesions_without_actinic keratoses
00300
2
$290.00
1
$580
2
22,358
$0.0259
.00008945


benign_lesions_without_actinic keratoses
00400
1
$225.00
1
$225
1
22,358
$0.0101
.00004473


benign_lesions_without_actinic keratoses
00820
1
$315.00
1
$315
1
22,358
$0.0141
.00004473


benign_lesions_without_actinic keratoses
0301
1
$39.00
1
$39
1
22,358
$0.0017
.00004473


benign_lesions_without_actinic keratoses
0320
1
$34.00
1
$34
1
22,358
$0.0015
.00004473


benign_lesions_without_actinic keratoses
0490
1
$336.00
6
$336
6
22,358
$0.0150
.00026836


benign_lesions_without_actinic keratoses
0551
1
$425.00
5
$425
5
22,358
$0.0190
.00022363


benign_lesions_without_actinic keratoses
0969
1
$8.00
2
$8
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
10022
1
$100.00
1
$100
1
22,358
$0.0045
.00004473


benign_lesions_without_actinic keratoses
11000
1
$53.00
1
$53
1
22,358
$0.0024
.00004473


benign_lesions_without_actinic keratoses
11042
2
$84.50
1
$169
2
22,358
$0.0076
.00008945


benign_lesions_without_actinic keratoses
11100
1,699
$89.42
1
$151,931
1,770
22,358
$6.7954
.07916629


benign_lesions_without_actinic keratoses
11101
423
$61.89
2
$26,181
636
22,358
$1.1710
.02844619


benign_lesions_without_actinic keratoses
11200
3
$50.00
1
$150
3
22,358
$0.0067
.00013418


benign_lesions_without_actinic keratoses
11201
1
$140.00
4
$140
4
22,358
$0.0063
.00017891


benign_lesions_without_actinic keratoses
11300
1,068
$67.39
2
$71,969
1,636
22,358
$3.2189
.07317291


benign_lesions_without_actinic keratoses
11301
1,858
$90.66
1
$168,438
2,724
22,358
$7.5337
.12183558


benign_lesions_without_actinic keratoses
11302
475
$96.64
1
$45,904
569
22,358
$2.0531
.02544950


benign_lesions_without_actinic keratoses
11303
27
$118.74
1
$3,206
32
22,358
$0.1434
.00143126


benign_lesions_without_actinic keratoses
11305
471
$64.23
2
$30,250
763
22,358
$1.3530
.03412649


benign_lesions_without_actinic keratoses
11306
513
$102.81
2
$52,741
832
22,358
$2.3589
.03721263


benign_lesions_without_actinic keratoses
11307
94
$95.78
1
$9,003
99
22,358
$0.4027
.00442795


benign_lesions_without_actinic keratoses
11308
11
$102.91
1
$1,132
11
22,358
$0.0506
.00049199


benign_lesions_without_actinic keratoses
11310
548
$78.14
1
$42,822
724
22,358
$1.9153
.03238215


benign_lesions_without_actinic keratoses
11311
561
$106.09
1
$59,519
758
22,358
$2.6621
.03390285


benign_lesions_without_actinic keratoses
11312
106
$109.69
1
$11,627
118
22,358
$0.5200
.00527775


benign_lesions_without_actinic keratoses
11313
3
$140.00
1
$420
3
22,358
$0.0188
.00013418


benign_lesions_without_actinic keratoses
11400
428
$111.47
1
$47,710
512
22,358
$2.1339
.02290008


benign_lesions_without_actinic keratoses
11401
745
$137.40
1
$102,362
966
22,358
$4.5783
.04320601


benign_lesions_without_actinic keratoses
11402
466
$156.19
1
$72,786
531
22,358
$3.2555
.02374989


benign_lesions_without_actinic keratoses
11403
106
$183.32
1
$19,432
119
22,358
$0.8691
.00532248


benign_lesions_without_actinic keratoses
11404
31
$215.26
1
$6,673
34
22,358
$0.2985
.00152071


benign_lesions_without_actinic keratoses
11406
12
$252.92
1
$3,035
13
22,358
$0.1357
.00058145


benign_lesions_without_actinic keratoses
11420
88
$111.85
1
$9,843
110
22,358
$0.4402
.00491994


benign_lesions_without_actinic keratoses
11421
111
$131.81
1
$14,631
122
22,358
$0.6544
.00545666


benign_lesions_without_actinic keratoses
11422
57
$157.56
1
$8,981
63
22,358
$0.4017
.00281778


benign_lesions_without_actinic keratoses
11423
21
$192.19
1
$4,036
23
22,358
$0.1805
.00102871


benign_lesions_without_actinic keratoses
11424
6
$222.17
1
$1,333
6
22,358
$0.0596
.00026836


benign_lesions_without_actinic keratoses
11426
2
$261.50
1
$523
2
22,358
$0.0234
.00008945


benign_lesions_without_actinic keratoses
11440
216
$148.58
1
$32,093
273
22,358
$1.4354
.01221039


benign_lesions_without_actinic keratoses
11441
136
$165.09
1
$22,452
152
22,358
$1.0042
.00679846


benign_lesions_without_actinic keratoses
11442
55
$178.07
1
$9,794
57
22,358
$0.4381
.00254942


benign_lesions_without_actinic keratoses
11443
13
$242.38
1
$3,151
15
22,358
$0.1409
.00067090


benign_lesions_without_actinic keratoses
11444
2
$293.50
1
$587
2
22,358
$0.0263
.00008945


benign_lesions_without_actinic keratoses
11446
1
$371.00
1
$371
1
22,358
$0.0166
.00004473


benign_lesions_without_actinic keratoses
11600
1
$160.00
1
$160
1
22,358
$0.0072
.00004473


benign_lesions_without_actinic keratoses
11602
3
$162.67
1
$488
3
22,358
$0.0218
.00013418


benign_lesions_without_actinic keratoses
11603
2
$162.00
1
$324
2
22,358
$0.0145
.00008945


benign_lesions_without_actinic keratoses
11604
1
$244.00
1
$244
1
22,358
$0.0109
.00004473


benign_lesions_without_actinic keratoses
11755
2
$59.50
1
$119
2
22,358
$0.0053
.00008945


benign_lesions_without_actinic keratoses
11900
21
$51.76
1
$1,087
23
22,358
$0.0486
.00102871


benign_lesions_without_actinic keratoses
11901
11
$54.36
1
$598
11
22,358
$0.0267
.00049199


benign_lesions_without_actinic keratoses
12031
104
$189.34
1
$19,691
116
22,358
$0.8807
.00518830


benign_lesions_without_actinic keratoses
12032
95
$227.11
1
$21,575
99
22,358
$0.9650
.00442795


benign_lesions_without_actinic keratoses
12051
12
$219.08
1
$2,629
12
22,358
$0.1176
.00053672


benign_lesions_without_actinic keratoses
13101
8
$319.25
1
$2,554
8
22,358
$0.1142
.00035781


benign_lesions_without_actinic keratoses
13131
2
$315.00
1
$630
2
22,358
$0.0282
.00008945


benign_lesions_without_actinic keratoses
17000
4,018
$68.66
1
$275,888
4,424
22,358
$12.3396
.19787101


benign_lesions_without_actinic keratoses
17003
2,635
$11.03
3
$29,069
7,268
22,358
$1.3002
.32507380


benign_lesions_without_actinic keratoses
17004
33
$62.36
1
$2,058
34
22,358
$0.0920
.00152071


benign_lesions_without_actinic keratoses
17106
14
$367.43
1
$5,144
14
22,358
$0.2301
.00062617


benign_lesions_without_actinic keratoses
17110
2,499
$59.61
1
$148,953
2,657
22,358
$6.6622
.11883889


benign_lesions_without_actinic keratoses
17111
20
$39.40
1
$788
20
22,358
$0.0352
.00089453


benign_lesions_without_actinic keratoses
17281
1
$144.00
1
$144
1
22,358
$0.0064
.00004473


benign_lesions_without_actinic keratoses
27327
1
$539.00
1
$539
1
22,358
$0.0241
.00004473


benign_lesions_without_actinic keratoses
30100
2
$94.50
1
$189
2
22,358
$0.0085
.00008945


benign_lesions_without_actinic keratoses
36415
1
$6.00
1
$6
1
22,358
$0.0003
.00004473


benign_lesions_without_actinic keratoses
40490
21
$123.14
1
$2,586
23
22,358
$0.1157
.00102871


benign_lesions_without_actinic keratoses
54050
4
$159.75
1
$639
5
22,358
$0.0286
.00022363


benign_lesions_without_actinic keratoses
54056
7
$160.14
1
$1,121
7
22,358
$0.0501
.00031309


benign_lesions_without_actinic keratoses
54060
1
$278.00
1
$278
1
22,358
$0.0124
.00004473


benign_lesions_without_actinic keratoses
54100
2
$194.00
1
$388
2
22,358
$0.0174
.00008945


benign_lesions_without_actinic keratoses
56605
8
$90.00
1
$720
8
22,358
$0.0322
.00035781


benign_lesions_without_actinic keratoses
67810
25
$190.44
1
$4,761
28
22,358
$0.2129
.00125235


benign_lesions_without_actinic keratoses
69100
14
$83.14
1
$1,164
14
22,358
$0.0521
.00062617


benign_lesions_without_actinic keratoses
76942
2
$98.50
1
$197
2
22,358
$0.0088
.00008945


benign_lesions_without_actinic keratoses
80002
4
$5.00
1
$20
4
22,358
$0.0009
.00017891


benign_lesions_without_actinic keratoses
80003
2
$5.00
1
$10
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
80004
1
$5.00
1
$5
1
22,358
$0.0002
.00004473


benign_lesions_without_actinic keratoses
80005
2
$5.00
1
$10
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
80012
1
$6.00
1
$6
1
22,358
$0.0003
.00004473


benign_lesions_without_actinic keratoses
80048
78
$3.29
1
$257
81
22,358
$0.0115
.00362286


benign_lesions_without_actinic keratoses
80050
27
$14.00
1
$378
27
22,358
$0.0169
.00120762


benign_lesions_without_actinic keratoses
80051
2
$4.00
1
$8
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
80053
119
$5.13
1
$610
122
22,358
$0.0273
.00545666


benign_lesions_without_actinic keratoses
80061
91
$8.09
1
$736
92
22,358
$0.0329
.00411486


benign_lesions_without_actinic keratoses
80299
3
$13.33
1
$40
4
22,358
$0.0018
.00017891


benign_lesions_without_actinic keratoses
81000
8
$5.38
1
$43
8
22,358
$0.0019
.00035781


benign_lesions_without_actinic keratoses
82040
4
$5.75
1
$23
4
22,358
$0.0010
.00017891


benign_lesions_without_actinic keratoses
82248
20
$2.15
1
$43
20
22,358
$0.0019
.00089453


benign_lesions_without_actinic keratoses
82270
39
$3.44
1
$134
41
22,358
$0.0060
.00183380


benign_lesions_without_actinic keratoses
82310
2
$4.00
1
$8
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
82565
12
$4.75
1
$57
13
22,358
$0.0025
.00058145


benign_lesions_without_actinic keratoses
82947
27
$2.26
1
$61
27
22,358
$0.0027
.00120762


benign_lesions_without_actinic keratoses
84075
2
$4.00
1
$8
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
84100
1
$8.00
1
$8
1
22,358
$0.0004
.00004473


benign_lesions_without_actinic keratoses
84155
2
$3.00
1
$6
2
22,358
$0.0003
.00008945


benign_lesions_without_actinic keratoses
84436
2
$4.00
1
$8
2
22,358
$0.0004
.00008945


benign_lesions_without_actinic keratoses
84439
11
$8.00
1
$88
11
22,358
$0.0039
.00049199


benign_lesions_without_actinic keratoses
84443
48
$7.00
1
$336
48
22,358
$0.0150
.00214688


benign_lesions_without_actinic keratoses
84450
23
$3.48
1
$80
24
22,358
$0.0036
.00107344


benign_lesions_without_actinic keratoses
84460
57
$4.54
1
$259
63
22,358
$0.0116
.00281778


benign_lesions_without_actinic keratoses
84478
6
$4.00
1
$24
8
22,358
$0.0011
.00035781


benign_lesions_without_actinic keratoses
84520
1
$3.00
1
$3
1
22,358
$0.0001
.00004473


benign_lesions_without_actinic keratoses
85013
3
$5.00
1
$15
3
22,358
$0.0007
.00013418


benign_lesions_without_actinic keratoses
85014
11
$2.18
1
$24
12
22,358
$0.0011
.00053672


benign_lesions_without_actinic keratoses
85018
1
$6.00
1
$6
1
22,358
$0.0003
.00004473


benign_lesions_without_actinic keratoses
85025
109
$3.57
1
$389
127
22,358
$0.0174
.00568029


benign_lesions_without_actinic keratoses
85027
74
$2.27
1
$168
76
22,358
$0.0075
.00339923


benign_lesions_without_actinic keratoses
85044
1
$6.00
2
$6
2
22,358
$0.0003
.00008945


benign_lesions_without_actinic keratoses
85045
1
$4.00
2
$4
2
22,358
$0.0002
.00008945


benign_lesions_without_actinic keratoses
85049
1
$2.00
1
$2
1
22,358
$0.0001
.00004473


benign_lesions_without_actinic keratoses
85610
18
$4.83
2
$87
29
22,358
$0.0039
.00129707


benign_lesions_without_actinic keratoses
85651
5
$2.00
1
$10
5
22,358
$0.0004
.00022363


benign_lesions_without_actinic keratoses
85652
4
$2.00
1
$8
4
22,358
$0.0004
.00017891


benign_lesions_without_actinic keratoses
85730
6
$3.00
1
$18
6
22,358
$0.0008
.00026836


benign_lesions_without_actinic keratoses
86140
5
$3.00
1
$15
5
22,358
$0.0007
.00022363


benign_lesions_without_actinic keratoses
86141
2
$10.00
1
$20
2
22,358
$0.0009
.00008945


benign_lesions_without_actinic keratoses
86580
2
$7.50
1
$15
2
22,358
$0.0007
.00008945


benign_lesions_without_actinic keratoses
86618
3
$12.00
1
$36
3
22,358
$0.0016
.00013418


benign_lesions_without_actinic keratoses
86644
3
$18.67
1
$56
4
22,358
$0.0025
.00017891


benign_lesions_without_actinic keratoses
86645
1
$28.00
2
$28
2
22,358
$0.0013
.00008945


benign_lesions_without_actinic keratoses
86777
1
$8.00
1
$8
1
22,358
$0.0004
.00004473


benign_lesions_without_actinic keratoses
86850
2
$19.50
1
$39
2
22,358
$0.0017
.00008945


benign_lesions_without_actinic keratoses
86900
2
$2.00
1
$4
2
22,358
$0.0002
.00008945


benign_lesions_without_actinic keratoses
86901
2
$2.00
1
$4
2
22,358
$0.0002
.00008945


benign_lesions_without_actinic keratoses
87101
6
$8.00
1
$48
6
22,358
$0.0021
.00026836


benign_lesions_without_actinic keratoses
87106
4
$4.00
1
$16
4
22,358
$0.0007
.00017891


benign_lesions_without_actinic keratoses
87340
1
$7.00
1
$7
1
22,358
$0.0003
.00004473


benign_lesions_without_actinic keratoses
87390
1
$8.00
1
$8
1
22,358
$0.0004
.00004473


benign_lesions_without_actinic keratoses
88106
1
$21.00
1
$21
1
22,358
$0.0009
.00004473


benign_lesions_without_actinic keratoses
88173
2
$39.50
2
$79
3
22,358
$0.0035
.00013418


benign_lesions_without_actinic keratoses
88304
77
$16.25
1
$1,251
83
22,358
$0.0560
.00371232


benign_lesions_without_actinic keratoses
88305
6,637
$50.11
2
$332,602
10,756
22,358
$14.8762
.48108060


benign_lesions_without_actinic keratoses
88307
2
$68.00
1
$136
2
22,358
$0.0061
.00008945


benign_lesions_without_actinic keratoses
88312
35
$28.37
2
$993
62
22,358
$0.0444
.00277306


benign_lesions_without_actinic keratoses
88321
13
$91.54
1
$1,190
14
22,358
$0.0532
.00062617


benign_lesions_without_actinic keratoses
88342
16
$296.63
2
$4,746
32
22,358
$0.2123
.00143126


benign_lesions_without_actinic keratoses
92002
1
$76.00
1
$76
1
22,358
$0.0034
.00004473


benign_lesions_without_actinic keratoses
92012
1
$68.00
1
$68
1
22,358
$0.0030
.00004473


benign_lesions_without_actinic keratoses
93000
17
$30.82
1
$524
17
22,358
$0.0234
.00076035


benign_lesions_without_actinic keratoses
93005
5
$51.60
1
$258
5
22,358
$0.0115
.00022363


benign_lesions_without_actinic keratoses
93010
5
$27.20
1
$136
5
22,358
$0.0061
.00022363


benign_lesions_without_actinic keratoses
93971
1
$154.00
1
$154
1
22,358
$0.0069
.00004473


benign_lesions_without_actinic keratoses
94010
1
$124.00
1
$124
1
22,358
$0.0055
.00004473


benign_lesions_without_actinic keratoses
94240
1
$125.00
1
$125
1
22,358
$0.0056
.00004473


benign_lesions_without_actinic keratoses
94720
2
$82.50
1
$165
2
22,358
$0.0074
.00008945


benign_lesions_without_actinic keratoses
95810
1
$295.00
1
$295
1
22,358
$0.0132
.00004473


benign_lesions_without_actinic keratoses
95816
1
$159.00
1
$159
1
22,358
$0.0071
.00004473


benign_lesions_without_actinic keratoses
95819
1
$116.00
1
$116
1
22,358
$0.0052
.00004473


benign_lesions_without_actinic keratoses
96910
1
$59.00
1
$59
1
22,358
$0.0026
.00004473


benign_lesions_without_actinic keratoses
99201
1
$38.00
1
$38
1
22,358
$0.0017
.00004473


benign_lesions_without_actinic keratoses
99202
93
$70.82
1
$6,586
99
22,358
$0.2946
.00442795


benign_lesions_without_actinic keratoses
99203
156
$108.70
1
$16,957
160
22,358
$0.7584
.00715628


benign_lesions_without_actinic keratoses
99204
11
$143.91
1
$1,583
11
22,358
$0.0708
.00049199


benign_lesions_without_actinic keratoses
99205
1
$164.00
1
$164
1
22,358
$0.0073
.00004473


benign_lesions_without_actinic keratoses
99211
11
$24.36
1
$268
11
22,358
$0.0120
.00049199


benign_lesions_without_actinic keratoses
99212
1,230
$41.79
1
$51,402
1,311
22,358
$2.2990
.05863673


benign_lesions_without_actinic keratoses
99213
6,470
$58.10
1
$375,886
6,814
22,358
$16.8121
.30476787


benign_lesions_without_actinic keratoses
99214
116
$91.59
1
$10,624
117
22,358
$0.4752
.00523303


benign_lesions_without_actinic keratoses
99215
4
$162.50
1
$650
5
22,358
$0.0291
.00022363


benign_lesions_without_actinic keratoses
99233
1
$86.00
1
$86
1
22,358
$0.0038
.00004473


benign_lesions_without_actinic keratoses
99241
105
$53.00
1
$5,565
105
22,358
$0.2489
.00469631


benign_lesions_without_actinic keratoses
99242
2,122
$99.17
1
$210,441
2,166
22,358
$9.4123
.09687807


benign_lesions_without_actinic keratoses
99243
4,196
$131.13
1
$550,225
4,264
22,358
$24.6098
.19071473


benign_lesions_without_actinic keratoses
99244
15
$184.33
1
$2,765
15
22,358
$0.1237
.00067090


benign_lesions_without_actinic keratoses
99245
2
$237.00
1
$474
2
22,358
$0.0212
.00008945


benign_lesions_without_actinic keratoses
99252
1
$79.00
1
$79
1
22,358
$0.0035
.00004473


benign_lesions_without_actinic keratoses
99253
2
$107.50
1
$215
2
22,358
$0.0096
.00008945


benign_lesions_without_actinic keratoses
99254
1
$154.00
1
$154
1
22,358
$0.0069
.00004473


benign_lesions_without_actinic keratoses
99312
1
$65.00
1
$65
1
22,358
$0.0029
.00004473


benign_lesions_without_actinic keratoses
99385
5
$56.00
1
$280
5
22,358
$0.0125
.00022363


benign_lesions_without_actinic keratoses
99386
2
$56.00
1
$112
2
22,358
$0.0050
.00008945


benign_lesions_without_actinic keratoses
99391
1
$56.00
1
$56
1
22,358
$0.0025
.00004473


benign_lesions_without_actinic keratoses
99394
3
$56.00
1
$168
3
22,358
$0.0075
.00013418


benign_lesions_without_actinic keratoses
99395
18
$56.00
1
$1,008
18
22,358
$0.0451
.00080508


benign_lesions_without_actinic keratoses
99396
50
$56.00
1
$2,800
50
22,358
$0.1252
.00223634


benign_lesions_without_actinic keratoses
99601
1
$95.00
1
$95
1
22,358
$0.0042
.00004473


benign_lesions_without_actinic keratoses
A0425
1
$60.00
10
$60
10
22,358
$0.0027
.00044727


benign_lesions_without_actinic keratoses
A0429
1
$325.00
1
$325
1
22,358
$0.0145
.00004473


benign_lesions_without_actinic keratoses
A4550
1
$49.00
1
$49
1
22,358
$0.0022
.00004473


benign_lesions_without_actinic keratoses
A4646
3
$73.00
1
$219
3
22,358
$0.0098
.00013418


benign_lesions_without_actinic keratoses
A4649
1
$73.00
1
$73
1
22,358
$0.0033
.00004473


benign_lesions_without_actinic keratoses
AS
6
$226.17
1
$1,357
6
22,358
$0.0607
.00026836


benign_lesions_without_actinic keratoses
CL
1
$163.00
2
$163
2
22,358
$0.0073
.00008945


benign_lesions_without_actinic keratoses
ER
4
$123.00
1
$492
4
22,358
$0.0220
.00017891


benign_lesions_without_actinic keratoses
H0A
2
$48.00
28
$96
55
22,358
$0.0043
.00245997


benign_lesions_without_actinic keratoses
H3A
799
$20.82
16
$16,635
12,963
22,358
$0.7440
.57979247


benign_lesions_without_actinic keratoses
H6J
8
$25.13
15
$201
117
22,358
$0.0090
.00523303


benign_lesions_without_actinic keratoses
J2250
1
$28.00
1
$28
1
22,358
$0.0013
.00004473


benign_lesions_without_actinic keratoses
J3010
1
$1.00
1
$1
1
22,358
$0.0000
.00004473


benign_lesions_without_actinic keratoses
J3301
15
$13.53
1
$203
21
22,358
$0.0091
.00093926


benign_lesions_without_actinic keratoses
J7050
10
$4.50
1
$45
11
22,358
$0.0020
.00049199


benign_lesions_without_actinic keratoses
J9A
8
$6.50
21
$52
168
22,358
$0.0023
.00751409


benign_lesions_without_actinic keratoses
L1A
1
$161.00
3
$161
3
22,358
$0.0072
.00013418


benign_lesions_without_actinic keratoses
L1B
3
$336.33
30
$1,009
90
22,358
$0.0451
.00402540


benign_lesions_without_actinic keratoses
L9B
133
$62.86
26
$8,361
3,440
22,358
$0.3740
.15385992


benign_lesions_without_actinic keratoses
Q5N
98
$125.34
27
$12,283
2,666
22,358
$0.5494
.11924143


benign_lesions_without_actinic keratoses
S0630
11
$41.27
1
$454
11
22,358
$0.0203
.00049199


benign_lesions_without_actinic keratoses
S2B
91
$56.53
43
$5,144
3,905
22,358
$0.2301
.17465784


benign_lesions_without_actinic keratoses
Z2A
7
$32.57
16
$228
114
22,358
$0.0102
.00509885


benign_lesions_without_actinic keratoses
Z2G
70
$201.26
29
$14,088
2,036
22,358
$0.6301
.09106360
















TABLE A8





Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic keratoses diagnosis 702.xx


etg 0682

























Total
Your
Other


quartile
category
services
service description
Svcs
Svcs
Svcs





Q1
A
00300
ANESTHESIA, HEAD, NECK, POST TRUNK INTEGUMENTARY, MUSCLE
2
2
0





NERVES





Q1
A
94720
CARBON MONOXIDE DIFFUSING CAPACITY
2
2
0


Q1
A
94240
FUNCTIONAL RESIDUAL CAPACITY/VOLUME: HELIUM/NITROGEN OPEN
1
1
0





CIRCUIT/OTHER





Q1
A
94010
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RATE W/WO
1
1
0





MAXIMAL VOLUN





Q1
A
A4646

2
0
2


Q1
A
99601
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (TO 2 HRS);
1
1
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
A
88321
CONSULTATION & REPORT, REFERRED SLIDES PREPARED ELSEWHERE
1
0
1


Q1
A
88342
IMMUNOCYTOCHEMISTRY (W/TISSUE IMMUNOPEROXIDASE), EACH 
3
3
0





ANTIBODY





Q1
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,008
1,723
285













A Total

2,356
1,776
580













Q1
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND PROB
2,356
2,184
172


Q1
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED 
45
31
14





EXAM;





Q1
M
99205
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS:COMPREHENSIVE 
1
0
1





HX;COMPREHENSIV





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
M
99241
OFFICE CONSULTATION, 3 KEY COMPONENTS: PROB FOCUS HX; PROB 
1
1
0





FOCUS EXAM;





Q1
M
99202
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX; 
2
0
2





EXPAND





Q1
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX; 
10
3
7





DETAILED EXAM;





Q1
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
253
229
24





PROB FOCUS EX





Q1
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB
341
327
14





FOCUS HX;EXPAND PROB





Q1
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX;
536
510
26





DETAILED EXAM; MED
















M Total

3,568
3,288
280













Q1
P
L9B
VITAMIN A DERIVATIVES
1,900
1,736
164


Q1
P
H3A
ANALGESICS, NARCOTICS
4,432
795
3,637


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
P
J9A
INTESTINAL MOTILITY STIMULANTS
32
0
32


Q1
P
H0A
LOCAL ANESTHETICS
25
0
25


Q1
P
S2B
NSAIDS, CYCLOOXYGENASE INHIBITOR—TYPE
875
200
675













P Total

8,919
4,171
4,748













Q1
R
76942
US GUIDANCE, NEEDLE PLACEMENT, RADIOLOGICAL S&I
1
0
1













R Total

1
0
1













Q1
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
1,343
1,320
23





CUTANEOUS VASC P





Q1
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
524
509
15


Q1
S
17004
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
13
13
0





CUTANEOUS VASC P





Q1
S
54060
DESTRUCTION, PENILE LESION, SIMPLE; SURGICAL EXCISION
1
1
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
S
11442
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
3
1
2





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q1
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
5
5
0





HANDS/FEET/GE





Q1
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, 
94
89
5





TRUNK/ARMS/L





Q1
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
95
86
9


Q1
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
465
448
17


Q1
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS 
124
118
6





MEMBRANE; DIAME





Q1
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, 
5
4
1





TRUNK/ARMS/L





Q1
S
12031
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES;
5
4
1





2.5 CM/<





Q1
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
11
6
5





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q1
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
13
10
3





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q1
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
585
573
12


Q1
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
50
50
0


Q1
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, 
67
63
4





TRUNK/ARMS/L





Q1
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 
50
47
3





0.6-1.0





Q1
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS 
64
61
3





MEMBRANE; DIAME





Q1
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, 
98
93
5





TRUNK/ARMS/L
















S Total

6,616
6,446
170











Q1 Total

21,460
15,681
5,779













Q2
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,823
2,414
409


Q2
A
88342
IMMUNOCYTOCHEMISTRY (W/TISSUE IMMUNOPEROXIDASE), EACH 
10
5
5





ANTIBODY





Q2
A
00820
ANESTHESIA, PROC, LOWER POSTERIOR ABDOMINAL WALL
1
0
1


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
A
80053
COMPREHENSIVE METABOLIC PANEL
22
0
22


Q2
A
84460
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
10
0
10


Q2
A
84443
THYROID STIMULATING HORMONE (TSH)
5
0
5


Q2
A
80050
GENERAL HEALTH PANEL
2
0
2













A Total

3,029
2,449
580













Q2
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
445
417
28





HX; EXPAND PROB





Q2
M
99204
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: COMPREHENSIVE HX; 
4
0
4





COMPREHENSIVE E





Q2
M
99245
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
1
0
1





COMPREHENSIVE E





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
M
99241
OFFICE CONSULTATION, 3 KEY COMPONENTS: PROB FOCUS HX; PROB FOCUS EXAM
3
2
1


Q2
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX;
13
2
11





DETAILED EXAM;





Q2
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; 
183
150
33





PROB FOCUS EX





Q2
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX;
779
756
23





DETAILED EXAM; MED





Q2
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; 
999
776
223





EXPAND PROB
















M Total

2,485
2,114
371













Q2
P
S2B
NSAIDS, CYCLOOXYGENASE INHIBITOR—TYPE
899
132
767


Q2
P
Z2G
IMMUNOMODULATORS
443
385
58


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
P
J7050
Infusion, normal saline solution, 250 cc
1
1
0


Q2
P
Z2A
ANTIHISTAMINES
8
6
2


Q2
P
L9B
VITAMIN A DERIVATIVES
341
267
74













P Total

4,910
1,992
2,918













Q2
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
580
567
13


Q2
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
236
234
2


Q2
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
307
302
5


Q2
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
671
654
17


Q2
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; 
285
274
11





DIAMETER 0.5 CM/<





Q2
S
11312
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
51
51
0





MUCOUS MEMBRANE; DIAME





Q2
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
374
357
17


Q2
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
167
165
2





MUCOUS MEMBRANE; DIAME





Q2
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
97
96
1





TAG, TRUNK/ARMS/L





Q2
S
11603
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/ARMS/LEGS;
2
2
0





EXCISED DIAM





Q2
S
11307
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; 
23
23
0





DIAMETER 1.1-2.0





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
S
40490
BX, LIP
4
4
0


Q2
S
11900
INJECTION, INTRALESIONAL; UP TO & INCL 7 LESIONS
2
2
0


Q2
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
140
135
5





MUCOUS MEMBRANE; DIAME





Q2
S
17004
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
1
1
0





CUTANEOUS VASC P





Q2
S
11420
EXCISE BENIGN SKIN LESION W/MARG, EXCPT SKIN TAG SCALP/NECK
15
15
0





HANDS/FEET/





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
S
11442
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
3
2
1





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q2
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
144
139
5





DIAMETER 0.6-1.0





Q2
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
8
8
0





HANDS/FEET/GE





Q2
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/
35
33
2





NOSE/LIPS/M





Q2
S
12032
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES; 2.6-
7
5
2





7.5 CM





Q2
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
5
5
0


Q2
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
9
7
2


Q2
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
145
136
9


Q2
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
72
69
3


Q2
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
758
722
36





CUTANEOUS VASC P
















S Total

4,832
4,668
164











Q2 Total

15,256
11,223
4,033













Q3
A
0551
SKILLED NURSING—PER VISIT
5
5
0


Q3
A
88321
CONSULTATION & REPORT, REFERRED SLIDES PREPARED ELSEWHERE
8
7
1


Q3
A
88342
IMMUNOCYTOCHEMISTRY (W/TISSUE IMMUNOPEROXIDASE),
14
6
8





EACH ANTIBODY





Q3
A
0490
AMBULATORY SURGICAL CARE GENERAL CLASSIFICATION
6
6
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
A
AS
Ambulatory Surgery
2
1
1


Q3
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
3,056
2,549
507













A Total

3,531
2,658
873













Q3
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAIL
2,013
1,983
30





EXAM; MED





Q3
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
2,464
2,063
401





EXPAND PROB





Q3
M
99241
OFFICE CONSULTATION, 3 KEY COMPONENTS: PROB FOCUS HX; 
100
99
1





PROB FOCUS EXAM;





Q3
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
511
439
72





PROB FOCUS EX





Q3
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX;
82
57
25





DETAILED EXAM;





Q3
M
99202
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: EXPAND PROB FOCUS
51
37
14





HX; EXPAND





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
M
99204
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS:
2
0
2





COMPREHENSIVE HX;COMPREHENSIV





Q3
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
3
1
2





COMPREHENSIVE E





Q3
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX;
23
3
20





DETAILED EXAM;





Q3
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX;
705
680
25





EXPAND PROB
















M Total

6,002
5,364
638













Q3
p
L1B
ACNE AGENTS, SYSTEMIC
60
60
0


Q3
p
L1A
ANTIPSORIATIC AGENTS, SYSTEMIC
3
3
0


Q3
p
Z2A
ANTIHISTAMINES
60
0
60


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
p
Z2G
IMMUNOMODULATORS
564
508
56


Q3
p
H3A
ANALGESICS, NARCOTICS
3,760
934
2,826


Q3
p
Q5N
TOPICAL ANTINEOPLASTIC & PREMALIGNANT LESION AGNTS
580
580
0













P Total

7,487
3,043
4,444













Q3
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
521
518
3





DIAMETER 0.6-1.0





Q3
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
444
438
6





MUCOUS MEMBRANE; DIAME





Q3
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN 
1,711
1,683
28





TAGS/CUTANEOUS VASC P





Q3
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
1,130
1,092
38


Q3
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
75
71
4





TAG, TRUNK/ARMS/L





Q3
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
132
119
13





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q3
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
327
317
10





MUCOUS MEMBRANE; DIAME





Q3
S
11404
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT
25
21
4





SKIN TAG, TRUNK/ARMS/L





Q3
S
17106
DESTRUCTION, CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 
12
12
0





<10 SQ CM





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
63
62
1





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q3
S
12031
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES; 2 CM/<
47
43
4


Q3
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
193
185
8





TAG, TRUNK/ARMS/L





Q3
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
191
187
4


Q3
S
54056
DESTRUCTION, PENILE LESION, SIMPLE; CRYOSURGERY
6
6
0


Q3
S
11424
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
4
4
0





HANDS/FEET/GE





Q3
S
67810
BX, EYELID
8
8
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
S
11901
INJECTION, INTRALESIONAL; >7 LESIONS
7
7
0


Q3
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT
335
317
18





SKIN TAG, TRUNK/ARMS/L





Q3
S
11426
EXCISE BENIGN SKIN LESION W/MARG, EXCEPT SKIN
1
1
0





TAG SCALP/NECK/HANDS/FT/G





Q3
S
17004
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT
15
15
0





SKIN TAGS/CUTANEOUS/VASC P





Q3
S
11444
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
1
1
0





FACE/EARS/EYELIDS/NOSE/LIPS/M





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
167
160
7





DIAMETER 0.5 CM/<





Q3
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
110
96
14


Q3
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, 
130
125
5





TRUNK/ARMS/L





Q3
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
259
238
21


Q3
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
367
325
42













S Total

9,313
8,900
413











Q3 Total

26,333
19,965
6,368













Q4
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,869
2,614
255


Q4
A
AS
Ambulatory Surgery
2
2
0


Q4
A
ER
Emergency
2
2
0


Q4
A
S0630
Removal of sutures by a physician other than the physician who originall
5
5
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
A
85025
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, 
13
0
13





WBC, & PLATELET) &





Q4
A
84460
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
3
0
3


Q4
A
80053
COMPREHENSIVE METABOLIC PANEL
14
0
14


Q4
A
80061
LIPID PANEL
8
0
8


Q4
A
88321
CONSULTATION & REPORT, REFERRED SLIDES PREPARED ELSEWHERE
1
0
1













A Total

3,050
2,669
381













Q4
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX;EXPAND PROB
675
664
11


Q4
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
936
907
29





HX; DETAILED EXAM; MED





Q4
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; 
364
307
57





PROB FOCUS EX





Q4
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX; 
55
35
20





DETAILED EXAM;





Q4
M
99202
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: EXPAND PROB FOCUS 
32
20
12





HX; EXPAND





Q4
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX;
32
20
12





DETAILED EXAM;





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
M
99395
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/
2
0
2





EXAM, EST PT; 18-39





Q4
M
99204
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: COMPREHENSIVE 
1
0
1





HX;COMPREHENSIV





Q4
M
99241
OFFICE CONSULTATION, 3 KEY COMPONENTS: PROB FOCUS HX; 
1
1
0





PROB FOCUS EXAM;





Q4
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; 
995
742
253





EXPAND PROB
















M Total

3,117
2,703
414













Q4
P
Q5N
TOPICAL ANTINEOPLASTIC & PREMALIGNANT LESION AGNTS
676
656
20


Q4
P
J3301
Injection, triamcinolone acetonide, per 10 mg
12
8
4


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
P
L9B
VITAMIN A DERIVATIVES
172
77
95













P Total

4,275
1,518
2,757













Q4
R
76942
US GUIDANCE, NEEDLE PLACEMENT, RADIOLOGICAL S&I
1
0
1













R Total

1
0
1













Q4
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN 
388
378
10





TAG, TRUNK/ARMS/L





Q4
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN 
199
194
5





TAG, TRUNK/ARMS/L





Q4
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
191
190
1





TAG, TRUNK/ARMS/L





Q4
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
479
473
6


Q4
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
69
67
2





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q4
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
68
68
0





HANDS/FEET/GE





Q4
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
93
92
1





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q4
S
12031
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES; 2 CM/<
47
44
3


Q4
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
358
334
24


Q4
S
11422
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
34
34
0





HANDS/FEET/GE





Q4
S
11420
EXCISE BENIGN SKIN LESION W/MARG, EXCPT SKIN
55
55
0





TAG SCALP/NECK/HANDS/FEET/





Q4
S
12032
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES;
27
26
1





2.6-7.5 CM





Q4
S
13101
REPAIR, COMPLEX, TRUNK; 2.6 TO 7.5 CM
8
8
0


Q4
S
11442
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
19
18
1





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q4
S
11307
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
35
35
0





DIAMETER 1.1-2.0





Q4
S
11312
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
34
34
0





MUCOUS MEMBRANE; DIAME





Q4
S
67810
BX, EYELID
18
18
0


Q4
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
34
33
1





TAG, TRUNK/ARMS/L





Q4
S
11406
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
7
6
1





TAG, TRUNK/ARMS/L





Q4
S
40490
BX, LIP
13
13
0


Q4
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
133
124
9





MUCOUS MEMBRANE; DIAME





Q4
S
11308
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; 
9
9
0





DIAMETER > 2.0 CM





Q4
S
11303
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER >2.0 CM
12
11
1


Q4
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
147
143
4





DIAMETER 0.5 CM/<





Q4
S
13131
REPAIR, COMPLEX, FOREHEAD/CHEEKS/CHIN/MOUTH/NECK/
2
2
0





AXILLAE/GENITALIA/HAND





Q4
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
124
118
6


Q4
S
12051
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS/
4
3
1





MUCOUS MEMBRANES; 2.





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
S
17106
DESTRUCTION, CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; <10 SQ CM
2
2
0


Q4
S
54056
DESTRUCTION, PENILE LESION, SIMPLE; CRYOSURGERY
1
1
0


Q4
S
11404
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN
5
4
1





TAG, TRUNK/ARMS/L





Q4
S
11443
EXCISE, BENIGN SKIN LESION, INCL MARGINS, 
1
1
0





FACE/EARS/EYELIDS/NOSE/LIPS/M





Q4
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
92
87
5


Q4
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; 
117
113
4





DIAMETER 0.6-1.0





Q4
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/
83
82
1





MUCOUS MEMBRANE; DIAME





Q4
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
338
334
4


Q4
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
612
589
23





CUTANEOUS VASC P
















S Total

5,038
4,893
145











Q4 Total

15,481
11,783
3,698


Grand Total

78,530
58,652
19,878






























Total Costs





Expected
Stratum




Total Cost
per stratum


quartile
category
services
Svcs
episodes
Total Costs
Your Costs
Others Costs
Expected Costs
Difference
episodes





Q1
A
00300
.58
6,455
$580
$580
$0
$167
$413
$0


Q1
A
94720
.58
6,455
$165
$165
$0
$48
$117
$0


Q1
A
94240
.29
6,455
$125
$125
$0
$36
$89
$0


Q1
A
94010
.29
6,455
$124
$124
$0
$36
$88
$0


Q1
A
A4646
.87
6,455
$149
$0
$149
$63
$86
$0


Q1
A
99601
.29
6,455
$95
$95
$0
$27
$68
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q1
A
88321
4.04
6,455
$85
$0
$85
$344
($259)
$0


Q1
A
88342
9.24
6,455
$476
$476
$0
$1,370
($894)
$0


Q1
A
88305
3105.38
6,455
$62,122
$53,278
$8,844
$96,026
($33,904)
$10

















A Total
3435.95

$66,375
$55,690
$10,685
$100,909
($34,534)
$10

















Q1
M
99213
1967.28
6,455
$130,482
$121,036
$9,446
$108,522
$21,960
$20


Q1
M
99214
33.78
6,455
$3,973
$2,734
$1,239
$3,067
$906
$1


Q1
M
99205
.29
6,455
$164
$0
$164
$47
$117
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q1
M
99241
30.31
6,455
$53
$53
$0
$1,607
($1,554)
$0


Q1
M
99202
28.58
6,455
$119
$0
$119
$1,901
($1,782)
$0


Q1
M
99203
46.19
6,455
$1,020
$302
$718
$4,896
($3,876)
$0


Q1
M
99212
378.50
6,455
$9,866
$8,935
$931
$14,840
($4,974)
$2


Q1
M
99242
625.35
6,455
$32,863
$31,514
$1,349
$60,757
($27,894)
$5


Q1
M
99243
1231.06
6,455
$69,132
$65,789
$3,343
$158,856
($89,724)
$11

















M Total
4371.37

$249,522
$230,790
$18,732
$357,088
($107,566)
$39

















Q1
P
L9B
993.17
6,455
$4,900
$4,397
$503
$2,414
$2,486
$1


Q1
P
H3A
3742.56
6,455
$5,607
$1,073
$4,534
$4,803
$804
$1


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q1
P
J9A
48.50
6,455
$8
$0
$8
$15
($7)
$0


Q1
P
H0A
15.88
6,455
$10
$0
$10
$28
($18)
$0


Q1
P
S2B
1127.42
6,455
$1,355
$468
$887
$1,485
($130)
$0

















P Total
7386.96

$20,728
$13,487
$7,241
$16,845
$3,883
$3

















Q1
R
76942
.58
6,455
$39
$0
$39
$57
($18)
$0

















R Total
.58

$39
$0
$39
$57
($18)
$0

















Q1
S
17000
1277.26
6,455
$86,301
$84,932
$1,369
$79,652
$6,649
$13


Q1
S
11300
472.33
6,455
$24,845
$24,100
$745
$20,778
$4,067
$4


Q1
S
17004
9.82
6,455
$858
$858
$0
$594
$264
$0


Q1
S
54060
.29
6,455
$278
$278
$0
$80
$198
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q1
S
11442
16.46
6,455
$396
$198
$198
$2,828
($2,432)
$0


Q1
S
11421
35.22
6,455
$676
$676
$0
$4,224
($3,548)
$0


Q1
S
11400
147.82
6,455
$10,040
$9,466
$574
$13,774
($3,734)
$2


Q1
S
11101
183.62
6,455
$3,596
$3,242
$354
$7,559
($3,963)
$1


Q1
S
11100
511.02
6,455
$39,576
$38,139
$1,437
$43,864
($4,288)
$6


Q1
S
11310
209.03
6,455
$7,985
$7,608
$377
$12,363
($4,378)
$1


Q1
S
11403
34.36
6,455
$825
$646
$179
$5,610
($4,785)
$0


Q1
S
12031
33.49
6,455
$899
$713
$186
$5,685
($4,786)
$0


Q1
S
11441
43.88
6,455
$1,496
$797
$699
$6,482
($4,986)
$0


Q1
S
11440
78.82
6,455
$1,751
$1,358
$393
$9,266
($7,515)
$0


Q1
S
11301
786.45
6,455
$39,819
$39,200
$619
$48,630
($8,811)
$6


Q1
S
11302
164.28
6,455
$4,274
$4,274
$0
$13,253
($8,979)
$1


Q1
S
11402
153.31
6,455
$9,737
$9,105
$632
$21,014
($11,277)
$2


Q1
S
11306
240.21
6,455
$3,848
$3,631
$217
$15,227
($11,379)
$1


Q1
S
11311
218.84
6,455
$5,715
$5,430
$285
$17,184
($11,469)
$1


Q1
S
11401
278.89
6,455
$10,989
$10,532
$457
$29,553
($18,564)
$2

















S Total
7399.95

$280,871
$271,549
$9,322
$397,845
($116,974)
$44















Q1 Total
22594.81

$617,535
$571,516
$46,019
$872,743
($255,208)
$96

















Q2
A
88305
2137.44
4,443
$87,190
$74,527
$12,663
$66,095
$21,095
$20


Q2
A
88342
6.36
4,443
$1,587
$793
$794
$943
$644
$0


Q2
A
00820
.20
4,443
$315
$0
$315
$63
$252
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q2
A
80053
24.24
4,443
$110
$0
$110
$121
($11)
$0


Q2
A
84460
12.52
4,443
$34
$0
$34
$51
($17)
$0


Q2
A
84443
9.54
4,443
$35
$0
$35
$67
($32)
$0


Q2
A
80050
5.37
4,443
$28
$0
$28
$75
($47)
$0

















A Total
2348.48

$91,878
$76,951
$14,927
$69,078
$22,800
$21

















Q2
M
99242
430.43
4,443
$43,318
$40,616
$2,702
$41,819
$1,499
$10


Q2
M
99204
2.19
4,443
$586
$0
$586
$315
$271
$0


Q2
M
99245
.40
4,443
$234
$0
$234
$94
$140
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q2
M
99241
20.87
4,443
$159
$106
$53
$1,106
($947)
$0


Q2
M
99203
31.80
4,443
$1,289
$205
$1,084
$3,370
($2,081)
$0


Q2
M
99212
260.52
4,443
$7,280
$5,990
$1,290
$10,215
($2,935)
$2


Q2
M
99243
847.35
4,443
$100,552
$97,581
$2,971
$109,341
($8,789)
$23


Q2
M
99213
1354.08
4,443
$55,484
$43,371
$12,113
$74,696
($19,212)
$12

















M Total
3013.20

$213,438
$188,618
$24,820
$246,083
($32,645)
$48

















Q2
P
S2B
776.00
4,443
$1,316
$238
$1,078
$1,022
$294
$0


Q2
P
Z2G
404.60
4,443
$3,074
$2,775
$299
$2,800
$274
$1


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q2
P
J7050
2.19
4,443
$7
$7
$0
$9
($2)
$0


Q2
P
Z2A
22.65
4,443
$26
$18
$8
$45
($19)
$0


Q2
P
L9B
683.60
4,443
$669
$552
$117
$1,662
($993)
$0

















P Total
5062.41

$11,384
$7,127
$4,257
$11,354
$30
$3

















Q2
S
11100
351.74
4,443
$51,962
$50,826
$1,136
$30,192
$21,770
$12


Q2
S
11302
113.07
4,443
$17,768
$17,591
$177
$9,122
$8,646
$4


Q2
S
11101
126.39
4,443
$13,545
$13,367
$178
$5,203
$8,342
$3


Q2
S
11301
541.32
4,443
$38,844
$37,832
$1,012
$33,472
$5,372
$9


Q2
S
11305
151.62
4,443
$10,542
$10,043
$499
$6,011
$4,531
$2


Q2
S
11312
23.45
4,443
$5,154
$5,154
$0
$2,311
$2,843
$1


Q2
S
11300
325.11
4,443
$16,356
$15,573
$783
$14,302
$2,054
$4


Q2
S
11311
150.63
4,443
$13,139
$12,949
$190
$11,828
$1,311
$3


Q2
S
11400
101.75
4,443
$10,317
$10,210
$107
$9,481
$836
$2


Q2
S
11603
.40
4,443
$324
$324
$0
$64
$260
$0


Q2
S
11307
19.67
4,443
$2,010
$2,010
$0
$1,789
$221
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q2
S
40490
4.57
4,443
$411
$411
$0
$514
($103)
$0


Q2
S
11900
4.57
4,443
$104
$104
$0
$216
($112)
$0


Q2
S
11310
143.87
4,443
$8,226
$7,886
$340
$8,510
($284)
$2


Q2
S
17004
6.76
4,443
$66
$66
$0
$409
($343)
$0


Q2
S
11420
21.86
4,443
$1,573
$1,573
$0
$1,956
($383)
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q2
S
11442
11.33
4,443
$412
$230
$182
$1,946
($1,534)
$0


Q2
S
11306
165.34
4,443
$8,946
$8,558
$388
$10,481
($1,535)
$2


Q2
S
11421
24.24
4,443
$992
$992
$0
$2,907
($1,915)
$0


Q2
S
11440
54.25
4,443
$4,240
$4,030
$210
$6,378
($2,138)
$1


Q2
S
12032
19.67
4,443
$1,562
$1,120
$442
$4,287
($2,725)
$0


Q2
S
11403
23.65
4,443
$914
$914
$0
$3,862
($2,948)
$0


Q2
S
11441
30.21
4,443
$1,481
$1,143
$338
$4,462
($2,981)
$0


Q2
S
11401
191.96
4,443
$17,276
$16,281
$995
$20,341
($3,065)
$4


Q2
S
11402
105.52
4,443
$11,261
$10,858
$403
$14,464
($3,203)
$3


Q2
S
17000
879.14
4,443
$45,979
$43,698
$2,281
$54,825
($8,846)
$10

















S Total
5091.23

$294,660
$283,572
$11,088
$273,829
$20,831
$66















Q2 Total
15515.33

$611,360
$556,268
$55,092
$600,343
$11,017
$138

















Q3
A
0551
1.74
7,788
$425
$425
$0
$148
$277
$0


Q3
A
88321
4.88
7,788
$680
$595
$85
$415
$265
$0


Q3
A
88342
11.15
7,788
$1,890
$951
$939
$1,653
$237
$0


Q3
A
0490
2.09
7,788
$336
$336
$0
$117
$219
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
A
AS
2.09
7,788
$284
$219
$65
$473
($189)
$0


Q3
A
88305
3746.66
7,788
$94,768
$79,088
$15,680
$115,856
($21,088)
$12

















A Total
4150.72

$102,204
$83,082
$19,122
$121,893
($19,689)
$13

















Q3
M
99243
1485.29
7,788
$259,400
$255,556
$3,844
$191,661
$67,739
$33


Q3
M
99213
2373.53
7,788
$134,726
$113,540
$21,186
$130,933
$3,793
$17


Q3
M
99241
36.57
7,788
$5,300
$5,247
$53
$1,938
$3,362
$1


Q3
M
99212
456.66
7,788
$20,119
$17,403
$2,716
$17,905
$2,214
$3


Q3
M
99203
55.73
7,788
$7,797
$5,422
$2,375
$5,907
$1,890
$1


Q3
M
99202
34.48
7,788
$3,054
$2,264
$790
$2,294
$760
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
M
99204
3.83
7,788
$293
$0
$293
$551
($258)
$0


Q3
M
99244
5.22
7,788
$554
$185
$369
$963
($409)
$0


Q3
M
99214
40.75
7,788
$2,071
$265
$1,806
$3,701
($1,630)
$0


Q3
M
99242
754.49
7,788
$68,631
$66,197
$2,434
$73,303
($4,672)
$9

















M Total
5281.41

$504,876
$466,125
$38,751
$431,288
$73,588
$65

















Q3
p
L1B
31.35
7,788
$582
$582
$0
$351
$231
$0


Q3
p
L1A
1.04
7,788
$161
$161
$0
$56
$105
$0


Q3
p
Z2A
39.71
7,788
$112
$0
$112
$79
$33
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
p
Z2G
709.20
7,788
$4,246
$3,962
$284
$4,907
($661)
$1


Q3
p
H3A
4515.42
7,788
$4,958
$1,420
$3,538
$5,794
($836)
$1


Q3
p
Q5N
928.65
7,788
$2,375
$2,375
$0
$4,279
($1,904)
$0

















P Total
8895.00

$16,796
$10,593
$6,203
$20,356
($3,560)
$2

















Q3
S
11306
289.81
7,788
$31,883
$31,670
$213
$18,371
$13,512
$4


Q3
S
11311
264.04
7,788
$34,032
$33,524
$508
$20,732
$13,300
$4


Q3
S
17000
1541.02
7,788
$107,753
$106,108
$1,645
$96,101
$11,652
$14


Q3
S
11301
948.86
7,788
$69,328
$66,961
$2,367
$58,672
$10,656
$9


Q3
S
11403
41.45
7,788
$13,183
$12,672
$511
$6,769
$6,414
$2


Q3
S
11440
95.09
7,788
$15,293
$13,920
$1,373
$11,179
$4,114
$2


Q3
S
11310
252.19
7,788
$18,610
$18,126
$484
$14,916
$3,694
$2


Q3
S
11404
11.84
7,788
$4,994
$4,161
$833
$2,324
$2,670
$1


Q3
S
17106
4.88
7,788
$4,362
$4,362
$0
$1,792
$2,570
$1


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
S
11441
52.95
7,788
$9,204
$9,043
$161
$7,821
$1,383
$1


Q3
S
12031
40.41
7,788
$7,821
$7,252
$569
$6,859
$962
$1


Q3
S
11402
184.96
7,788
$26,296
$25,237
$1,059
$25,354
$942
$3


Q3
S
11302
198.20
7,788
$16,910
$16,582
$328
$15,990
$920
$2


Q3
S
54056
2.44
7,788
$1,000
$1,000
$0
$390
$610
$0


Q3
S
11424
2.09
7,788
$919
$919
$0
$464
$455
$0


Q3
S
67810
9.75
7,788
$2,057
$2,057
$0
$1,658
$399
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
S
11901
3.83
7,788
$343
$343
$0
$208
$135
$0


Q3
S
11401
336.49
7,788
$35,760
$34,110
$1,650
$35,656
$104
$5


Q3
S
11426
.70
7,788
$282
$282
$0
$182
$100
$0


Q3
S
17004
11.84
7,788
$814
$814
$0
$717
$97
$0


Q3
S
11444
.70
7,788
$280
$280
$0
$204
$76
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q3
S
11305
265.78
7,788
$6,227
$5,943
$284
$10,537
($4,310)
$1


Q3
S
11101
221.54
7,788
$4,223
$3,697
$526
$9,120
($4,897)
$1


Q3
S
11400
178.35
7,788
$11,277
$10,908
$369
$16,619
($5,342)
$1


Q3
S
11300
569.87
7,788
$11,209
$10,330
$879
$25,069
($13,860)
$1


Q3
S
11100
616.55
7,788
$31,241
$28,008
$3,233
$52,922
($21,681)
$4

















S Total
8974.42

$518,752
$499,077
$19,675
$489,127
$29,625
$67















Q3 Total
27301.54

$1,142,628
$1,058,877
$83,751
$1,062,664
$79,964
$147

















Q4
A
88305
1766.53
3,672
$88,522
$80,632
$7,890
$54,625
$33,897
$24


Q4
A
AS
.99
3,672
$513
$513
$0
$223
$290
$0


Q4
A
ER
.66
3,672
$305
$305
$0
$81
$224
$0


Q4
A
S0630
1.81
3,672
$216
$216
$0
$75
$141
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q4
A
85025
20.86
3,672
$39
$0
$39
$64
($25)
$0


Q4
A
84460
10.35
3,672
$13
$0
$13
$43
($30)
$0


Q4
A
80053
20.04
3,672
$70
$0
$70
$100
($30)
$0


Q4
A
80061
15.11
3,672
$64
$0
$64
$121
($57)
$0


Q4
A
88321
2.30
3,672
$85
$0
$85
$195
($110)
$0

















A Total
1945.71

$92,174
$83,419
$8,755
$57,213
$34,961
$25

















Q4
M
99242
355.74
3,672
$65,629
$64,578
$1,051
$34,562
$31,067
$18


Q4
M
99243
700.30
3,672
$121,141
$117,517
$3,624
$90,367
$30,774
$33


Q4
M
99212
215.31
3,672
$14,137
$11,867
$2,270
$8,442
$5,695
$4


Q4
M
99203
26.28
3,672
$6,851
$4,826
$2,025
$2,785
$4,066
$2


Q4
M
99202
16.26
3,672
$2,474
$1,740
$734
$1,082
$1,392
$1


Q4
M
99214
19.22
3,672
$3,077
$1,766
$1,311
$1,745
$1,332
$1


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q4
M
99395
2.96
3,672
$112
$0
$112
$166
($54)
$0


Q4
M
99204
1.81
3,672
$147
$0
$147
$260
($113)
$0


Q4
M
99241
17.24
3,672
$53
$53
$0
$914
($861)
$0


Q4
M
99213
1119.11
3,672
$55,194
$41,218
$13,976
$61,734
($6,540)
$15

















M Total
2486.87

$271,026
$244,855
$26,171
$203,021
$68,005
$74

















Q4
P
Q5N
437.85
3,672
$3,602
$3,515
$87
$2,017
$1,585
$1


Q4
P
J3301
3.45
3,672
$80
$60
$20
$33
$47
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q4
P
L9B
564.97
3,672
$427
$159
$268
$1,373
($946)
$0

















P Total
4131.53

$9,627
$6,095
$3,532
$9,359
$268
$3

















Q4
R
76942
.33
3,672
$158
$0
$158
$32
$126
$0

















R Total
.33

$158
$0
$158
$32
$126
$0

















Q4
S
11401
158.65
3,672
$38,337
$37,510
$827
$16,812
$21,525
$10


Q4
S
11402
87.21
3,672
$25,492
$24,873
$619
$11,954
$13,538
$7


Q4
S
11400
84.09
3,672
$16,076
$15,974
$102
$7,836
$8,240
$4


Q4
S
11300
268.69
3,672
$19,559
$19,344
$215
$11,820
$7,739
$5


Q4
S
11441
24.96
3,672
$10,271
$10,038
$233
$3,687
$6,584
$3


Q4
S
11421
20.04
3,672
$8,103
$8,103
$0
$2,403
$5,700
$2


Q4
S
11440
44.84
3,672
$10,809
$10,686
$123
$5,271
$5,538
$3


Q4
S
12031
19.05
3,672
$8,025
$7,589
$436
$3,234
$4,791
$2


Q4
S
11100
290.70
3,672
$29,152
$27,305
$1,847
$24,953
$4,199
$8


Q4
S
11422
10.35
3,672
$4,979
$4,979
$0
$1,475
$3,504
$1


Q4
S
11420
18.07
3,672
$4,806
$4,806
$0
$1,617
$3,189
$1


Q4
S
12032
16.26
3,672
$5,932
$5,770
$162
$3,543
$2,389
$2


Q4
S
13101
1.31
3,672
$2,554
$2,554
$0
$419
$2,135
$1


Q4
S
11442
9.36
3,672
$3,483
$3,315
$168
$1,609
$1,874
$1


Q4
S
11307
16.26
3,672
$3,126
$3,126
$0
$1,479
$1,647
$1


Q4
S
11312
19.38
3,672
$3,459
$3,459
$0
$1,910
$1,549
$1


Q4
S
67810
4.60
3,672
$2,138
$2,138
$0
$782
$1,356
$1


Q4
S
11403
19.54
3,672
$4,510
$4,312
$198
$3,191
$1,319
$1


Q4
S
11406
2.14
3,672
$1,591
$1,339
$252
$498
$1,093
$0


Q4
S
40490
3.78
3,672
$1,473
$1,473
$0
$425
$1,048
$0


Q4
S
11310
118.91
3,672
$8,001
$7,555
$446
$7,033
$968
$2


Q4
S
11308
1.81
3,672
$926
$926
$0
$186
$740
$0


Q4
S
11303
5.26
3,672
$1,196
$1,104
$92
$527
$669
$0


Q4
S
11305
125.31
3,672
$5,579
$5,417
$162
$4,968
$611
$2


Q4
S
13131
.33
3,672
$630
$630
$0
$103
$527
$0


Q4
S
11101
104.45
3,672
$4,817
$4,592
$225
$4,300
$517
$1


Q4
S
12051
1.97
3,672
$904
$672
$232
$432
$472
$0


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.


Q4
S
17106
2.30
3,672
$782
$782
$0
$845
($63)
$0


Q4
S
54056
1.15
3,672
$121
$121
$0
$184
($63)
$0


Q4
S
11404
5.58
3,672
$846
$737
$109
$1,096
($250)
$0


Q4
S
11443
2.46
3,672
$222
$222
$0
$518
($296)
$0


Q4
S
11302
93.45
3,672
$6,952
$6,621
$331
$7,539
($587)
$2


Q4
S
11306
136.64
3,672
$8,064
$7,920
$144
$8,662
($598)
$2


Q4
S
11311
124.49
3,672
$6,633
$6,593
$40
$9,775
($3,142)
$2


Q4
S
11301
447.38
3,672
$20,447
$20,270
$177
$27,664
($7,217)
$6


Q4
S
17000
726.58
3,672
$35,855
$34,605
$1,250
$45,311
($9,456)
$10

















S Total
4235.33

$316,052
$307,155
$8,897
$231,346
$84,706
$86















Q4 Total
12799.77

$689,037
$641,524
$47,513
$500,971
$188,066
$188


Grand Total
78211.45

$3,060,560
$2,828,185
$232,375
$3,036,722
$23,838
$568


























episodes






Difference

Other

this






per stratum
Your costs
costs per
Spec costs
service



quartile
category
services
episodes
per svc
svc
per svc
occurred






Q1
A
00300
$0
$290
$0
$290
2



Q1
A
94720
$0
$83
$0
$83
2



Q1
A
94240
$0
$125
$0
$125
1



Q1
A
94010
$0
$124
$0
$124
1



Q1
A
A4646
$0
$0
$75
$73
2



Q1
A
99601
$0
$95
$0
$95
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q1
A
88321
($0)
$0
$85
$85
1



Q1
A
88342
($0)
$159
$0
$148
2



Q1
A
88305
($5)
$31
$31
$31
1,403











A Total
($5)

















Q1
M
99213
$3
$55
$55
$55
2,261



Q1
M
99214
$0
$88
$89
$91
45



Q1
M
99205
$0
$0
$164
$164
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q1
M
99241
($0)
$53
$0
$53
1



Q1
M
99202
($0)
$0
$60
$67
2



Q1
M
99203
($1)
$101
$103
$106
10



Q1
M
99212
($1)
$39
$39
$39
249



Q1
M
99242
($4)
$96
$96
$97
339



Q1
M
99243
($14)
$129
$129
$129
529











M Total
($17)

















Q1
P
L9B
$0
$3
$3
$2
79



Q1
P
H3A
$0
$1
$1
$1
233



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q1
P
J9A
($0)
$0
$0
$0
2



Q1
P
H0A
($0)
$0
$0
$2
1



Q1
P
S2B
($0)
$2
$1
$1
21











P Total
$1

















Q1
R
76942
($0)
$0
$39
$99
1











R Total
($0)

















Q1
S
17000
$1
$64
$60
$62
1,215



Q1
S
11300
$1
$47
$50
$44
398



Q1
S
17004
$0
$66
$0
$61
13



Q1
S
54060
$0
$278
$0
$278
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q1
S
11442
($0)
$198
$99
$172
3



Q1
S
11421
($1)
$135
$0
$120
5



Q1
S
11400
($1)
$106
$115
$93
88



Q1
S
11101
($1)
$38
$39
$41
83



Q1
S
11100
($1)
$85
$85
$86
458



Q1
S
11310
($1)
$64
$63
$59
105



Q1
S
11403
($1)
$162
$179
$163
4



Q1
S
12031
($1)
$178
$186
$170
5



Q1
S
11441
($1)
$133
$140
$148
10



Q1
S
11440
($1)
$136
$131
$118
12



Q1
S
11301
($1)
$68
$52
$62
462



Q1
S
11302
($1)
$85
$0
$81
45



Q1
S
11402
($2)
$145
$158
$137
64



Q1
S
11306
($2)
$77
$72
$63
43



Q1
S
11311
($2)
$89
$95
$79
60



Q1
S
11401
($3)
$113
$91
$106
92











S Total
($18)












Q1 Total
($40)

















Q2
A
88305
$5
$31
$31
$31
1,760



Q2
A
88342
$0
$159
$159
$148
7



Q2
A
00820
$0
$0
$315
$315
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q2
A
80053
($0)
$0
$5
$5
21



Q2
A
84460
($0)
$0
$3
$4
10



Q2
A
84443
($0)
$0
$7
$7
5



Q2
A
80050
($0)
$0
$14
$14
2











A Total
$5

















Q2
M
99242
$0
$97
$97
$97
440



Q2
M
99204
$0
$0
$147
$144
4



Q2
M
99245
$0
$0
$234
$237
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q2
M
99241
($0)
$53
$53
$53
3



Q2
M
99203
($0)
$103
$99
$106
13



Q2
M
99212
($1)
$40
$39
$39
173



Q2
M
99243
($2)
$129
$129
$129
767



Q2
M
99213
($4)
$56
$54
$55
959











M Total
($7)

















Q2
P
S2B
$0
$2
$1
$1
18



Q2
P
Z2G
$0
$7
$5
$7
17



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q2
P
J7050
($0)
$7
$0
$4
1



Q2
P
Z2A
($0)
$3
$4
$2
3



Q2
P
L9B
($0)
$2
$2
$2
9











P Total
$0

















Q2
S
11100
$5
$90
$87
$86
574



Q2
S
11302
$2
$75
$89
$81
183



Q2
S
11101
$2
$44
$36
$41
181



Q2
S
11301
$1
$58
$60
$62
437



Q2
S
11305
$1
$37
$45
$40
126



Q2
S
11312
$1
$101
$0
$99
47



Q2
S
11300
$0
$44
$46
$44
247



Q2
S
11311
$0
$78
$95
$79
137



Q2
S
11400
$0
$106
$107
$93
92



Q2
S
11603
$0
$162
$0
$162
2



Q2
S
11307
$0
$87
$0
$91
20



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q2
S
40490
($0)
$103
$0
$112
3



Q2
S
11900
($0)
$52
$0
$47
2



Q2
S
11310
($0)
$58
$68
$59
104



Q2
S
17004
($0)
$66
$0
$61
1



Q2
S
11420
($0)
$105
$0
$89
15



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q2
S
11442
($0)
$115
$182
$172
3



Q2
S
11306
($0)
$62
$78
$63
104



Q2
S
11421
($0)
$124
$0
$120
7



Q2
S
11440
($0)
$122
$105
$118
29



Q2
S
12032
($1)
$224
$221
$218
7



Q2
S
11403
($1)
$183
$0
$163
5



Q2
S
11441
($1)
$163
$169
$148
9



Q2
S
11401
($1)
$120
$111
$106
129



Q2
S
11402
($1)
$157
$134
$137
70



Q2
S
17000
($2)
$61
$63
$62
707











S Total
$5












Q2 Total
$2

















Q3
A
0551
$0
$85
$0
$85
1



Q3
A
88321
$0
$85
$85
$85
8



Q3
A
88342
$0
$159
$117
$148
7



Q3
A
0490
$0
$56
$0
$56
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
A
AS
($0)
$219
$65
$226
2



Q3
A
88305
($3)
$31
$31
$31
2,048











A Total
($3)

















Q3
M
99243
$9
$129
$128
$129
2,004



Q3
M
99213
$0
$55
$53
$55
2,351



Q3
M
99241
$0
$53
$53
$53
100



Q3
M
99212
$0
$40
$38
$39
488



Q3
M
99203
$0
$95
$95
$106
82



Q3
M
99202
$0
$61
$56
$67
51



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
M
99204
($0)
$0
$147
$144
2



Q3
M
99244
($0)
$185
$185
$184
3



Q3
M
99214
($0)
$88
$90
$91
23



Q3
M
99242
($1)
$97
$97
$97
699











M Total
$9

















Q3
p
L1B
$0
$10
$0
$11
2



Q3
p
L1A
$0
$54
$0
$54
1



Q3
p
Z2A
$0
$0
$2
$2
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
p
Z2G
($0)
$8
$5
$7
22



Q3
p
H3A
($0)
$2
$1
$1
272



Q3
p
Q5N
($0)
$4
$0
$5
16











P Total
($0)

















Q3
S
11306
$2
$61
$71
$63
283



Q3
S
11311
$2
$77
$85
$79
297



Q3
S
17000
$1
$63
$59
$62
1,580



Q3
S
11301
$1
$61
$62
$62
742



Q3
S
11403
$1
$178
$128
$163
69



Q3
S
11440
$1
$117
$106
$118
108



Q3
S
11310
$0
$57
$48
$59
251



Q3
S
11404
$0
$198
$208
$196
24



Q3
S
17106
$0
$364
$0
$367
12



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
S
11441
$0
$146
$161
$148
58



Q3
S
12031
$0
$169
$142
$170
44



Q3
S
11402
$0
$136
$132
$137
177



Q3
S
11302
$0
$89
$82
$81
174



Q3
S
54056
$0
$167
$0
$160
6



Q3
S
11424
$0
$230
$0
$222
4



Q3
S
67810
$0
$257
$0
$170
7



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
S
11901
$0
$49
$0
$54
7



Q3
S
11401
$0
$108
$92
$106
270



Q3
S
11426
$0
$282
$0
$262
1



Q3
S
17004
$0
$54
$0
$61
15



Q3
S
11444
$0
$280
$0
$294
1



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q3
S
11305
($1)
$37
$41
$40
119



Q3
S
11101
($1)
$39
$38
$41
78



Q3
S
11400
($1)
$87
$74
$93
102



Q3
S
11300
($2)
$43
$42
$44
189



Q3
S
11100
($3)
$86
$77
$86
350











S Total
$4












Q3 Total
$10

















Q4
A
88305
$9
$31
$31
$31
1,581



Q4
A
AS
$0
$257
$0
$226
2



Q4
A
ER
$0
$153
$0
$123
2



Q4
A
S0630
$0
$43
$0
$41
5



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q4
A
85025
($0)
$0
$3
$3
13



Q4
A
84460
($0)
$0
$4
$4
3



Q4
A
80053
($0)
$0
$5
$5
14



Q4
A
80061
($0)
$0
$8
$8
8



Q4
A
88321
($0)
$0
$85
$85
1











A Total
$10

















Q4
M
99242
$8
$97
$96
$97
672



Q4
M
99243
$8
$130
$125
$129
931



Q4
M
99212
$2
$39
$40
$39
331



Q4
M
99203
$1
$138
$101
$106
55



Q4
M
99202
$0
$87
$61
$67
32



Q4
M
99214
$0
$88
$109
$91
31



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q4
M
99395
($0)
$0
$56
$56
2



Q4
M
99204
($0)
$0
$147
$144
1



Q4
M
99241
($0)
$53
$0
$53
1



Q4
M
99213
($2)
$56
$55
$55
939











M Total
$19

















Q4
P
Q5N
$0
$5
$4
$5
29



Q4
P
J3301
$0
$8
$5
$10
10



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q4
P
L9B
($0)
$2
$3
$2
9











P Total
$0

















Q4
R
76942
$0
$0
$158
$99
1











R Total
$0

















Q4
S
11401
$6
$99
$83
$106
270



Q4
S
11402
$4
$128
$124
$137
169



Q4
S
11400
$2
$84
$102
$93
151



Q4
S
11300
$2
$41
$36
$44
264



Q4
S
11441
$2
$150
$117
$148
61



Q4
S
11421
$2
$119
$0
$120
62



Q4
S
11440
$2
$116
$123
$118
74



Q4
S
12031
$1
$172
$145
$170
44



Q4
S
11100
$1
$82
$77
$86
355



Q4
S
11422
$1
$146
$0
$143
32



Q4
S
11420
$1
$87
$0
$89
45



Q4
S
12032
$1
$222
$162
$218
27



Q4
S
13101
$1
$319
$0
$319
8



Q4
S
11442
$1
$184
$168
$172
19



Q4
S
11307
$0
$89
$0
$91
33



Q4
S
11312
$0
$102
$0
$99
33



Q4
S
67810
$0
$119
$0
$170
16



Q4
S
11403
$0
$131
$198
$163
32



Q4
S
11406
$0
$223
$252
$233
7



Q4
S
40490
$0
$113
$0
$112
12



Q4
S
11310
$0
$61
$50
$59
100



Q4
S
11308
$0
$103
$0
$103
9



Q4
S
11303
$0
$100
$92
$100
10



Q4
S
11305
$0
$38
$41
$40
101



Q4
S
13131
$0
$315
$0
$315
2



Q4
S
11101
$0
$39
$38
$41
95



Q4
S
12051
$0
$224
$232
$219
4



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



.
.
.
.
.
.
.
.



Q4
S
17106
($0)
$391
$0
$367
2



Q4
S
54056
($0)
$121
$0
$160
1



Q4
S
11404
($0)
$184
$109
$196
5



Q4
S
11443
($0)
$222
$0
$210
1



Q4
S
11302
($0)
$76
$66
$81
77



Q4
S
11306
($0)
$70
$36
$63
91



Q4
S
11311
($1)
$80
$40
$79
74



Q4
S
11301
($2)
$61
$44
$62
250



Q4
S
17000
($3)
$59
$54
$62
552











S Total
$23












Q4 Total
$51




Grand Total
$24
















TABLE A9





Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role benign neoplasm of the skin without actinic keratoses diagnosis 702.xx


etg 0682


Cost driver threshold $2 (rounded value)




















quartile
category
services
service description
Total Svcs
Your Svcs





Q1
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,008
1,723












A Total

2,008
1,723












Q1
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
2,356
2,184





EXPAND PROB




Q1
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
253
229





PROB FOCUS EX




Q1
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
341
327





HX;EXPAND PROB




Q1
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX;
536
510





DETAILED EXAM; MED














M Total

3,486
3,250












Q1
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
1,343
1,320





CUTANEOUS VASC P




Q1
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
524
509


Q1
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
94
89





TRUNK/ARMS/L




Q1
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
465
448


Q1
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
585
573


Q1
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
67
63





TRUNK/ARMS/L




Q1
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
98
93





TRUNK/ARMS/L














S Total

3,176
3,095










Q1 Total

8,670
8,068












Q2
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,823
2,414












A Total

2,823
2,414












Q2
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
445
417





HX;EXPAND PROB




Q2
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
183
150





PROB FOCUS EX




Q2
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX;
779
756





DETAILED EXAM; MED




Q2
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
999
776





EXPAND PROB














M Total

2,406
2,099












Q2
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
580
567


Q2
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
236
234


Q2
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADDL LESION
307
302


Q2
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
671
654


Q2
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
285
274





DIAMETER 0.5 CM/<




Q2
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
374
357


Q2
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
167
165





MEMBRANE; DIAME




Q2
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
97
96





TRUNK/ARMS/L




Q2
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
140
135





MEMBRANE; DIAME




Q2
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
144
139





DIAMETER 0.6-1.0




Q2
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
145
136





TRUNK/ARMS/L




Q2
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
72
69





TRUNK/ARMS/L




Q2
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
758
722





CUTANEOUS VASC P














S Total

3,976
3,850










Q2 Total

9,205
8,363












Q3
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
3,056
2,549












A Total

3,056
2,549












Q3
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX:
2,013
1,983





DETAILED EXAM; MED




Q3
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
2,464
2,063





EXPAND PROB




Q3
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
511
439





PROB FOCUS EX




Q3
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
705
680





HX; EXPAND PROB














M Total

5,693
5,165












Q3
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
521
518





DIAMETER 0.6-1.0




Q3
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
444
438





MEMBRANE; DIAME




Q3
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
1,711
1,683





CUTANEOUS VASC P




Q3
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
1,130
1,092


Q3
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
75
71





TRUNK/ARMS/L




Q3
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/
132
119





NOSE/LIPS/M




Q3
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
327
317





MEMBRANE; DIAME




Q3
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
193
185





TRUNK/ARMS/L




Q3
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
191
187


Q3
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
335
317





TRUNK/ARMS/L




Q3
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
367
325












S Total

5,426
5,252










Q3 Total

14,175
12,966












Q4
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
2,869
2,614












A Total

2,869
2,614












Q4
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
675
664





HX;EXPAND PROB




Q4
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX;
936
907





DETAILED HX; DETAILED EXAM; MED




Q4
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX;
364
307





PROB FOCUS EX




Q4
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX;
55
35





DETAILED EXAM;




Q4
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
995
742





EXPAND PROB














M Total

3,025
2,655












Q4
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
388
378





TRUNK/ARMS/L




Q4
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
199
194





TRUNK/ARMS/L




Q4
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG,
191
190





TRUNK/ARMS/L




Q4
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
479
473


Q4
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/
69
67





NOSE/LIPS/M




Q4
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/
68
68





HANDS/FEET/GE




Q4
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/
93
92





EYELIDS/NOSE/LIPS/M




Q4
S
12031
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES;
47
44





2.5 CM/<




Q4
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
358
334


Q4
S
12032
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES;
27
26





2.6-7.5 CM




Q4
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
133
124





MEMBRANE; DIAME




Q4
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
147
143





DIAMETER 0.5 CM/<




Q4
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
92
87


Q4
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA;
117
113





DIAMETER 0.6-1.0




Q4
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS
83
82





MEMBRANE; DIAME




Q4
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
338
334


Q4
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/
612
589





CUTANEOUS VASC P














S Total

3,441
3,338










Q4 Total

9,335
8,607


Grand Total

41,385
38,004























Other
Expected
Quartile


Others

Total Cost


quartile
category
services
Svcs
Svcs
episodes
Total Costs
Your Costs
Costs
Expected Costs
Difference





Q1
A
88305
285
3105.38
6,455
$62,122
$53,278
$8,844
$96,026
($33,904)

















A Total
285


$62,122
$53,278
$8,844
$96,026
($33,904)

















Q1
M
99213
172
1967.28
6,455
$130,482
$121,036
$9,446
$108,522
$21,960


Q1
M
99212
24
378.50
6,455
$9,866
$8,935
$931
$14,840
($4,974)


Q1
M
99242
14
625.35
6,455
$32,863
$31,514
$1,349
$60,757
($27,894)


Q1
M
99243
26
1231.06
6,455
$69,132
$65,789
$3,343
$158,856
($89,724)

















M Total
236


$242,343
$227,274
$15,069
$342,975
($100,632)

















Q1
S
17000
23
1277.26
6,455
$86,301
$84,932
$1,369
$79,652
$6,649


Q1
S
11300
15
472.33
6,455
$24,845
$24,100
$745
$20,778
$4,067


Q1
S
11400
5
147.82
6,455
$10,040
$9,466
$574
$13,774
($3,734)


Q1
S
11100
17
511.02
6,455
$39,576
$38,139
$1,437
$43,864
($4,288)


Q1
S
11301
12
786.45
6,455
$39,819
$39,200
$619
$48,630
($8,811)


Q1
S
11402
4
153.31
6,455
$9,737
$9,105
$632
$21,014
($11,277)


Q1
S
11401
5
278.89
6,455
$10,989
$10,532
$457
$29,553
($18,564)

















S Total
81


$221,307
$215,474
$5,833
$257,266
($35,959)















Q1 Total
602


$525,772
$496,026
$29,746
$696,267
($170,495)

















Q2
A
88305
409
2137.44
4,443
$87,190
$74,527
$12,663
$66,095
$21,095

















A Total
409


$87,190
$74,527
$12,663
$66,095
$21,095

















Q2
M
99242
28
430.43
4,443
$43,318
$40,616
$2,702
$41,819
$1,499


Q2
M
99212
33
260.52
4,443
$7,280
$5,990
$1,290
$10,215
($2,935)


Q2
M
99243
23
847.35
4,443
$100,552
$97,581
$2,971
$109,341
($8,789)


Q2
M
99213
223
1354.08
4,443
$55,484
$43,371
$12,113
$74,696
($19,212)

















M Total
307


$206,634
$187,558
$19,076
$236,071
($29,437)

















Q2
S
11100
13
351.74
4,443
$51,962
$50,826
$1,136
$30,192
$21,770


Q2
S
11302
2
113.07
4,443
$17,768
$17,591
$177
$9,122
$8,646


Q2
S
11101
5
126.39
4,443
$13,545
$13,367
$178
$5,203
$8,342


Q2
S
11301
17
541.32
4,443
$38,844
$37,832
$1,012
$33,472
$5,372


Q2
S
11305
11
151.62
4,443
$10,542
$10,043
$499
$6,011
$4,531


Q2
S
11300
17
325.11
4,443
$16,356
$15,573
$783
$14,302
$2,054


Q2
S
11311
2
150.63
4,443
$13,139
$12,949
$190
$11,828
$1,311


Q2
S
11400
1
101.75
4,443
$10,317
$10,210
$107
$9,481
$836


Q2
S
11310
5
143.87
4,443
$8,226
$7,886
$340
$8,510
($284)


Q2
S
11306
5
165.34
4,443
$8,946
$8,558
$388
$10,481
($1,535)


Q2
S
11401
9
191.96
4,443
$17,276
$16,281
$995
$20,341
($3,065)


Q2
S
11402
3
105.52
4,443
$11,261
$10,858
$403
$14,464
($3,203)


Q2
S
17000
36
879.14
4,443
$45,979
$43,698
$2,281
$54,825
($8,846)

















S Total
126


$264,161
$255,672
$8,489
$228,231
$35,930















Q2 Total
842


$557,985
$517,757
$40,228
$530,397
$27,588

















Q3
A
88305
507
3746.66
7,788
$94,768
$79,088
$15,680
$115,856
($21,088)

















A Total
507


$94,768
$79,088
$15,680
$115,856
($21,088)

















Q3
M
99243
30
1485.29
7,788
$259,400
$255,556
$3,844
$191,661
$67,739


Q3
M
99213
401
2373.53
7,788
$134,726
$113,540
$21,186
$130,933
$3,793


Q3
M
99212
72
456.66
7,788
$20,119
$17,403
$2,716
$17,905
$2,214


Q3
M
99242
25
754.49
7,788
$68,631
$66,197
$2,434
$73,303
($4,672)

















M Total
528


$482,876
$452,696
$30,180
$413,802
$69,074

















Q3
S
11306
3
289.81
7,788
$31,883
$31,670
$213
$18,371
$13,512


Q3
S
11311
6
264.04
7,788
$34,032
$33,524
$508
$20,732
$13,300


Q3
S
17000
28
1541.02
7,788
$107,753
$106,108
$1,645
$96,101
$11,652


Q3
S
11301
38
948.86
7,788
$69,328
$66,961
$2,367
$58,672
$10,656


Q3
S
11403
4
41.45
7,788
$13,183
$12,672
$511
$6,769
$6,414


Q3
S
11440
13
95.09
7,788
$15,293
$13,920
$1,373
$11,179
$4,114


Q3
S
11310
10
252.19
7,788
$18,610
$18,126
$484
$14,916
$3,694


Q3
S
11402
8
184.96
7,788
$26,296
$25,237
$1,059
$25,354
$942


Q3
S
11302
4
198.20
7,788
$16,910
$16,582
$328
$15,990
$920


Q3
S
11401
18
336.49
7,788
$35,760
$34,110
$1,650
$35,656
$104


Q3
S
11100
42
616.55
7,788
$31,241
$28,008
$3,233
$52,922
($21,681)

















S Total
174


$400,289
$386,918
$13,371
$356,662
$43,627















Q3 Total
1,209


$977,933
$918,702
$59,231
$886,320
$91,613

















Q4
A
88305
255
1766.53
3,672
$88,522
$80,632
$7,890
$54,625
$33,897

















A Total
255


$88,522
$80,632
$7,890
$54,625
$33,897

















Q4
M
99242
11
355.74
3,672
$65,629
$64,578
$1,051
$34,562
$31,067


Q4
M
99243
29
700.30
3,672
$121,141
$117,517
$3,624
$90,367
$30,774


Q4
M
99212
57
215.31
3,672
$14,137
$11,867
$2,270
$8,442
$5,695


Q4
M
99203
20
26.28
3,672
$6,851
$4,826
$2,025
$2,785
$4,066


Q4
M
99213
253
1119.11
3,672
$55,194
$41,218
$13,976
$61,734
($6,540)

















M Total
370


$262,952
$240,006
$22,946
$197,890
$65,062

















Q4
S
11401
10
158.65
3,672
$38,337
$37,510
$827
$16,812
$21,525


Q4
S
11402
5
87.21
3,672
$25,492
$24,873
$619
$11,954
$13,538


Q4
S
11400
1
84.09
3,672
$16,076
$15,974
$102
$7,836
$8,240


Q4
S
11300
6
268.69
3,672
$19,559
$19,344
$215
$11,820
$7,739


Q4
S
11441
2
24.96
3,672
$10,271
$10,038
$233
$3,687
$6,584


Q4
S
11421
0
20.04
3,672
$8,103
$8,103
$0
$2,403
$5,700


Q4
S
11440
1
44.84
3,672
$10,809
$10,686
$123
$5,271
$5,538


Q4
S
12031
3
19.05
3,672
$8,025
$7,589
$436
$3,234
$4,791


Q4
S
11100
24
290.70
3,672
$29,152
$27,305
$1,847
$24,953
$4,199


Q4
S
12032
1
16.26
3,672
$5,932
$5,770
$162
$3,543
$2,389


Q4
S
11310
9
118.91
3,672
$8,001
$7,555
$446
$7,033
$968


Q4
S
11305
4
125.31
3,672
$5,579
$5,417
$162
$4,968
$611


Q4
S
11302
5
93.45
3,672
$6,952
$6,621
$331
$7,539
($587)


Q4
S
11306
4
136.64
3,672
$8,064
$7,920
$144
$8,662
($598)


Q4
S
11311
1
124.49
3,672
$6,633
$6,593
$40
$9,775
($3,142)


Q4
S
11301
4
447.38
3,672
$20,447
$20,270
$177
$27,664
($7,217)


Q4
S
17000
23
726.58
3,672
$35,855
$34,605
$1,250
$45,311
($9,456)

















S Total
103


$263,287
$256,173
$7,114
$202,465
$60,822















Q4 Total
728


$614,761
$576,811
$37,950
$454,980
$159,781


Grand Total
3,381


$2,676,451
$2,509,296
$167,155
$2,567,965
$108,486




























episodes






Total Costs
Difference

Other
Spec
this






per stratum
per stratum
Your costs
costs per
costs per
service



quartile
category
services
episodes
episodes
per svc
svc
svc
occurred






Q1
A
88305
$10
($5)
$31
$31
$31
11,403

















A Total
$10
($5)



1,403

















Q1
M
99213
$20
$3
$55
$55
$55
2,261



Q1
M
99212
$2
($1)
$39
$39
$39
249



Q1
M
99242
$5
($4)
$96
$96
$97
339



Q1
M
99243
$11
($14)
$129
$129
$129
529

















M Total
$38
($16)



3,378

















Q1
S
17000
$13
$1
$64
$60
$62
1,215



Q1
S
11300
$4
$1
$47
$50
$44
398



Q1
S
11400
$2
($1)
$106
$115
$93
88



Q1
S
11100
$6
($1)
$85
$85
$86
458



Q1
S
11301
$6
($1)
$68
$52
$62
462



Q1
S
11402
$2
($2)
$145
$158
$137
64



Q1
S
11401
$2
($3)
$113
$91
$106
92

















S Total
$34
($6)



2,777















Q1 Total
$81
($26)



7,558

















Q2
A
88305
$20
$5
$31
$31
$31
1,760

















A Total
$20
$5



1,760

















Q2
M
99242
$10
$0
$97
$97
$97
440



Q2
M
99212
$2
($1)
$40
$39
$39
173



Q2
M
99243
$23
($2)
$129
$129
$129
767



Q2
M
99213
$12
($4)
$56
$54
$55
959

















M Total
$47
($7)



2,339

















Q2
S
11100
$12
$5
$90
$87
$86
574



Q2
S
11302
$4
$2
$75
$89
$81
183



Q2
S
11101
$3
$2
$44
$36
$41
181



Q2
S
11301
$9
$1
$58
$60
$62
437



Q2
S
11305
$2
$1
$37
$45
$40
126



Q2
S
11300
$4
$0
$44
$46
$44
247



Q2
S
11311
$3
$0
$78
$95
$79
137



Q2
S
11400
$2
$0
$106
$107
$93
92



Q2
S
11310
$2
($0)
$58
$68
$59
104



Q2
S
11306
$2
($0)
$62
$78
$63
104



Q2
S
11401
$4
($1)
$120
$111
$106
129



Q2
S
11402
$3
($1)
$157
$134
$137
70



Q2
S
17000
$10
($2)
$61
$63
$62
707

















S Total
$59
$8



3,091















Q2 Total
$126
$6



7,190

















Q3
A
88305
$12
($3)
$31
$31
$31
2,048

















A Total
$12
($3)



2,048

















Q3
M
99243
$33
$9
$129
$128
$129
2,004



Q3
M
99213
$17
$0
$55
$53
$55
2,351



Q3
M
99212
$3
$0
$40
$38
$39
488



Q3
M
99242
$9
($1)
$97
$97
$97
699

















M Total
$62
$9



5,542

















Q3
S
11306
$4
$2
$61
$71
$63
283



Q3
S
11311
$4
$2
$77
$85
$79
297



Q3
S
17000
$14
$1
$63
$59
$62
1,580



Q3
S
11301
$9
$1
$61
$62
$62
742



Q3
S
11403
$2
$1
$178
$128
$163
69



Q3
S
11440
$2
$1
$117
$106
$118
108



Q3
S
11310
$2
$0
$57
$48
$59
251



Q3
S
11402
$3
$0
$136
$132
$137
177



Q3
S
11302
$2
$0
$89
$82
$81
174



Q3
S
11401
$5
$0
$108
$92
$106
270



Q3
S
11100
$4
($3)
$86
$77
$86
350

















S Total
$51
$6



4,301















Q3 Total
$126
$12



11,891

















Q4
A
88305
$24
$9
$31
$31
$31
1,581

















A Total
$24
$9



1,581

















Q4
M
99242
$18
$8
$97
$96
$97
672



Q4
M
99243
$33
$8
$130
$125
$129
931



Q4
M
99212
$4
$2
$39
$40
$39
331



Q4
M
99203
$2
$1
$138
$101
$106
55



Q4
M
99213
$15
($2)
$56
$55
$55
939

















M Total
$72
$18



2,928

















Q4
S
11401
$10
$6
$99
$83
$106
270



Q4
S
11402
$7
$4
$128
$124
$137
169



Q4
S
11400
$4
$2
$84
$102
$93
151



Q4
S
11300
$5
$2
$41
$36
$44
264



Q4
S
11441
$3
$2
$150
$117
$148
61



Q4
S
11421
$2
$2
$119
$0
$120
62



Q4
S
11440
$3
$2
$116
$123
$118
74



Q4
S
12031
$2
$1
$172
$145
$170
44



Q4
S
11100
$8
$1
$82
$77
$86
355



Q4
S
12032
$2
$1
$222
$162
$218
27



Q4
S
11310
$2
$0
$61
$50
$59
100



Q4
S
11305
$2
$0
$38
$41
$40
101



Q4
S
11302
$2
($0)
$76
$66
$81
77



Q4
S
11306
$2
($0)
$70
$36
$63
91



Q4
S
11311
$2
($1)
$80
$40
$79
74



Q4
S
11301
$6
($2)
$61
$44
$62
250



Q4
S
17000
$10
($3)
$59
$54
$62
552

















S Total
$72
$17



2,722















Q4 Total
$167
$44



7,231



Grand Total
$500
$35



33,870
















TABLE A10





Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total role benign neoplasm of the skin, without actinic keratoses


etg 0682























Total


Provider ID
category
services
service description
Svcs





CCP010000014
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
645


CCP010000014
A
S0630
Removal of sutures by a physician other than the physician who originall
3


CCP010000014
A
A4649
Surgical supply; miscellaneous
1


CCP010000014
A
88307
LEVEL V—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
1


CCP010000014
A
93000
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; W/INTERPRETATION & REPO
2


CCP010000014
A
A4550
Surgical trays
1


CCP010000014
A
88312
SPECIAL STAINS; GROUP I, MICROORGANISMS, EACH
4


CCP010000014
A
86644
ANTIBODY; CYTOMEGALOVIRUS (CMV)
1


CCP010000014
A
86777
ANTIBODY; TOXOPLASMA
1


CCP010000014
A
82947
GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)
2


CCP010000014
A
86140
C-REACTIVE PROTEIN
2


CCP010000014
A
85025
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, & PLATELET) &
7


CCP010000014
A
80003

1


CCP010000014
A
80005

1


CCP010000014
A
82040
ALBUMIN; SERUM
1


CCP010000014
A
80051
ELECTROLYTE PANEL
1


CCP010000014
A
85651
SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
2


CCP010000014
A
84450
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
2


CCP010000014
A
82565
CREATININE; BLOOD
1


CCP010000014
A
85730
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA/WHOLE BLOOD
1


CCP010000014
A
85652
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
1


CCP010000014
A
85014
BLOOD COUNT; HEMATOCRIT
1


CCP010000014
A
80053
COMPREHENSIVE METABOLIC PANEL
5


CCP010000014
A
80048
BASIC METABOLIC PANEL
3


CCP010000014
A
80050
GENERAL HEALTH PANEL
1


CCP010000014
A
85027
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, & PLATELET)
2


CCP010000014
A
82270
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTAN
1


CCP010000014
A
88304
LEVEL III—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
3


CCP010000014
A
80061
LIPID PANEL
2











A Total

699











CCP010000014
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED EXAM; MED
255


CCP010000014
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX; DETAILED EXAM:
33


CCP010000014
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX; EXPAND PROB
129


CCP010000014
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND PROB
320


CCP010000014
M
99202
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX; EXPAND
15


CCP010000014
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED EXAM;
8


CCP010000014
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE, TYPICALLY 5
2


CCP010000014
M
99395
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 18-39
1


CCP010000014
M
99396
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 40-64
1


CCP010000014
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB FOCUS EX
32











M Total

796











CCP010000014
P
J3301
Injection, triamcinolone acetonide, per 10 mg
1


CCP010000014
P
Z2A
ANTIHISTAMINES
1


CCP010000014
P
S2B
NSAIDS, CYCLOOXYGENASE INHIBITOR—TYPE
157


CCP010000014
P
L9B
VITAMIN A DERIVATIVES
55


CCP010000014
P
H3A
ANALGESICS, NARCOTICS
502


CCP010000014
P
Z2G
IMMUNOMODULATORS
28











P Total

744











CCP010000014
S
11401
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
131


CCP010000014
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
113


CCP010000014
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
42


CCP010000014
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
48


CCP010000014
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
35


CCP010000014
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
39


CCP010000014
S
11420
EXCISE BENIGN SKIN LESION W/MARG, EXCPT SKIN TAG SCALP/NECK/HANDS/FEET/
34


CCP010000014
S
11422
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
12


CCP010000014
S
11442
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
9


CCP010000014
S
11307
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 1.1-2.0
12


CCP010000014
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 0.6-1.0
41


CCP010000014
S
11308
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER >2.0 CM
7


CCP010000014
S
11303
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER >2.0 CM
6


CCP010000014
S
11446
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11444
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11312
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
7


CCP010000014
S
11423
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
2


CCP010000014
S
11424
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
1


CCP010000014
S
11443
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11900
INJECTION, INTRALESIONAL; UP TO & INCL 7 LESIONS
2


CCP010000014
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
5


CCP010000014
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
22


CCP010000014
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
19


CCP010000014
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 0.5 CM/<
22


CCP010000014
S
12032
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES; 2.6-7.5 CM
1


CCP010000014
S
17003
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/CUTANEOUS VASC P
31


CCP010000014
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
8


CCP010000014
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
15


CCP010000014
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
30


CCP010000014
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
77


CCP010000014
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
29


CCP010000014
S
17110
DESTRUCTION, FLAT WARTS, MOLLUSCUM CONTAGIOSUM/MILIA; UP TO 14 LESIONS
8


CCP010000014
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/CUTANEOUS VASC P
7











S Total

818









CCP010000014 Total

3,057

























Expected
Practitioner






Provider ID
category
services
Your Svcs
Other Svcs
Svcs
episodes
Total Costs
Your Costs
Others Costs
Expected Costs





CCP010000014
A
88305
638
7
451.73
939
$19,902
$19,685
$217
$13,969


CCP010000014
A
S0630
3
0
.46
939
$148
$148
$0
$19


CCP010000014
A
A4649
1
0
.04
939
$73
$73
$0
$3


CCP010000014
A
88307
1
0
.08
939
$68
$68
$0
$6


CCP010000014
A
93000
0
2
.71
939
$79
$0
$79
$22


CCP010000014
A
A4550
1
0
.04
939
$49
$49
$0
$2


CCP010000014
A
88312
4
0
2.60
939
$64
$64
$0
$42


CCP010000014
A
86644
0
1
.17
939
$14
$0
$14
$2


CCP010000014
A
86777
0
1
.04
939
$8
$0
$8
$0


CCP010000014
A
82947
0
2
1.13
939
$8
$0
$8
$3


CCP010000014
A
86140
0
2
.21
939
$6
$0
$6
$1


CCP010000014
A
85025
0
7
5.33
939
$21
$0
$21
$16


CCP010000014
A
80003
0
1
.08
939
$5
$0
$5
$0


CCP010000014
A
80005
0
1
.08
939
$5
$0
$5
$0


CCP010000014
A
82040
0
1
.17
939
$5
$0
$5
$1


CCP010000014
A
80051
0
1
.08
939
$4
$0
$4
$0


CCP010000014
A
85651
0
2
.21
939
$4
$0
$4
$0


CCP010000014
A
84450
0
2
1.01
939
$6
$0
$6
$3


CCP010000014
A
82565
0
1
.55
939
$5
$0
$5
$2


CCP010000014
A
85730
0
1
.25
939
$3
$0
$3
$1


CCP010000014
A
85652
0
1
.17
939
$2
$0
$2
$0


CCP010000014
A
85014
0
1
.50
939
$2
$0
$2
$1


CCP010000014
A
80053
0
5
5.12
939
$25
$0
$25
$26


CCP010000014
A
80048
0
3
3.40
939
$9
$0
$9
$11


CCP010000014
A
80050
0
1
1.13
939
$14
$0
$14
$16


CCP010000014
A
85027
0
2
3.19
939
$4
$0
$4
$7


CCP010000014
A
82270
0
1
1.72
939
$2
$0
$2
$6


CCP010000014
A
88304
3
0
3.49
939
$45
$45
$0
$53


CCP010000014
A
80061
0
2
3.86
939
$16
$0
$16
$31

















A Total
651
48
487.60

$20,596
$20,132
$464
$14,243

















CCP010000014
M
99243
252
3
179.08
939
$33,762
$33,384
$378
$23,109


CCP010000014
M
99203
29
4
6.72
939
$4,725
$4,241
$484
$712


CCP010000014
M
99242
127
2
90.97
939
$12,829
$12,653
$176
$8,838


CCP010000014
M
99213
266
54
286.18
939
$18,609
$15,059
$3,550
$15,787


CCP010000014
M
99202
15
0
4.16
939
$1,395
$1,395
$0
$277


CCP010000014
M
99214
1
7
4.91
939
$904
$88
$816
$446


CCP010000014
M
99211
0
2
.46
939
$70
$0
$70
$11


CCP010000014
M
99395
0
1
.76
939
$56
$0
$56
$42


CCP010000014
M
99396
0
1
2.10
939
$56
$0
$56
$118


CCP010000014
M
99212
23
9
55.06
939
$1,328
$912
$416
$2,159

















M Total
713
83
630.40

$73,734
$67,732
$6,002
$51,498

















CCP010000014
P
J3301
1
0
.88
939
$25
$25
$0
$9


CCP010000014
P
Z2A
1
0
4.79
939
$5
$5
$0
$10


CCP010000014
P
S2B
20
137
164.00
939
$65
$15
$50
$216


CCP010000014
P
L9B
0
55
144.47
939
$191
$0
$191
$351


CCP010000014
P
H3A
60
442
544.43
939
$483
$83
$400
$699


CCP010000014
P
Z2G
0
28
85.51
939
$134
$0
$134
$592

















P Total
82
662
944.08

$903
$128
$775
$1,876

















CCP010000014
S
11401
128
3
40.57
939
$14,782
$14,574
$208
$4,299


CCP010000014
S
11400
113
0
21.50
939
$10,270
$10,270
$0
$2,004


CCP010000014
S
11441
41
1
6.38
939
$6,485
$6,337
$148
$943


CCP010000014
S
11440
48
0
11.47
939
$6,017
$6,017
$0
$1,348


CCP010000014
S
11421
35
0
5.12
939
$4,541
$4,541
$0
$614


CCP010000014
S
11402
39
0
22.30
939
$6,600
$6,600
$0
$3,057


CCP010000014
S
11420
34
0
4.62
939
$2,950
$2,950
$0
$413


CCP010000014
S
11422
12
0
2.65
939
$2,034
$2,034
$0
$377


CCP010000014
S
11442
9
0
2.39
939
$1,912
$1,912
$0
$411


CCP010000014
S
11307
12
0
4.16
939
$1,106
$1,106
$0
$378


CCP010000014
S
11306
41
0
34.94
939
$2,887
$2,887
$0
$2,215


CCP010000014
S
11308
7
0
.46
939
$696
$696
$0
$48


CCP010000014
S
11303
6
0
1.34
939
$549
$549
$0
$135


CCP010000014
S
11446
1
0
.04
939
$371
$371
$0
$16


CCP010000014
S
11444
1
0
.08
939
$307
$307
$0
$25


CCP010000014
S
11312
7
0
4.96
939
$766
$766
$0
$488


CCP010000014
S
11423
2
0
.97
939
$390
$390
$0
$170


CCP010000014
S
11424
1
0
.25
939
$244
$244
$0
$56


CCP010000014
S
11443
1
0
.63
939
$222
$222
$0
$132


CCP010000014
S
11900
2
0
.97
939
$55
$55
$0
$46


CCP010000014
S
11403
5
0
5.00
939
$755
$755
$0
$816


CCP010000014
S
11310
21
1
30.41
939
$1,435
$1,365
$70
$1,798


CCP010000014
S
11101
19
0
26.71
939
$734
$734
$0
$1,100


CCP010000014
S
11305
22
0
32.04
939
$850
$850
$0
$1,270


CCP010000014
S
12032
1
0
4.16
939
$223
$223
$0
$906


CCP010000014
S
17003
28
3
305.24
939
$87
$60
$27
$1,221


CCP010000014
S
11302
8
0
23.90
939
$683
$683
$0
$1,928


CCP010000014
S
11311
15
0
31.83
939
$1,233
$1,233
$0
$2,500


CCP010000014
S
11300
30
0
68.71
939
$1,300
$1,300
$0
$3,023


CCP010000014
S
11301
77
0
114.40
939
$4,307
$4,307
$0
$7,074


CCP010000014
S
11100
28
1
74.34
939
$2,608
$2,524
$84
$6,381


CCP010000014
S
17110
8
0
111.59
939
$507
$507
$0
$6,256


CCP010000014
S
17000
6
1
185.80
939
$454
$396
$58
$11,587

















S Total
808
10
1179.94

$78,360
$77,765
$595
$63,034















CCP010000014 Total
2,254
803
3242.02

$173,593
$165,757
$7,836
$130,651

























Total Costs
Difference



episodes this






Total Cost
per stratum
per stratum
Your costs
Other costs
Spec costs
service



Provider ID
category
services
Difference
episodes
episodes
per svc
per svc
per svc
occurred






CCP010000014
A
88305
$5,933
$21
$6
$31
$31
$31
349



CCP010000014
A
S0630
$129
$0
$0
$49
$0
$41
3



CCP010000014
A
A4649
$70
$0
$0
$73
$0
$73
1



CCP010000014
A
88307
$62
$0
$0
$68
$0
$68
1



CCP010000014
A
93000
$57
$0
$0
$0
$40
$31
2



CCP010000014
A
A4550
$47
$0
$0
$49
$0
$49
1



CCP010000014
A
88312
$22
$0
$0
$16
$0
$16
2



CCP010000014
A
86644
$12
$0
$0
$0
$14
$14
1



CCP010000014
A
86777
$8
$0
$0
$0
$8
$8
1



CCP010000014
A
82947
$5
$0
$0
$0
$4
$2
2



CCP010000014
A
86140
$5
$0
$0
$0
$3
$3
2



CCP010000014
A
85025
$5
$0
$0
$0
$3
$3
7



CCP010000014
A
80003
$5
$0
$0
$0
$5
$5
1



CCP010000014
A
80005
$5
$0
$0
$0
$5
$5
1



CCP010000014
A
82040
$4
$0
$0
$0
$5
$6
1



CCP010000014
A
80051
$4
$0
$0
$0
$4
$4
1



CCP010000014
A
85651
$4
$0
$0
$0
$2
$2
2



CCP010000014
A
84450
$3
$0
$0
$0
$3
$3
1



CCP010000014
A
82565
$3
$0
$0
$0
$5
$4
1



CCP010000014
A
85730
$2
$0
$0
$0
$3
$3
1



CCP010000014
A
85652
$2
$0
$0
$0
$2
$2
1



CCP010000014
A
85014
$1
$0
$0
$0
$2
$2
1



CCP010000014
A
80053
($1)
$0
($0)
$0
$5
$5
5



CCP010000014
A
80048
($2)
$0
($0)
$0
$3
$3
3



CCP010000014
A
80050
($2)
$0
($0)
$0
$14
$14
1



CCP010000014
A
85027
($3)
$0
($0)
$0
$2
$2
2



CCP010000014
A
82270
($4)
$0
($0)
$0
$2
$3
1



CCP010000014
A
88304
($8)
$0
($0)
$15
$0
$15
3



CCP010000014
A
80061
($15)
$0
($0)
$0
$8
$8
2















A Total
$6,353
$22
$7



















CCP010000014
M
99243
$10,653
$36
$11
$132
$126
$129
254



CCP010000014
M
99203
$4,013
$5
$4
$146
$121
$106
33



CCP010000014
M
99242
$3,991
$14
$4
$100
$88
$97
129



CCP010000014
M
99213
$2,822
$20
$3
$57
$66
$55
311



CCP010000014
M
99202
$1,118
$1
$1
$93
$0
$67
15



CCP010000014
M
99214
$458
$1
$0
$88
$117
$91
8



CCP010000014
M
99211
$59
$0
$0
$0
$35
$24
2



CCP010000014
M
99395
$14
$0
$0
$0
$56
$56
1



CCP010000014
M
99396
($62)
$0
($0)
$0
$56
$56
1



CCP010000014
M
99212
($831)
$1
($1)
$40
$46
$39
32















M Total
$22,236
$79
$24



















CCP010000014
P
J3301
$16
$0
$0
$25
$0
$10
1



CCP010000014
P
Z2A
($5)
$0
($0)
$5
$0
$2
1



CCP010000014
P
S2B
($151)
$0
($0)
$1
$0
$1
6



CCP010000014
P
L9B
($160)
$0
($0)
$0
$3
$2
3



CCP010000014
P
H3A
($216)
$1
($0)
$1
$1
$1
35



CCP010000014
P
Z2G
($458)
$0
($0)
$0
$5
$7
1















P Total
($973)
$1
($1)



















CCP010000014
S
11401
$10,483
$16
$11
$114
$69
$106
100



CCP010000014
S
11400
$8,266
$11
$9
$91
$0
$93
90



CCP010000014
S
11441
$5,542
$7
$6
$155
$148
$148
38



CCP010000014
S
11440
$4,669
$6
$5
$125
$0
$118
38



CCP010000014
S
11421
$3,927
$5
$4
$130
$0
$120
31



CCP010000014
S
11402
$3,543
$7
$4
$169
$0
$137
38



CCP010000014
S
11420
$2,537
$3
$3
$87
$0
$89
27



CCP010000014
S
11422
$1,657
$2
$2
$170
$0
$143
12



CCP010000014
S
11442
$1,501
$2
$2
$212
$0
$172
9



CCP010000014
S
11307
$728
$1
$1
$92
$0
$91
10



CCP010000014
S
11306
$672
$3
$1
$70
$0
$63
28



CCP010000014
S
11308
$648
$1
$1
$99
$0
$103
7



CCP010000014
S
11303
$414
$1
$0
$92
$0
$100
4



CCP010000014
S
11446
$355
$0
$0
$371
$0
$371
1



CCP010000014
S
11444
$282
$0
$0
$307
$0
$294
1



CCP010000014
S
11312
$278
$1
$0
$109
$0
$99
7



CCP010000014
S
11423
$220
$0
$0
$195
$0
$175
2



CCP010000014
S
11424
$188
$0
$0
$244
$0
$222
1



CCP010000014
S
11443
$90
$0
$0
$222
$0
$210
1



CCP010000014
S
11900
$9
$0
$0
$28
$0
$47
2



CCP010000014
S
11403
($61)
$1
($0)
$151
$0
$163
5



CCP010000014
S
11310
($363)
$2
($0)
$65
$70
$59
17



CCP010000014
S
11101
($366)
$1
($0)
$39
$0
$41
16



CCP010000014
S
11305
($420)
$1
($0)
$39
$0
$40
14



CCP010000014
S
12032
($683)
$0
($1)
$223
$0
$218
1



CCP010000014
S
17003
($1,134)
$0
($1)
$2
$9
$4
7



CCP010000014
S
11302
($1,245)
$1
($1)
$85
$0
$81
7



CCP010000014
S
11311
($1,267)
$1
($1)
$82
$0
$79
12



CCP010000014
S
11300
($1,723)
$1
($2)
$43
$0
$44
18



CCP010000014
S
11301
($2,767)
$5
($3)
$56
$0
$62
48



CCP010000014
S
11100
($3,773)
$3
($4)
$90
$84
$86
29



CCP010000014
S
17110
($5,749)
$1
($6)
$63
$0
$56
8



CCP010000014
S
17000
($11,133)
$0
($12)
$66
$58
$62
7















S Total
$15,326
$83
$16













CCP010000014 Total
$42,942
$185
$46
















TABLE A11





Dermatology


Dates of Service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total role MPPT Meta Drilldown all etg's























Total


Provider ID
category
services
service description
Svcs





CCP010000014
A
88305
LEVEL IV—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
762


CCP010000014
A
CL
Clinic/TreatmDermatology/Testing
28


CCP010000014
A
AS
Ambulatory Surgery
2


CCP010000014
A
93000
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; W/INTERPRETATION & REPO
7


CCP010000014
A
82627
DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)
12


CCP010000014
A
00300
ANESTHESIA, HEAD, NECK, POST TRUNK INTEGUMENTARY, MUSCLES/NERVES
1


CCP010000014
A
84402
TESTOSTERONE; FREE
8


CCP010000014
A
S0630
Removal of sutures by a physician other than the physician who originall
3


CCP010000014
A
83550
IRON BINDING CAPACITY
21


CCP010000014
A
88312
SPECIAL STAINS; GROUP I, MICROORGANISMS, EACH
27


CCP010000014
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY NUMBER
22


CCP010000014
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY NUMBER
44


CCP010000014
A
86376
MICROSOMAL ANTIBODIES, EACH
8


CCP010000014
A
84443
THYROID STIMULATING HORMONE (TSH)
34


CCP010000014
A
86038
ANTINUCLEAR ANTIBODIES (ANA)
26


CCP010000014
A
ER
Emergency
6


CCP010000014
A
A4550
Surgical trays
2


CCP010000014
A
93017
CARDIOVASCULAR STRESS TEST W/ECG MONITOR; TRACING ONLY, W/O INTERPRETAT
1


CCP010000014
A
84403
TESTOSTERONE; TOTAL
9


CCP010000014
A
80053
COMPREHENSIVE METABOLIC PANEL
41


CCP010000014
A
85652
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
38


CCP010000014
A
87101
CULTURE, FUNGI (MOLD/YEAST) ISOLATION, W/PRESUMPTIVE ID OF ISOLATES; SK
24


CCP010000014
A
88307
LEVEL V—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
1


CCP010000014
A
A4649
Surgical supply; miscellaneous
1


CCP010000014
A
86235
EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD, EACH ANTIBODY
19


CCP010000014
A
86618
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
5


CCP010000014
A
83540
IRON
22


CCP010000014
A
80076
HEPATIC FUNCTION PANEL
24


CCP010000014
A
86644
ANTIBODY; CYTOMEGALOVIRUS (CMV)
3


CCP010000014
A
83735
MAGNESIUM
7


CCP010000014
A
80050
GENERAL HEALTH PANEL
9


CCP010000014
A
83498
HYDROXYPROGESTERONE, 17-D
3


CCP010000014
A
86665
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)
4


CCP010000014
A
86617
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST
1


CCP010000014
A
86039
ANTINUCLEAR ANTIBODIES (ANA); TITER
5


CCP010000014
A
93005
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; TRACING ONLY W/O INTER
1


CCP010000014
A
82550
CREATINE KINASE (CK), (CPK); TOTAL
7


CCP010000014
A
87620
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HUMAN PAPILLOMAVIRUS, DIRECT
1


CCP010000014
A
86431
RHEUMATOID FACTOR; QUANTITATIVE
5


CCP010000014
A
85021

1


CCP010000014
A
86580
SKIN TEST; TUBERCULOSIS, INTRADERMAL
2


CCP010000014
A
87107
CULTURE, FUNGI, DEFINITIVE ID, EACH ORGANISM; MOLD
2


CCP010000014
A
93010
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; INTERPRETATION & REPORT
1


CCP010000014
A
86777
ANTIBODY; TOXOPLASMA
1


CCP010000014
A
85023

3


CCP010000014
A
82728
FERRITIN
4


CCP010000014
A
82947
GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)
6


CCP010000014
A
80005

1


CCP010000014
A
84450
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
6


CCP010000014
A
86787
ANTIBODY; VARICELLA-ZOSTER
1


CCP010000014
A
85014
BLOOD COUNT; HEMATOCRIT
3


CCP010000014
A
86140
C-REACTIVE PROTEIN
2


CCP010000014
A
83036
HEMOGLOBIN; GLYCATED
3


CCP010000014
A
86765
ANTIBODY; RUBEOLA
1


CCP010000014
A
85651
SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
9


CCP010000014
A
85008
BLOOD COUNT; BLOOD SMEAR, MICROSCOP EXAM W/O MANUAL DIFFERENTIAL
1





WBC CO



CCP010000014
A
80003

1


CCP010000014
A
85730
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA/WHOLE BLOOD
2


CCP010000014
A
82950
GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)
1


CCP010000014
A
80051
ELECTROLYTE PANEL
1


CCP010000014
A
87206
SMEAR, PRIME SRCE, W/INTERPR; FLUORESC &/OR ACID FAST STAIN, BACTERIA/F
1


CCP010000014
A
81050
VOLUME MEASUREMENT, TIMED COLLECTION, EACH
1


CCP010000014
A
83002
GONADOTROPIN; LUTEINIZING HORMONE (LH)
1


CCP010000014
A
84146
PROLACTIN
1


CCP010000014
A
85025
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, & PLATELET) &
46


CCP010000014
A
86308
HETEROPHILE ANTIBODIES; SCREENING
1


CCP010000014
A
81003
URINALYSIS, DIP STICK/TABLET REAGENT; AUTOMATED, W/O MICROSCOPY
1


CCP010000014
A
84478
TRIGLYCERIDES
10


CCP010000014
A
81000
URINALYSIS, DIP STICK/TABLET REAGENT; NON-AUTOMATED W/MICROSCOPY
2


CCP010000014
A
81002
URINALYSIS, DIP STICK/TABLET REAGENT; NON-AUTOMATED, W/O MICROSCOPY
3


CCP010000014
A
83615
LACTATE DEHYDROGENASE (LD), (LDH)
2


CCP010000014
A
87210
SMEAR, PRIMARY SOURCE W/INTERPRETATION; WET MOUNT, FOR INFECTIOUS AGENT
27


CCP010000014
A
84436
THYROXINE; TOTAL
1


CCP010000014
A
82565
CREATININE; BLOOD
1


CCP010000014
A
81001
URINALYSIS, DIP STICK/TABLET REAGENT; AUTOMATED W/O MICROSCOPY
1


CCP010000014
A
83001
GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
1


CCP010000014
A
87081
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY
5


CCP010000014
A
86162
COMPLEMENT; TOTAL HEMOLYTIC (CH50)
1


CCP010000014
A
82248
BILIRUBIN; DIRECT
1


CCP010000014
A
82270
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTAN
2


CCP010000014
A
85027
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, & PLATELET)
15


CCP010000014
A
82040
ALBUMIN; SERUM
2


CCP010000014
A
80048
BASIC METABOLIC PANEL
9


CCP010000014
A
87106
CULTURE, FUNGI, DEFINITIVE ID, EACH ORGANISM; YEAST
2


CCP010000014
A
87186
SUSCEPT STUDIES, ANTIMICROB AGNT; MICRODILUT/AGAR DILUT (MIC/BRKPNT), E
3


CCP010000014
A
80061
LIPID PANEL
15


CCP010000014
A
84439
THYROXINE; FREE
2


CCP010000014
A
86225
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE/DOUBLE STRANDED
2


CCP010000014
A
84460
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
1


CCP010000014
A
86160
COMPLEMENT; ANTIGEN, EACH COMPONENT
1


CCP010000014
A
87252
VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION & PRESUMPTIVE
2


CCP010000014
A
87070
CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE/BLOOD/STOOL, AEROBIC,
12


CCP010000014
A
88304
LEVEL III—SURGICAL PATHOLOGY, GROSS & MICROSCOPIC EXAM
13


CCP010000014
A
95044
PATCH/APPLICATION TEST(S) (SPECIFY NUMBER)
216











A Total

1,700











CCP010000014
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED EXAM; MED
671


CCP010000014
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND PROB
1,565


CCP010000014
M
99203
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: DETAILED HX; DETAILED EXAM;
77


CCP010000014
M
99202
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX; EXPAND
40


CCP010000014
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED EXAM;
36


CCP010000014
M
96910
PHOTOCHEMOTHERAPY; TAR & UVB/PETROLATUM & UVB
23


CCP010000014
M
99245
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX; COMPREHENSIVE E
1


CCP010000014
M
99385
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, NEW PT; 18-39
3


CCP010000014
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE, TYPICALLY 5
4


CCP010000014
M
99215
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: COMPREHENSIVE HX; COMPREHENSIV
2


CCP010000014
M
99204
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: COMPREHENSIVE HX; COMPREHENSIV
2


CCP010000014
M
99201
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: PROB FOCUS HX; PROB FOCUS EX
1


CCP010000014
M
99386
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, NEW PT; 40-64
1


CCP010000014
M
99395
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 18-39
3


CCP010000014
M
99396
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 40-64
5


CCP010000014
M
99394
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 12-17
1


CCP010000014
M
92012
OPHTHALMOLOGICAL MEDICAL EXAM & EVAL; INTERMEDIATE, ESTABLISHED
2





PATIENT



CCP010000014
M
99241
OFFICE CONSULTATION, 3 KEY COMPONENTS: PROB FOCUS HX; PROB FOCUS EXAM;
2


CCP010000014
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX; EXPAND PROB
274


CCP010000014
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB FOCUS EX
172











M Total

2,885











CCP010000014
P
Q5P
TOPICAL ANTI-INFLAMMATORY STEROIDAL
12,473


CCP010000014
P
W1D
MACROLIDES
3,320


CCP010000014
P
Z2E
IMMUNOSUPPRESSIVES
150


CCP010000014
P
J3301
Injection, triamcinolone acetonide, per 10 mg
27


CCP010000014
P
Q5H
TOPICAL LOCAL ANESTHETICS
390


CCP010000014
P
P4L
BONE RESORPTION INHIBITORS
360


CCP010000014
P
Q5W
TOPICAL ANTIBIOTICS
4,872


CCP010000014
P
H3D
ANALGESIC/ANTIPYRETICS, SALICYLATES
98


CCP010000014
P
W1Q
QUINOLONES
28


CCP010000014
P
Q8F
OTIC PREPARATIONS, ANTI-INFLAMMATORY-ANTIBIOTICS
5


CCP010000014
P
Q4F
VAGINAL ANTIFUNGALS
17


CCP010000014
P
W1W
CEPHALOSPORINS—1ST GENERATION
1,011


CCP010000014
P
J1030
Injection, methylprednisolone acetate, 40 mg
4


CCP010000014
P
W3A
ANTIFUNGAL ANTIBIOTICS
30


CCP010000014
P
L5G
ROSACEA AGENTS, TOPICAL
1,839


CCP010000014
P
J9A
INTESTINAL MOTILITY STIMULANTS
51


CCP010000014
P
J9260
Methotrexate sodium, 50 mg
1


CCP010000014
P
H2U
TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB
360


CCP010000014
P
H4B
ANTICONVULSANTS
338


CCP010000014
P
Q5R
TOPICAL ANTIPARASITICS
20


CCP010000014
P
H6J
ANTIEMETIC/ANTIVERTIGO AGENTS
20


CCP010000014
P
Q8W
EAR PREPARATIONS, ANTIBIOTICS
5


CCP010000014
P
S2A
COLCHICINE
60


CCP010000014
P
H0A
LOCAL ANESTHETICS
5


CCP010000014
P
D1A
PERIODONTAL COLLAGENASE INHIBITORS
30


CCP010000014
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
255


CCP010000014
P
U6W
BULK CHEMICALS
30


CCP010000014
P
J5F
ANAPHYLAXIS THERAPY AGENTS
21


CCP010000014
P
S2B
NSAIDS, CYCLOOXYGENASE INHIBITOR—TYPE
2,954


CCP010000014
P
L3P
ANTIPRURITICS, TOPICAL
20


CCP010000014
P
H3A
ANALGESICS, NARCOTICS
994


CCP010000014
P
W4E
ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTS
45


CCP010000014
P
P5A
GLUCOCORTICOIDS
632


CCP010000014
P
  0

15


CCP010000014
P
W1A
PENICILLINS
1,289


CCP010000014
P
W3B
ANTIFUNGAL AGENTS
473


CCP010000014
P
V1B
ANTIMETABOLITES
277


CCP010000014
P
L5E
ANTISEBORRHEIC AGENTS
60


CCP010000014
P
W1K
LINCOSAMIDES
52


CCP010000014
P
Z2A
ANTIHISTAMINES
5,696


CCP010000014
P
R1H
POTASSIUM SPARING DIURETICS
30


CCP010000014
P
L2A
EMOLLIENTS
110


CCP010000014
P
CL
Clinic/TreatmDermatology/Testing
1


CCP010000014
P
L9A
TOPICAL AGENTS, MISCELLANEOUS
30


CCP010000014
P
W5A
ANTIVIRALS, GENERAL
353


CCP010000014
P
Q5F
TOPICAL ANTIFUNGALS
2,015


CCP010000014
P
L1B
ACNE AGENTS, SYSTEMIC
90


CCP010000014
P
Q5S
TOPICAL SULFONAMIDES
245


CCP010000014
P
L5A
KERATOLYTICS
202


CCP010000014
P
Q5K
TOPICAL IMMUNOSUPPRESSIVE AGENTS
1,041


CCP010000014
P
Z2G
IMMUNOMODULATORS
70


CCP010000014
P
W1C
TETRACYCLINES
18,225


CCP010000014
P
L9B
VITAMIN A DERIVATIVES
1,010


CCP010000014
P
L5H
ACNE AGENTS, TOPICAL
240


CCP010000014
P
L5F
ANTIPSORIATICS AGENTS
310











P Total

62,299











CCP010000014
R
73630
RADIOLOGIC EXAM, FOOT; COMPLETE, 3+ VIEWS
3


CCP010000014
R
73130
RADIOLOGIC EXAM, HAND; 3+ VIEWS
2



R Total


5


CCP010000014
S
11400
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
124


CCP010000014
S
11441
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
46


CCP010000014
S
11440
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
50


CCP010000014
S
11402
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
88


CCP010000014
S
11421
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
35


CCP010000014
S
11420
EXCISE BENIGN SKIN LESION W/MARG, EXCPT SKIN TAG SCALP/NECK/HANDS/FEET/
36


CCP010000014
S
11442
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
11


CCP010000014
S
11422
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
14


CCP010000014
S
11641
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
8


CCP010000014
S
11306
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 0.6-1.0
44


CCP010000014
S
11643
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
3


CCP010000014
S
14040
ADJACENT TISSUE TRANSFER, FOREHEAD/CHEEKS/CHIN/MOUTH/NECK/AXILLAE/
2





GENIT



CCP010000014
S
11308
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER >2.0 CM
7


CCP010000014
S
11307
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 1.1-2.0
12


CCP010000014
S
11603
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/ARMS/LEGS; EXCISED DIAM
4


CCP010000014
S
11303
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER >2.0 CM
6


CCP010000014
S
11644
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11446
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11622
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NECK/HANDS/FEET/GENITAL
2


CCP010000014
S
11444
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
14020
ADJACENT TISSUE TRANSFER/REARRANGEMENT, SCALP, ARMS &/OR LEGS; DEFECT 1
1


CCP010000014
S
11770
EXCISION, PILONIDAL CYST/SINUS; SIMPLE
1


CCP010000014
S
13132
REPAIR, COMPLEX, FOREHEAD/CHEEKS/CHIN/MOUTH/NECK/AXILLAE/GENITALIA/HAND
1


CCP010000014
S
11312
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
7


CCP010000014
S
17110
DESTRUCTION, FLAT WARTS, MOLLUSCUM CONTAGIOSUM/MILIA; UP TO 14 LESIONS
250


CCP010000014
S
11623
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NECK/HANDS/FEET/GENITAL
1


CCP010000014
S
11424
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
1


CCP010000014
S
11621
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NECK/HANDS/FEET/GENITAL
2


CCP010000014
S
11730
AVULSION, NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; SINGLE
3


CCP010000014
S
11900
INJECTION, INTRALESIONAL; UP TO & INCL 7 LESIONS
35


CCP010000014
S
11640
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
56605
BX, VULVA/PERINEUM (SEP PROC); 1 LESION
1


CCP010000014
S
11732
AVULSION, NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; ADD'L NAIL PLATE
2


CCP010000014
S
20550
INJECTION(S); SINGLE TENDON SHEATH, LIGAMENT, APONEUROSIS
1


CCP010000014
S
11443
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11423
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCALP/NECK/HANDS/FEET/GE
2


CCP010000014
S
11601
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/ARMS/LEGS; EXCISED DIAM
1


CCP010000014
S
11602
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/ARMS/LEGS; EXCISED DIAM
3


CCP010000014
S
10060
INCISION & DRAINAGE, ABSCESS; SIMPLE/SINGLE
5


CCP010000014
S
11642
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EARS/EYELIDS/NOSE/LIPS/M
1


CCP010000014
S
11403
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT SKIN TAG, TRUNK/ARMS/L
5


CCP010000014
S
17111
DESTRUCTION, FLAT WARTS, MOLLUSCUM CONTAGIOSUM/MILIA; 15 +
2


CCP010000014
S
11310
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
23


CCP010000014
S
11305
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITALIA; DIAMETER 0.5 CM/<
22


CCP010000014
S
11101
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADD'L LESION
22


CCP010000014
S
12032
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMITIES; 2.6-7.5 CM
1


CCP010000014
S
11901
INJECTION, INTRALESIONAL; >7 LESIONS
4


CCP010000014
S
11302
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1-2.0 CM
8


CCP010000014
S
11311
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANE; DIAME
16


CCP010000014
S
11300
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5 CM/<
31


CCP010000014
S
17003
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/CUTANEOUS VASC P
245


CCP010000014
S
17304
CHEMOSURGERY (MOHS MICROGRAPHIC TECHNIQUE); 1ST STAGE, FRESH TISSUE, TO
1


CCP010000014
S
11301
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6-1.0 CM
80


CCP010000014
S
11100
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
35


CCP010000014
S
17000
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN TAGS/CUTANEOUS VASC P
47











S Total

1,493











CCP010000014
T
 0421
PHYSICAL THEAPY VISIT CHARGE
3











T Total

3









CCP010000014 Total

68,385

























Expected
Practitioner






Provider ID
category
services
Your Svcs
Other Svcs
Svcs
episodes
Total Costs
Your Costs
Others Costs
Expected Costs





CCP010000014
A
88305
748
14
509.99
2,540
$23,516
$23,083
$433
$15,764


CCP010000014
A
CL
26
2
16.33
2,540
$1,221
$543
$678
$580


CCP010000014
A
AS
0
2
1.94
2,540
$1,198
$0
$1,198
$755


CCP010000014
A
93000
0
7
3.88
2,540
$311
$0
$311
$115


CCP010000014
A
82627
4
8
3.60
2,540
$264
$88
$176
$79


CCP010000014
A
00300
0
1
.45
2,540
$360
$0
$360
$178


CCP010000014
A
84402
2
6
2.87
2,540
$224
$56
$168
$81


CCP010000014
A
S0630
3
0
.55
2,540
$148
$148
$0
$21


CCP010000014
A
83550
8
13
4.15
2,540
$147
$56
$91
$29


CCP010000014
A
88312
26
1
19.65
2,540
$432
$416
$16
$315


CCP010000014
A
95024
0
22
2.11
2,540
$125
$0
$125
$13


CCP010000014
A
95004
0
44
12.59
2,540
$166
$0
$166
$54


CCP010000014
A
86376
4
4
1.00
2,540
$128
$64
$64
$16


CCP010000014
A
84443
14
20
18.03
2,540
$238
$98
$140
$128


CCP010000014
A
86038
6
20
13.87
2,540
$208
$48
$160
$112


CCP010000014
A
ER
3
3
6.89
2,540
$1,048
$435
$613
$953


CCP010000014
A
A4550
1
1
.07
2,540
$98
$49
$49
$3


CCP010000014
A
93017
0
1
.07
2,540
$93
$0
$93
$7


CCP010000014
A
84403
2
7
4.98
2,540
$180
$40
$140
$104


CCP010000014
A
80053
13
28
26.64
2,540
$205
$65
$140
$134


CCP010000014
A
85652
16
22
5.16
2,540
$76
$32
$44
$11


CCP010000014
A
87101
7
17
15.95
2,540
$191
$56
$135
$127


CCP010000014
A
88307
1
0
.10
2,540
$68
$68
$0
$7


CCP010000014
A
A4649
1
0
.07
2,540
$73
$73
$0
$13


CCP010000014
A
86235
8
11
11.24
2,540
$141
$60
$81
$81


CCP010000014
A
86618
1
4
1.25
2,540
$60
$12
$48
$15


CCP010000014
A
83540
8
14
8.30
2,540
$66
$24
$42
$25


CCP010000014
A
80076
8
16
11.49
2,540
$72
$24
$48
$34


CCP010000014
A
86644
0
3
.35
2,540
$42
$0
$42
$5


CCP010000014
A
83735
0
7
1.04
2,540
$35
$0
$35
$5


CCP010000014
A
80050
2
7
6.68
2,540
$126
$28
$98
$97


CCP010000014
A
83498
0
3
1.21
2,540
$48
$0
$48
$19


CCP010000014
A
86665
0
4
.69
2,540
$32
$0
$32
$6


CCP010000014
A
86617
0
1
.24
2,540
$32
$0
$32
$8


CCP010000014
A
86039
2
3
2.39
2,540
$45
$18
$27
$21


CCP010000014
A
93005
1
0
.73
2,540
$54
$54
$0
$38


CCP010000014
A
82550
0
7
3.88
2,540
$28
$0
$28
$16


CCP010000014
A
87620
0
1
.03
2,540
$12
$0
$12
$0


CCP010000014
A
86431
1
4
2.18
2,540
$20
$4
$16
$9


CCP010000014
A
85021
1
0
.07
2,540
$11
$11
$0
$0


CCP010000014
A
86580
0
2
.93
2,540
$18
$0
$18
$8


CCP010000014
A
87107
0
2
.28
2,540
$10
$0
$10
$1


CCP010000014
A
93010
1
0
1.25
2,540
$31
$31
$0
$23


CCP010000014
A
86777
0
1
.10
2,540
$8
$0
$8
$1


CCP010000014
A
85023
0
3
.66
2,540
$9
$0
$9
$2


CCP010000014
A
82728
0
4
3.18
2,540
$32
$0
$32
$25


CCP010000014
A
82947
1
5
4.64
2,540
$16
$2
$14
$10


CCP010000014
A
80005
0
1
.21
2,540
$5
$0
$5
$1


CCP010000014
A
84450
0
6
4.29
2,540
$20
$0
$20
$16


CCP010000014
A
86787
0
1
.62
2,540
$10
$0
$10
$6


CCP010000014
A
85014
1
2
2.11
2,540
$9
$5
$4
$5


CCP010000014
A
86140
0
2
.86
2,540
$6
$0
$6
$3


CCP010000014
A
83036
0
3
2.39
2,540
$15
$0
$15
$12


CCP010000014
A
86765
0
1
.80
2,540
$15
$0
$15
$12


CCP010000014
A
85651
4
5
7.30
2,540
$18
$8
$10
$16


CCP010000014
A
85008
0
1
.03
2,540
$2
$0
$2
$0


CCP010000014
A
80003
0
1
.62
2,540
$5
$0
$5
$3


CCP010000014
A
85730
0
2
1.38
2,540
$6
$0
$6
$4


CCP010000014
A
82950
0
1
.21
2,540
$2
$0
$2
$0


CCP010000014
A
80051
0
1
.62
2,540
$4
$0
$4
$2


CCP010000014
A
87206
0
1
.76
2,540
$5
$0
$5
$4


CCP010000014
A
81050
0
1
.52
2,540
$2
$0
$2
$1


CCP010000014
A
83002
0
1
.93
2,540
$12
$0
$12
$11


CCP010000014
A
84146
0
1
.97
2,540
$11
$0
$11
$11


CCP010000014
A
85025
12
34
44.91
2,540
$138
$36
$102
$138


CCP010000014
A
86308
0
1
.59
2,540
$4
$0
$4
$4


CCP010000014
A
81003
0
1
1.56
2,540
$1
$0
$1
$2


CCP010000014
A
84478
4
6
10.21
2,540
$30
$12
$18
$31


CCP010000014
A
81000
1
1
3.25
2,540
$16
$6
$10
$17


CCP010000014
A
81002
2
1
3.70
2,540
$12
$8
$4
$14


CCP010000014
A
83615
0
2
2.42
2,540
$6
$0
$6
$9


CCP010000014
A
87210
27
0
29.82
2,540
$201
$201
$0
$205


CCP010000014
A
84436
1
0
1.76
2,540
$4
$4
$0
$8


CCP010000014
A
82565
0
1
2.15
2,540
$5
$0
$5
$9


CCP010000014
A
81001
0
1
3.22
2,540
$2
$0
$2
$6


CCP010000014
A
83001
0
1
1.56
2,540
$8
$0
$8
$12


CCP010000014
A
87081
0
5
6.12
2,540
$20
$0
$20
$25


CCP010000014
A
86162
1
0
1.38
2,540
$15
$15
$0
$21


CCP010000014
A
82248
0
1
4.22
2,540
$2
$0
$2
$9


CCP010000014
A
82270
0
2
3.49
2,540
$4
$0
$4
$11


CCP010000014
A
85027
3
12
18.72
2,540
$30
$6
$24
$39


CCP010000014
A
82040
0
2
3.81
2,540
$10
$0
$10
$21


CCP010000014
A
80048
0
9
12.11
2,540
$27
$0
$27
$38


CCP010000014
A
87106
2
0
4.91
2,540
$8
$8
$0
$20


CCP010000014
A
87186
1
2
5.47
2,540
$15
$5
$10
$28


CCP010000014
A
80061
2
13
17.16
2,540
$120
$16
$104
$137


CCP010000014
A
84439
1
1
4.50
2,540
$16
$8
$8
$36


CCP010000014
A
86225
0
2
3.74
2,540
$24
$0
$24
$45


CCP010000014
A
84460
0
1
6.57
2,540
$5
$0
$5
$26


CCP010000014
A
86160
0
1
2.73
2,540
$13
$0
$13
$35


CCP010000014
A
87252
1
1
3.74
2,540
$30
$15
$15
$56


CCP010000014
A
87070
2
10
17.58
2,540
$74
$12
$62
$111


CCP010000014
A
88304
12
1
18.03
2,540
$198
$183
$15
$272


CCP010000014
A
95044
216
0
437.81
2,540
$1,722
$1,722
$0
$3,460

















A Total
1,212
488
1435.61

$34,573
$27,956
$6,617
$25,003

















CCP010000014
M
99243
653
18
456.36
2,540
$88,094
$85,793
$2,301
$58,791


CCP010000014
M
99213
1,282
283
1434.12
2,540
$92,196
$73,944
$18,252
$78,728


CCP010000014
M
99203
64
13
19.27
2,540
$10,618
$9,211
$1,407
$1,958


CCP010000014
M
99202
39
1
18.58
2,540
$3,687
$3,618
$69
$1,183


CCP010000014
M
99214
1
35
29.13
2,540
$3,458
$88
$3,370
$2,578


CCP010000014
M
96910
23
0
12.35
2,540
$1,255
$1,255
$0
$637


CCP010000014
M
99245
0
1
.48
2,540
$239
$0
$239
$110


CCP010000014
M
99385
0
3
.76
2,540
$168
$0
$168
$43


CCP010000014
M
99211
0
4
2.94
2,540
$140
$0
$140
$67


CCP010000014
M
99215
0
2
1.49
2,540
$259
$0
$259
$189


CCP010000014
M
99204
0
2
1.63
2,540
$294
$0
$294
$235


CCP010000014
M
99201
0
1
.28
2,540
$61
$0
$61
$11


CCP010000014
M
99386
0
1
.35
2,540
$56
$0
$56
$19


CCP010000014
M
99395
0
3
2.84
2,540
$168
$0
$168
$159


CCP010000014
M
99396
0
5
5.02
2,540
$280
$0
$280
$281


CCP010000014
M
99394
0
1
1.25
2,540
$56
$0
$56
$70


CCP010000014
M
92012
0
2
1.00
2,540
$20
$0
$20
$43


CCP010000014
M
99241
0
2
12.52
2,540
$126
$0
$126
$665


CCP010000014
M
99242
265
9
293.29
2,540
$27,510
$26,602
$908
$28,438


CCP010000014
M
99212
118
54
329.10
2,540
$7,450
$5,009
$2,441
$12,820

















M Total
2,445
440
2622.76

$236,135
$205,520
$30,615
$187,026

















CCP010000014
P
Q5P
10,881
1,592
10633.52
2,540
$33,903
$32,099
$1,804
$22,958


CCP010000014
P
W1D
2,915
405
1519.47
2,540
$7,180
$6,449
$731
$2,298


CCP010000014
P
Z2E
150
0
92.83
2,540
$1,024
$1,024
$0
$356


CCP010000014
P
J3301
27
0
23.32
2,540
$672
$672
$0
$177


CCP010000014
P
Q5H
315
75
252.95
2,540
$1,153
$783
$370
$757


CCP010000014
P
P4L
90
270
208.60
2,540
$824
$201
$623
$462


CCP010000014
P
Q5W
4,277
595
4063.45
2,540
$5,507
$4,650
$857
$5,255


CCP010000014
P
H3D
0
98
32.90
2,540
$194
$0
$194
$49


CCP010000014
P
W1Q
28
0
16.09
2,540
$276
$276
$0
$152


CCP010000014
P
Q8F
0
5
.21
2,540
$73
$0
$73
$5


CCP010000014
P
Q4F
3
14
.86
2,540
$68
$37
$31
$5


CCP010000014
P
W1W
912
99
590.98
2,540
$645
$450
$195
$595


CCP010000014
P
J1030
4
0
.48
2,540
$32
$32
$0
$6


CCP010000014
P
W3A
30
0
88.05
2,540
$224
$224
$0
$199


CCP010000014
P
L5G
1,680
159
1932.06
2,540
$5,162
$4,643
$519
$5,142


CCP010000014
P
J9A
0
51
21.04
2,540
$25
$0
$25
$8


CCP010000014
P
J9260
1
0
.38
2,540
$15
$15
$0
$2


CCP010000014
P
H2U
30
330
202.71
2,540
$48
$5
$43
$36


CCP010000014
P
H4B
0
338
153.76
2,540
$102
$0
$102
$91


CCP010000014
P
Q5R
20
0
37.16
2,540
$159
$159
$0
$151


CCP010000014
P
H6J
6
14
24.32
2,540
$104
$75
$29
$108


CCP010000014
P
Q8W
0
5
8.62
2,540
$18
$0
$18
$25


CCP010000014
P
S2A
0
60
81.65
2,540
$10
$0
$10
$23


CCP010000014
P
H0A
0
5
23.73
2,540
$16
$0
$16
$33


CCP010000014
P
D1A
30
0
47.05
2,540
$65
$65
$0
$100


CCP010000014
P
Z4B
90
165
245.96
2,540
$622
$201
$421
$662


CCP010000014
P
U6W
30
0
58.92
2,540
$16
$16
$0
$62


CCP010000014
P
J5F
21
0
22.80
2,540
$181
$181
$0
$234


CCP010000014
P
S2B
396
2,558
2552.63
2,540
$4,147
$646
$3,501
$4,206


CCP010000014
P
L3P
20
0
44.74
2,540
$72
$72
$0
$135


CCP010000014
P
H3A
287
707
867.53
2,540
$1,068
$450
$618
$1,136


CCP010000014
P
W4E
22
23
110.61
2,540
$31
$15
$16
$104


CCP010000014
P
P5A
405
227
663.78
2,540
$281
$97
$184
$355


CCP010000014
P
  0
15
0
70.10
2,540
$48
$48
$0
$186


CCP010000014
P
W1A
911
378
1254.69
2,540
$1,343
$632
$711
$1,483


CCP010000014
P
W3B
440
33
265.96
2,540
$1,191
$1,122
$69
$1,339


CCP010000014
P
V1B
189
88
397.09
2,540
$251
$215
$36
$400


CCP010000014
P
L5E
0
60
175.04
2,540
$16
$0
$16
$247


CCP010000014
P
W1K
42
10
97.57
2,540
$220
$194
$26
$475


CCP010000014
P
Z2A
3,004
2,692
6474.40
2,540
$11,822
$6,103
$5,719
$12,298


CCP010000014
P
R1H
0
30
458.54
2,540
$18
$0
$18
$552


CCP010000014
P
L2A
0
110
494.80
2,540
$168
$0
$168
$723


CCP010000014
P
CL
1
0
16.33
2,540
$7
$7
$0
$580


CCP010000014
P
L9A
0
30
388.75
2,540
$84
$0
$84
$975


CCP010000014
P
W5A
336
17
475.66
2,540
$946
$721
$225
$2,237


CCP010000014
P
Q5F
1,471
544
2635.63
2,540
$3,772
$2,899
$873
$5,211


CCP010000014
P
L1B
90
0
220.98
2,540
$829
$829
$0
$3,145


CCP010000014
P
Q5S
245
0
1525.67
2,540
$507
$507
$0
$3,118


CCP010000014
P
L5A
90
112
1990.61
2,540
$167
$72
$95
$3,311


CCP010000014
P
Q5K
831
210
1927.36
2,540
$4,333
$3,669
$664
$8,103


CCP010000014
P
Z2G
0
70
608.80
2,540
$564
$0
$564
$4,562


CCP010000014
P
W1C
16,856
1,369
18512.14
2,540
$21,875
$20,225
$1,650
$28,915


CCP010000014
P
L9B
805
205
4351.76
2,540
$3,079
$2,548
$531
$12,860


CCP010000014
P
L5H
85
155
3074.00
2,540
$592
$201
$391
$10,413


CCP010000014
P
L5F
130
180
2401.95
2,540
$1,495
$665
$830
$11,897

















P Total
48,211
14,088
72441.02

$117,244
$94,194
$23,050
$158,917

















CCP010000014
R
73630
0
3
.55
2,540
$90
$0
$90
$14


CCP010000014
R
73130
0
2
.35
2,540
$62
$0
$62
$9

















R Total
0
5
.90

$152
$0
$152
$23

















CCP010000014
S
11401
133
3
38.06
2,540
$15,321
$15,113
$208
$4,022


CCP010000014
S
11400
123
1
20.59
2,540
$11,236
$11,130
$106
$1,914


CCP010000014
S
11441
45
1
7.16
2,540
$7,057
$6,909
$148
$1,042


CCP010000014
S
11440
50
0
12.46
2,540
$6,222
$6,222
$0
$1,458


CCP010000014
S
11402
88
0
24.39
2,540
$7,823
$7,823
$0
$3,155


CCP010000014
S
11421
35
0
6.68
2,540
$4,541
$4,541
$0
$771


CCP010000014
S
11420
36
0
5.05
2,540
$3,087
$3,087
$0
$443


CCP010000014
S
11442
10
1
3.77
2,540
$2,277
$2,094
$183
$624


CCP010000014
S
11422
14
0
6.02
2,540
$2,280
$2,280
$0
$820


CCP010000014
S
11641
8
0
1.31
2,540
$1,549
$1,549
$0
$259


CCP010000014
S
11306
44
0
35.19
2,540
$3,015
$3,015
$0
$2,244


CCP010000014
S
11643
3
0
.59
2,540
$839
$839
$0
$175


CCP010000014
S
14040
0
2
.59
2,540
$1,008
$0
$1,008
$372


CCP010000014
S
11308
7
0
1.11
2,540
$696
$696
$0
$119


CCP010000014
S
11307
12
0
6.82
2,540
$1,106
$1,106
$0
$587


CCP010000014
S
11603
4
0
1.80
2,540
$749
$749
$0
$290


CCP010000014
S
11303
6
0
1.31
2,540
$549
$549
$0
$132


CCP010000014
S
11644
1
0
.03
2,540
$392
$392
$0
$14


CCP010000014
S
11446
1
0
.03
2,540
$371
$371
$0
$13


CCP010000014
S
11622
2
0
.76
2,540
$434
$434
$0
$131


CCP010000014
S
11444
1
0
.10
2,540
$307
$307
$0
$30


CCP010000014
S
14020
0
1
.07
2,540
$306
$0
$306
$32


CCP010000014
S
11770
0
1
.03
2,540
$229
$0
$229
$8


CCP010000014
S
13132
0
1
.62
2,540
$447
$0
$447
$242


CCP010000014
S
11312
7
0
5.71
2,540
$766
$766
$0
$561


CCP010000014
S
17110
239
11
284.37
2,540
$15,800
$15,183
$617
$15,602


CCP010000014
S
11623
1
0
.21
2,540
$244
$244
$0
$47


CCP010000014
S
11424
1
0
.35
2,540
$244
$244
$0
$73


CCP010000014
S
11621
2
0
.38
2,540
$188
$188
$0
$54


CCP010000014
S
11730
0
3
1.28
2,540
$231
$0
$231
$101


CCP010000014
S
11900
35
0
20.14
2,540
$1,075
$1,075
$0
$956


CCP010000014
S
11640
1
0
.38
2,540
$167
$167
$0
$62


CCP010000014
S
56605
0
1
.48
2,540
$125
$0
$125
$44


CCP010000014
S
11732
0
2
.24
2,540
$68
$0
$68
$9


CCP010000014
S
20550
0
1
.38
2,540
$57
$0
$57
$25


CCP010000014
S
11443
1
0
.93
2,540
$222
$222
$0
$199


CCP010000014
S
11423
2
0
2.18
2,540
$390
$390
$0
$371


CCP010000014
S
11601
1
0
.86
2,540
$91
$91
$0
$128


CCP010000014
S
11602
3
0
3.60
2,540
$491
$491
$0
$542


CCP010000014
S
10060
3
2
9.13
2,540
$815
$396
$419
$933


CCP010000014
S
11642
1
0
1.49
2,540
$245
$245
$0
$367


CCP010000014
S
11403
5
0
6.78
2,540
$755
$755
$0
$1,115


CCP010000014
S
17111
0
2
9.06
2,540
$88
$0
$88
$454


CCP010000014
S
11310
22
1
31.21
2,540
$1,474
$1,404
$70
$1,875


CCP010000014
S
11305
22
0
33.11
2,540
$850
$850
$0
$1,315


CCP010000014
S
11101
22
0
33.42
2,540
$871
$871
$0
$1,360


CCP010000014
S
12032
1
0
5.71
2,540
$223
$223
$0
$1,197


CCP010000014
S
11901
4
0
17.99
2,540
$195
$195
$0
$1,180


CCP010000014
S
11302
8
0
24.57
2,540
$683
$683
$0
$1,978


CCP010000014
S
11311
16
0
33.32
2,540
$1,328
$1,328
$0
$2,660


CCP010000014
S
11300
31
0
63.18
2,540
$1,331
$1,331
$0
$2,783


CCP010000014
S
17003
242
3
688.83
2,540
$1,018
$991
$27
$2,706


CCP010000014
S
17304
0
1
4.50
2,540
$649
$0
$649
$2,820


CCP010000014
S
11301
80
0
107.50
2,540
$4,469
$4,469
$0
$6,709


CCP010000014
S
11100
33
2
115.35
2,540
$3,220
$3,053
$167
$9,826


CCP010000014
S
17000
44
3
454.90
2,540
$3,145
$2,955
$190
$28,738

















S Total
1,450
43
2136.09

$113,359
$108,016
$5,343
$105,691

















CCP010000014
T
 0421
3
0
.45
2,540
$375
$375
$0
$42

















T Total
3
0
.45

$375
$375
$0
$42















CCP010000014 Total
53,321
15,064
78636.83

$501,838
$436,061
$65,777
$476,702

























Total Costs
Difference



episodes this






Total Cost
per stratum
per stratum
Your costs
Other costs
Spec costs
service



Provider ID
category
services
Difference
episodes
episodes
per svc
per svc
per svc
occurred






CCP010000014
A
88305
$7,752
$9
$3
$31
$31
$31
414



CCP010000014
A
CL
$641
$0
$0
$21
$339
$36
9



CCP010000014
A
AS
$443
$0
$0
$0
$599
$390
2



CCP010000014
A
93000
$196
$0
$0
$0
$44
$30
7



CCP010000014
A
82627
$185
$0
$0
$22
$22
$22
11



CCP010000014
A
00300
$182
$0
$0
$0
$360
$396
1



CCP010000014
A
84402
$143
$0
$0
$28
$28
$28
8



CCP010000014
A
S0630
$127
$0
$0
$49
$0
$38
3



CCP010000014
A
83550
$118
$0
$0
$7
$7
$7
21



CCP010000014
A
88312
$117
$0
$0
$16
$16
$16
15



CCP010000014
A
95024
$112
$0
$0
$0
$6
$6
1



CCP010000014
A
95004
$112
$0
$0
$0
$4
$4
1



CCP010000014
A
86376
$112
$0
$0
$16
$16
$16
8



CCP010000014
A
84443
$110
$0
$0
$7
$7
$7
34



CCP010000014
A
86038
$96
$0
$0
$8
$8
$8
26



CCP010000014
A
ER
$95
$0
$0
$145
$204
$138
6



CCP010000014
A
A4550
$95
$0
$0
$49
$49
$49
2



CCP010000014
A
93017
$86
$0
$0
$0
$93
$100
1



CCP010000014
A
84403
$76
$0
$0
$20
$20
$21
9



CCP010000014
A
80053
$71
$0
$0
$5
$5
$5
31



CCP010000014
A
85652
$65
$0
$0
$2
$2
$2
38



CCP010000014
A
87101
$64
$0
$0
$8
$8
$8
22



CCP010000014
A
88307
$61
$0
$0
$68
$0
$68
1



CCP010000014
A
A4649
$60
$0
$0
$73
$0
$187
1



CCP010000014
A
86235
$60
$0
$0
$8
$7
$7
9



CCP010000014
A
86618
$45
$0
$0
$12
$12
$12
5



CCP010000014
A
83540
$41
$0
$0
$3
$3
$3
22



CCP010000014
A
80076
$38
$0
$0
$3
$3
$3
22



CCP010000014
A
86644
$37
$0
$0
$0
$14
$14
3



CCP010000014
A
83735
$30
$0
$0
$0
$5
$5
3



CCP010000014
A
80050
$29
$0
$0
$14
$14
$15
9



CCP010000014
A
83498
$29
$0
$0
$0
$16
$16
3



CCP010000014
A
86665
$26
$0
$0
$0
$8
$8
1



CCP010000014
A
86617
$24
$0
$0
$0
$32
$32
1



CCP010000014
A
86039
$24
$0
$0
$9
$9
$9
5



CCP010000014
A
93005
$16
$0
$0
$54
$0
$52
1



CCP010000014
A
82550
$12
$0
$0
$0
$4
$4
4



CCP010000014
A
87620
$12
$0
$0
$0
$12
$12
1



CCP010000014
A
86431
$11
$0
$0
$4
$4
$4
5



CCP010000014
A
85021
$11
$0
$0
$11
$0
$7
1



CCP010000014
A
86580
$10
$0
$0
$0
$9
$9
2



CCP010000014
A
87107
$9
$0
$0
$0
$5
$5
2



CCP010000014
A
93010
$8
$0
$0
$31
$0
$18
1



CCP010000014
A
86777
$7
$0
$0
$0
$8
$8
1



CCP010000014
A
85023
$7
$0
$0
$0
$3
$3
3



CCP010000014
A
82728
$7
$0
$0
$0
$8
$8
4



CCP010000014
A
82947
$6
$0
$0
$2
$3
$2
6



CCP010000014
A
80005
$4
$0
$0
$0
$5
$5
1



CCP010000014
A
84450
$4
$0
$0
$0
$3
$4
5



CCP010000014
A
86787
$4
$0
$0
$0
$10
$10
1



CCP010000014
A
85014
$4
$0
$0
$5
$2
$3
3



CCP010000014
A
86140
$3
$0
$0
$0
$3
$3
2



CCP010000014
A
83036
$3
$0
$0
$0
$5
$5
3



CCP010000014
A
86765
$3
$0
$0
$0
$15
$15
1



CCP010000014
A
85651
$2
$0
$0
$2
$2
$2
9



CCP010000014
A
85008
$2
$0
$0
$0
$2
$2
1



CCP010000014
A
80003
$2
$0
$0
$0
$5
$5
1



CCP010000014
A
85730
$2
$0
$0
$0
$3
$3
2



CCP010000014
A
82950
$2
$0
$0
$0
$2
$2
1



CCP010000014
A
80051
$2
$0
$0
$0
$4
$4
1



CCP010000014
A
87206
$1
$0
$0
$0
$5
$5
1



CCP010000014
A
81050
$1
$0
$0
$0
$2
$2
1



CCP010000014
A
83002
$1
$0
$0
$0
$12
$12
1



CCP010000014
A
84146
$0
$0
$0
$0
$11
$11
1



CCP010000014
A
85025
($0)
$0
($0)
$3
$3
$3
39



CCP010000014
A
86308
($0)
$0
($0)
$0
$4
$7
1



CCP010000014
A
81003
($1)
$0
($0)
$0
$1
$1
1



CCP010000014
A
84478
($1)
$0
($0)
$3
$3
$3
8



CCP010000014
A
81000
($1)
$0
($0)
$6
$10
$5
2



CCP010000014
A
81002
($2)
$0
($0)
$4
$4
$4
3



CCP010000014
A
83615
($3)
$0
($0)
$0
$3
$4
2



CCP010000014
A
87210
($4)
$0
($0)
$7
$0
$7
27



CCP010000014
A
84436
($4)
$0
($0)
$4
$0
$4
1



CCP010000014
A
82565
($4)
$0
($0)
$0
$5
$4
1



CCP010000014
A
81001
($4)
$0
($0)
$0
$2
$2
1



CCP010000014
A
83001
($4)
$0
($0)
$0
$8
$8
1



CCP010000014
A
87081
($5)
$0
($0)
$0
$4
$4
5



CCP010000014
A
86162
($6)
$0
($0)
$15
$0
$15
1



CCP010000014
A
82248
($7)
$0
($0)
$0
$2
$2
1



CCP010000014
A
82270
($7)
$0
($0)
$0
$2
$3
2



CCP010000014
A
85027
($9)
$0
($0)
$2
$2
$2
15



CCP010000014
A
82040
($11)
$0
($0)
$0
$5
$5
2



CCP010000014
A
80048
($11)
$0
($0)
$0
$3
$3
9



CCP010000014
A
87106
($12)
$0
($0)
$4
$0
$4
2



CCP010000014
A
87186
($13)
$0
($0)
$5
$5
$5
3



CCP010000014
A
80061
($17)
$0
($0)
$8
$8
$8
14



CCP010000014
A
84439
($20)
$0
($0)
$8
$8
$8
2



CCP010000014
A
86225
($21)
$0
($0)
$0
$12
$12
2



CCP010000014
A
84460
($21)
$0
($0)
$0
$5
$4
1



CCP010000014
A
86160
($22)
$0
($0)
$0
$13
$13
1



CCP010000014
A
87252
($26)
$0
($0)
$15
$15
$15
2



CCP010000014
A
87070
($37)
$0
($0)
$6
$6
$6
12



CCP010000014
A
88304
($74)
$0
($0)
$15
$15
$15
9



CCP010000014
A
95044
($1,738)
$1
($1)
$8
$0
$8
9















A Total
$9,570
$14
$4



















CCP010000014
M
99243
$29,303
$35
$12
$131
$128
$129
666



CCP010000014
M
99213
$13,468
$36
$5
$58
$64
$55
1,303



CCP010000014
M
99203
$8,660
$4
$3
$144
$108
$102
76



CCP010000014
M
99202
$2,504
$1
$1
$93
$69
$64
40



CCP010000014
M
99214
$880
$1
$0
$88
$96
$89
34



CCP010000014
M
96910
$618
$0
$0
$55
$0
$52
5



CCP010000014
M
99245
$129
$0
$0
$0
$239
$228
1



CCP010000014
M
99385
$125
$0
$0
$0
$56
$56
3



CCP010000014
M
99211
$73
$0
$0
$0
$35
$23
4



CCP010000014
M
99215
$70
$0
$0
$0
$130
$127
2



CCP010000014
M
99204
$59
$0
$0
$0
$147
$144
2



CCP010000014
M
99201
$50
$0
$0
$0
$61
$41
1



CCP010000014
M
99386
$37
$0
$0
$0
$56
$56
1



CCP010000014
M
99395
$9
$0
$0
$0
$56
$56
3



CCP010000014
M
99396
($1)
$0
($0)
$0
$56
$56
5



CCP010000014
M
99394
($14)
$0
($0)
$0
$56
$56
1



CCP010000014
M
92012
($23)
$0
($0)
$0
$10
$43
2



CCP010000014
M
99241
($539)
$0
($0)
$0
$63
$53
2



CCP010000014
M
99242
($928)
$11
($0)
$100
$101
$97
273



CCP010000014
M
99212
($5,370)
$3
($2)
$42
$45
$39
164















M Total
$49,109
$93
$19



















CCP010000014
P
Q5P
$10,945
$13
$4
$3
$1
$2
415



CCP010000014
P
W1D
$4,882
$3
$2
$2
$2
$2
98



CCP010000014
P
Z2E
$668
$0
$0
$7
$0
$4
3



CCP010000014
P
J3301
$495
$0
$0
$25
$0
$8
25



CCP010000014
P
Q5H
$396
$0
$0
$2
$5
$3
17



CCP010000014
P
P4L
$362
$0
$0
$2
$2
$2
1



CCP010000014
P
Q5W
$252
$2
$0
$1
$1
$1
140



CCP010000014
P
H3D
$145
$0
$0
$0
$2
$2
2



CCP010000014
P
W1Q
$124
$0
$0
$10
$0
$9
2



CCP010000014
P
Q8F
$68
$0
$0
$0
$15
$24
1



CCP010000014
P
Q4F
$63
$0
$0
$12
$2
$6
1



CCP010000014
P
W1W
$50
$0
$0
$0
$2
$1
33



CCP010000014
P
J1030
$26
$0
$0
$8
$0
$12
3



CCP010000014
P
W3A
$25
$0
$0
$7
$0
$2
1



CCP010000014
P
L5G
$20
$2
$0
$3
$3
$3
71



CCP010000014
P
J9A
$17
$0
$0
$0
$0
$0
2



CCP010000014
P
J9260
$13
$0
$0
$15
$0
$5
1



CCP010000014
P
H2U
$12
$0
$0
$0
$0
$0
4



CCP010000014
P
H4B
$11
$0
$0
$0
$0
$1
5



CCP010000014
P
Q5R
$8
$0
$0
$8
$0
$4
5



CCP010000014
P
H6J
($4)
$0
($0)
$13
$2
$4
4



CCP010000014
P
Q8W
($7)
$0
($0)
$0
$4
$3
1



CCP010000014
P
S2A
($13)
$0
($0)
$0
$0
$0
1



CCP010000014
P
H0A
($17)
$0
($0)
$0
$3
$1
1



CCP010000014
P
D1A
($35)
$0
($0)
$2
$0
$2
1



CCP010000014
P
Z4B
($40)
$0
($0)
$2
$3
$3
2



CCP010000014
P
U6W
($46)
$0
($0)
$1
$0
$1
1



CCP010000014
P
J5F
($53)
$0
($0)
$9
$0
$10
2



CCP010000014
P
S2B
($59)
$2
($0)
$2
$1
$2
60



CCP010000014
P
L3P
($63)
$0
($0)
$4
$0
$3
2



CCP010000014
P
H3A
($68)
$0
($0)
$2
$1
$1
64



CCP010000014
P
W4E
($73)
$0
($0)
$1
$1
$1
6



CCP010000014
P
P5A
($74)
$0
($0)
$0
$1
$1
28



CCP010000014
P
  0
($138)
$0
($0)
$3
$0
$3
1



CCP010000014
P
W1A
($140)
$1
($0)
$1
$2
$1
81



CCP010000014
P
W3B
($148)
$0
($0)
$3
$2
$5
19



CCP010000014
P
V1B
($149)
$0
($0)
$1
$0
$1
7



CCP010000014
P
L5E
($231)
$0
($0)
$0
$0
$1
2



CCP010000014
P
W1K
($255)
$0
($0)
$5
$3
$5
9



CCP010000014
P
Z2A
($476)
$5
($0)
$2
$2
$2
121



CCP010000014
P
R1H
($534)
$0
($0)
$0
$1
$1
1



CCP010000014
P
L2A
($555)
$0
($0)
$0
$2
$1
4



CCP010000014
P
CL
($573)
$0
($0)
$7
$0
$36
1



CCP010000014
P
L9A
($891)
$0
($0)
$0
$3
$3
1



CCP010000014
P
W5A
($1,291)
$0
($1)
$2
$13
$5
8



CCP010000014
P
Q5F
($1,439)
$1
($1)
$2
$2
$2
90



CCP010000014
P
L1B
($2,316)
$0
($1)
$9
$0
$14
1



CCP010000014
P
Q5S
($2,611)
$0
($1)
$2
$0
$2
7



CCP010000014
P
L5A
($3,144)
$0
($1)
$1
$1
$2
7



CCP010000014
P
Q5K
($3,770)
$2
($1)
$4
$3
$4
35



CCP010000014
P
Z2G
($3,998)
$0
($2)
$0
$8
$7
3



CCP010000014
P
W1C
($7,040)
$9
($3)
$1
$1
$2
272



CCP010000014
P
L9B
($9,781)
$1
($4)
$3
$3
$3
40



CCP010000014
P
L5H
($9,821)
$0
($4)
$2
$3
$3
8



CCP010000014
P
L5F
($10,402)
$1
($4)
$5
$5
$5
11















P Total
($41,673)
$46
($16)



















CCP010000014
R
73630
$76
$0
$0
$0
$30
$24
2



CCP010000014
R
73130
$53
$0
$0
$0
$31
$26
1















R Total
$129
$0
$0



















CCP010000014
S
11401
$11,299
$6
$4
$114
$69
$106
105



CCP010000014
S
11400
$9,322
$4
$4
$90
$106
$93
101



CCP010000014
S
11441
$6,015
$3
$2
$154
$148
$145
42



CCP010000014
S
11440
$4,764
$2
$2
$124
$0
$117
39



CCP010000014
S
11402
$4,668
$3
$2
$89
$0
$129
47



CCP010000014
S
11421
$3,770
$2
$1
$130
$0
$115
31



CCP010000014
S
11420
$2,644
$1
$1
$86
$0
$88
29



CCP010000014
S
11442
$1,653
$1
$1
$209
$183
$166
11



CCP010000014
S
11422
$1,460
$1
$1
$163
$0
$136
13



CCP010000014
S
11641
$1,290
$1
$1
$194
$0
$197
8



CCP010000014
S
11306
$771
$1
$0
$69
$0
$64
31



CCP010000014
S
11643
$664
$0
$0
$280
$0
$297
3



CCP010000014
S
14040
$636
$0
$0
$0
$504
$633
1



CCP010000014
S
11308
$577
$0
$0
$99
$0
$108
7



CCP010000014
S
11307
$519
$0
$0
$92
$0
$86
10



CCP010000014
S
11603
$459
$0
$0
$187
$0
$161
3



CCP010000014
S
11303
$417
$0
$0
$92
$0
$100
4



CCP010000014
S
11644
$378
$0
$0
$392
$0
$392
1



CCP010000014
S
11446
$358
$0
$0
$371
$0
$371
1



CCP010000014
S
11622
$303
$0
$0
$217
$0
$172
2



CCP010000014
S
11444
$277
$0
$0
$307
$0
$289
1



CCP010000014
S
14020
$274
$0
$0
$0
$306
$459
1



CCP010000014
S
11770
$221
$0
$0
$0
$229
$229
1



CCP010000014
S
13132
$205
$0
$0
$0
$447
$389
1



CCP010000014
S
11312
$205
$0
$0
$109
$0
$98
7



CCP010000014
S
17110
$198
$6
$0
$64
$56
$55
137



CCP010000014
S
11623
$197
$0
$0
$244
$0
$228
1



CCP010000014
S
11424
$171
$0
$0
$244
$0
$212
1



CCP010000014
S
11621
$134
$0
$0
$94
$0
$143
1



CCP010000014
S
11730
$130
$0
$0
$0
$77
$79
2



CCP010000014
S
11900
$119
$0
$0
$31
$0
$47
32



CCP010000014
S
11640
$105
$0
$0
$167
$0
$164
1



CCP010000014
S
56605
$81
$0
$0
$0
$125
$90
1



CCP010000014
S
11732
$59
$0
$0
$0
$34
$36
1



CCP010000014
S
20550
$32
$0
$0
$0
$57
$67
1



CCP010000014
S
11443
$23
$0
$0
$222
$0
$213
1



CCP010000014
S
11423
$19
$0
$0
$195
$0
$170
2



CCP010000014
S
11601
($37)
$0
($0)
$91
$0
$148
1



CCP010000014
S
11602
($51)
$0
($0)
$164
$0
$151
3



CCP010000014
S
10060
($118)
$0
($0)
$132
$210
$102
4



CCP010000014
S
11642
($122)
$0
($0)
$245
$0
$247
1



CCP010000014
S
11403
($360)
$0
($0)
$151
$0
$164
5



CCP010000014
S
17111
($366)
$0
($0)
$0
$44
$50
1



CCP010000014
S
11310
($401)
$1
($0)
$64
$70
$60
18



CCP010000014
S
11305
($465)
$0
($0)
$39
$0
$40
14



CCP010000014
S
11101
($489)
$0
($0)
$40
$0
$41
19



CCP010000014
S
12032
($974)
$0
($0)
$223
$0
$210
1



CCP010000014
S
11901
($985)
$0
($0)
$49
$0
$66
4



CCP010000014
S
11302
($1,295)
$0
($1)
$85
$0
$81
7



CCP010000014
S
11311
($1,332)
$1
($1)
$83
$0
$80
13



CCP010000014
S
11300
($1,452)
$1
($1)
$43
$0
$44
19



CCP010000014
S
17003
($1,688)
$0
($1)
$4
$9
$4
38



CCP010000014
S
17304
($2,171)
$0
($1)
$0
$649
$627
1



CCP010000014
S
11301
($2,240)
$2
($1)
$56
$0
$62
50



CCP010000014
S
11100
($6,606)
$1
($3)
$93
$84
$85
35



CCP010000014
S
17000
($25,593)
$1
($10)
$67
$63
$63
44















S Total
$7,668
$45
$3



















CCP010000014
T
 0421
$333
$0
$0
$125
$0
$94
1















T Total
$333
$0
$0













CCP010000014 Total
$25,136
$198
$10
















TABLE B1







Allergy


Dates of service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Actual physician names and IDs removed


Allergic Rhinitis etg 0332

















total role


Responsible
Total role






episode
Responsible
total role
average per
expense per
cost



doctor
id list
count
expense
expense
episode
episode
rank
QUINTILE


















1
CCP010000013
181
$93,363
$115,782
$516
$640
1
Q1


2
CCP010000004
127
$72,348
$84,166
$570
$663
2
Q1


3
CCP010000011
164
$100,182
$113,283
$611
$691
3
Q1


4
CCP010000007
76
$36,371
$52,780
$479
$694
4
Q2


5
CCP010000015
194
$93,695
$135,933
$483
$701
5
Q2


6
CCP010000005
80
$42,292
$56,626
$529
$708
6
Q2


7
CCP010000009
603
$329,485
$430,038
$546
$713
7
Q3


8
CCP010000001
140
$88,318
$100,009
$631
$714
8
Q3


9
CCP010000008
200
$89,377
$143,388
$447
$717
9
Q3


10
CCP010000003
65
$36,455
$48,193
$561
$741
10
Q4


11
CCP010000002
160
$68,220
$119,405
$426
$746
11
Q4


12
CCP010000010
206
$128,860
$155,119
$626
$753
12
Q4


13
CCP010000014
149
$95,622
$118,949
$642
$798
13
Q4


14
CCP010000012
109
$74,708
$90,000
$685
$826
14
Q5


15
CCP010000006
65
$44,481
$54,945
$684
$845
15
Q5


16
CCP010000016
63
$43,554
$55,351
$691
$879
16
Q5





Note:


physician 10 assigned to Q4 because total costs per episode were more similar to Q4 than to Q3.













TABLE B2





Total Role Allergic Rhinitis ETGno 0332 by quintile


Each doctor with greater than or equal to 50 episodes


(3 doctors per Quintile, 4 in Q4)

























Total
Your
Other


quintile
category
services
PROC_DESC
Svcs
Svcs
Svcs





Q1
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
5,249
5,249
0





NUMBER





Q1
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY
1,809
1,809
0





NUMBER





Q1
A
94150
VITAL CAPACITY, TOTAL (SEP PROC)
10
0
10


Q1
A
86003
ALLERGEN SPECIFIC IGE; QUANTITATIVE/SEMIQUANTITATIVE, EACH
167
0
167





ALLERGEN





Q1
A
82785
GAMMAGLOBULIN; IGE
13
0
13


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
A
80053
COMPREHENSIVE METABOLIC PANEL
5
0
5


Q1
A
90782
THERAPEUTIC/PROPHYLACTIC/DX INJECTION (SPECIFY MATL INJECTED);
2
0
2





SUBQ/IM





Q1
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
16
16
0





NUMBER





Q1
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
16
16
0


Q1
A
ER
Emergency
2
2
0













A Total

7,390
7,123
267













Q1
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
49
46
3





COMPREHENSIVE E





Q1
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
168
158
10





HX; DETAILED EXAM;





Q1
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
80
80
0





IMMUNOTHERA





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q1
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE,
11
0
11





TYPICALLY 5





Q1
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB
8
3
5





FOCUS EX





Q1
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
35
35
0





EXAM; MED





Q1
M
99213
OFFICE/OP, VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
259
125
134





EXPAND PROB





Q1
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
20
20
0





IMMUNOTHER





Q1
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
222
171
51





EXTRACTS; SINGLE





Q1
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
5,342
5,012
330





IMMUNOTHER





Q1
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
3,059
2,391
668





EXTRACTS; 2+ INJ
















M Total

9,275
8,041
1,234













Q1
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
24,703
21,712
2,991


Q1
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
2,080
1,660
420


Q1
P
Z2A
ANTIHISTAMINES
22,109
16,777
5,332


Q1
P
Q7E
NASAL ANTIHISTAMINE
550
550
0


Q1
P
Q7A
NOSE PREPARATIONS, MISCELLANEOUS (RX)
30
30
0


Q1
P
B3J
EXPECTORANTS
49
0
49


Q1
P
P5A
GLUCOCORTICOIDS
42
30
12


Q1
P
Q6R
EYE ANTIHISTAMINES
448
313
135


Q1
P
B3K
COUGH AND/OR COLD PREPARATIONS
108
30
78













P Total

50,119
41,102
9,017













Q1
R
76375
CORONAL/SAGITTAL/MULTIPLANAR/OBLIQUE/3D/HOLOGRAPHIC CT/MRI
1
0
1





OTHER RECONS





Q1
R
70210
RADIOLOGIC EXAM, SINUSES, PARANASAL, <3 VIEWS
2
1
1


Q1
R
70486
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL
1
0
1


Q1
R
71020
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL & LATERAL
3
0
3













R Total

7
1
6













Q1
S
31231
NASAL ENDOSCOPY, DX, UNILAT/BILAT (SEP PROC)
2
2
0













S Total

2
2
0











Q1 Total

66,793
56,269
10,524













Q2
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
3,812
3,812
0





NUMBER





Q2
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
90
90
0





NUMBER





Q2
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY
1,539
1,539
0





NUMBER





Q2
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
81
81
0





NUMBER





Q2
A
87799
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), NOS; QUANTIFICATION
1
1
0





EA ORGAN





Q2
A
95070
INHALATION BRONCHIAL CHALLENGE TESTS; W/HISTAMINE/
1
1
0





METHACHOLINE





Q2
A
90782
THERAPEUTIC/PROPHYLACTIC/DX INJECTION (SPECIFY MATL INJECTED);
15
0
15





SUBQ/IM





Q2
A
85025
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC,
11
1
10





& PLATELET) &





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
A
CL
Clinic/Treatment/Testing
1
0
1


Q2
A
94010
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RATE W/WO
5
4
1





MAXIMAL VOLUN





Q2
A
ER
Emergency
1
0
1













A Total

5,651
5,532
119













Q2
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
6,420
6,300
120





IMMUNOTHER





Q2
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
577
231
346





EXTRACTS; SINGLE





Q2
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
22
22
0





HX;EXPAND PROB





Q2
M
99215
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: COMPREHENSIVE HX;
5
4
1





COMPREHENSIV





Q2
M
99205
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: COMPREHENSIVE HX;
1
1
0





COMPREHENSIV





Q2
M
99396
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM,
5
0
5





EST PT; 40-64





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
30
20
10





IMMUNOTHERA





Q2
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
20
10
10





IMMUNOTHER





Q2
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
67
48
19





EXAM;





Q2
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
172
57
115





EXPAND PROB





Q2
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
6
6
0





COMPREHENSIVE E





Q2
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
2,823
1,081
1,742





EXTRACTS; 2+ INJ
















M Total

10,225
7,814
2,411













Q2
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
1,124
690
434


Q2
P
Q6R
EYE ANTIHISTAMINES
437
191
246


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q2
P
B3J
EXPECTORANTS
85
30
55


Q2
P
P5A
GLUCOCORTICOIDS
10
0
10


Q2
P
Z2A
ANTIHISTAMINES
13,602
8,778
4,824


Q2
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
7,740
4,472
3,268













P Total

23,853
14,740
9,113













Q2
R
70486
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL
3
1
2


Q2
R
70250
RADIOLOGIC EXAM, SKULL; <4 VIEWS
1
1
0


Q2
R
71020
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL & LATERAL
3
1
2













R Total

7
3
4











Q2 Total

39,736
28,089
11,647













Q3
A
94010
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RATE W/WO
36
32
4





MAXIMAL VOLUN





Q3
A
A0427
Ambulance service, advanced life support, emergency transport, level 1 (
1
1
0


Q3
A
A0429
Ambulance service, basic life support, emergency transport (BLS —emerge
1
1
0


Q3
A
A0432
Paramedic intercept (PI), rural area, transport furnished by a volunteer
1
1
0


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
A
94150
VITAL CAPACITY, TOTAL (SEP PROC)
4
0
4


Q3
A
82785
GAMMAGLOBULIN; IGE
3
2
1


Q3
A
ER
Emergency
9
5
4


Q3
A
86003
ALLERGEN SPECIFIC IGE; QUANTITATIVE/SEMIQUANTITATIVE, EACH
41
32
9





ALLERGEN





Q3
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
6
6
0





NUMBER





Q3
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY
2,969
2,880
89





NUMBER





Q3
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
5,661
5,465
196





NUMBER
















A Total

8,969
8,458
511













Q3
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
11,361
7,460
3,901





EXTRACTS; 2+ INJ





Q3
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
19,554
19,034
520





IMMUNOTHER





Q3
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
1,224
487
737





EXTRACTS; SINGLE





Q3
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB
73
57
16





FOCUS EX





Q3
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
572
314
258





EXPAND PROB





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q3
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE,
55
4
51





TYPICALLY 5





Q3
M
99215
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: COMPREHENSIVE HX;
2
2
0





COMPREHENSIV





Q3
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS
1
0
1





HX;EXPAND PROB





Q3
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
76
72
4





EXAM; MED





Q3
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
34
30
4





COMPREHENSIVE E





Q3
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
32
20
12





IMMUNOTHERA





Q3
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
29
29
0





IMMUNOTHERA





Q3
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
91
52
39





EXAM;
















M Total

33,135
27,561
5,574













Q3
P
B3J
EXPECTORANTS
178
59
119


Q3
P
B3K
COUGH AND/OR COLD PREPARATIONS
378
229
149


Q3
P
P5A
GLUCOCORTICOIDS
34
20
14


Q3
P
Q6R
EYE ANTIHISTAMINES
600
472
128


Q3
P
Q7E
NASAL ANTIHISTAMINE
517
457
60


Q3
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
1,620
750
870


Q3
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
22,039
15,841
6,198


Q3
P
Z2A
ANTIHISTAMINES
29,922
19,060
10,862













P Total

55,288
36,888
18,400













Q3
R
70450
CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL
2
0
2


Q3
R
70160
RADIOLOGIC EXAM, NASAL BONES, COMPLETE, MINIMUM, 3 VIEWS
1
0
1


Q3
R
71020
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL & LATERAL
4
1
3


Q3
R
70486
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL
1
0
1













R Total

8
1
7











Q3 Total

97,400
72,908
24,492













Q4
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
5,563
5,477
86





NUMBER





Q4
A
CL
Clinic/Treatment/Testing
1
1
0


Q4
A
86003
ALLERGEN SPECIFIC IGE; QUANTITATIVE/SEMIQUANTITATIVE, EACH
122
14
108





ALLERGEN





Q4
A
94010
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RATE W/WO
19
17
2





IMMUNOTHER





Q4
A
92557
COMPREHENSIVE AUDIOMETRY THRESHOLD VAL & SPEECH
1
0
1





RECOGNITION





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
A
80053
COMPREHENSIVE METABOLIC PANEL
6
1
5


Q4
A
80050
GENERAL HEALTH PANEL
2
1
1


Q4
A
90782
THERAPEUTIC/PROPHYLACTIC/DX INJECTION (SPECIFY MATL INJECTED);
5
1
4





SUBQ/IM





Q4
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
20
20
0





NUMBER





Q4
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
10
10
0





NUMBER





Q4
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY
1,957
1,949
8





NUMBER
















A Total

7,822
7,505
317













Q4
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
258
216
42





EXAM;





Q4
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
130
110
20





IMMUNOTHER





Q4
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
131
121
10





IMMUNOTHERA





Q4
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
58
57
1





EXAM; MED





Q4
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE,
61
2
59





TYPICALLY 5





Q4
M
99215
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: COMPREHENSIVE HX;
5
4
1





COMPREHENSIV





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
333
152
181





EXPAND PROB





Q4
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS H
2
1
1





EXPAND PROB





Q4
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB
10
3
7


Q4
M
ER
Emergency
1
0
1


Q4
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
485
215
270





EXTRACTS; SINGLE





Q4
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
9,894
9,014
880





IMMUNOTHER





Q4
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
5,667
3,234
2,433





EXTRACTS; 2+ INJ
















M Total

17,086
13,158
3,928













Q4
P
Z2A
ANTIHISTAMINES
31,066
22,860
8,206


Q4
P
Q7E
NASAL ANTIHISTAMINE
863
699
164


Q4
P
Q6R
EYE ANTIHISTAMINES
694
565
129


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q4
P
B3J
EXPECTORANTS
66
10
56


Q4
P
B3K
COUGH AND/OR COLD PREPARATIONS
140
52
88


Q4
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
930
690
240


Q4
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
16,309
10,935
5,374













P Total

50,241
35,915
14,326













Q4
R
71020
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL & LATERAL
4
3
1


Q4
R
70220
RADIOLOGIC EXAM, SINUSES, PARANASAL, COMPLETE, MINIMUM,
1
0
1





3 VIEW





Q4
R
70486
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL
1
0
1













R Total

6
3
3













Q4
S
31231
NASAL ENDOSCOPY, DX, UNILAT/BILAT (SEP PROC)
2
0
2













S Total

2
0
2











Q4 Total

75,157
56,581
18,576













Q5
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC, EXTRACTS, SPECIFY
1,118
1,118
0





NUMBER





Q5
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
27
27
0





NUMBER





Q5
A
ER
Emergency
4
3
1


Q5
A
CL
Clinic/Treatment/Testing
3
0
3


Q5
A
90782
THERAPEUTIC/PROPHYLACTIC/DX INJECTION (SPECIFY MATL INJECTED
10
0
10


.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q5
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
7
7
0





NUMBER





Q5
A
94010
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RATE W/WO
1
1
0





MAXIMAL VOLUN





Q5
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
1,315
1,315
0





NUMBER
















A Total

2,612
2,475
137













Q5
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
4,930
4,740
190





IMMUNOTHER





Q5
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
2,558
1,907
651





EXTRACTS; 2+ INJ





Q5
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
120
110
10





IMMUNOTHERA





Q5
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
70
70
0





IMMUNOTHER





Q5
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
346
285
61





EXTRACTS; SINGLE





Q5
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
25
21
4





EXAM; MED





Q5
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE,
33
0
33





TYPICALLY 5





Q5
M
99212
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: PROB FOCUS HX; PROB
18
13
5





FOCUS EX





Q5
M
99204
OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS: COMPREHENSIVE
1
0
1





HX;COMPREHENSIV





.
.
.
.
.
.
.


.
.
.
.
.
.
.


.
.
.
.
.
.
.


Q5
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX;
140
77
63





EXPAND PROB





Q5
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
46
29
17





EXAM;





Q5
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
4
3
1





COMPREHENSIVE E
















M Total

8,299
7,258
1,041













Q5
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
9,599
7,868
1,731


Q5
P
Z2A
ANTIHISTAMINES
10,628
7,179
3,449


Q5
P
Q6R
EYE ANTIHISTAMINES
474
440
34


Q5
P
B3K
COUGH AND/OR COLD PREPARATIONS
304
238
66


Q5
P
Q7E
NASAL ANTIHISTAMINE
464
396
68


Q5
P
P5A
GLUCOCORTICOIDS
335
319
16


Q5
P
Q7A
NOSE PREPARATIONS, MISCELLANEOUS (RX)
45
45
0


Q5
P
B3J
EXPECTORANTS
49
0
49


Q5
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
450
270
180













P Total

22,348
16,755
5,593













Q5
R
70220
RADIOLOGIC EXAM, SINUSES, PARANASAL, COMPLETE, MINIMUM, 3
1
0
1





VIEWS
















R Total

1
0
1













Q5
S
30520
SEPTOPLASTY/SUBMUCOUS RESECTION W/WO CARTILAGE SCORING/
1
0
1





CONTOURING/GRAFT





Q5
S
31231
NASAL ENDOSCOPY, DX, UNILAT/BILAT (SEP PROC)
1
0
1













S Total

2
0
2











Q5 Total

33,262
26,488
6,774


Grand Total

312,348
240,335
72,013































Total Cost
Your












Difference
costs





Expected
quintile




Total Cost
per Quintile
per


quintile
category
services
Svcs
episodes
Total Costs
Your Costs
Other Costs
expected costs
Difference
Episode
svc





Q1
A
95004
4068.32
472
$20,676
$20,676
$0
$15,973
$4,703
$10
$4


Q1
A
95024
1768.96
472
$10,946
$10,946
$0
$10,545
$401
$1
$6


Q1
A
94150
2.64
472
$258
$0
$258
$59
$199
$0
$0


Q1
A
86003
73.83
472
$341
$0
$341
$153
$188
$0
$0


Q1
A
82785
3.96
472
$169
$0
$169
$51
$118
$0
$0


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.


Q1
A
80053
8.85
472
$25
$0
$25
$48
($23)
($0)
$0


Q1
A
90782
9.23
472
$18
$0
$18
$74
($56)
($0)
$0


Q1
A
95010
23.17
472
$390
$390
$0
$557
($167)
($0)
$24


Q1
A
95015
28.25
472
$356
$356
$0
$623
($267)
($1)
$22


Q1
A
ER
5.09
472
$365
$365
$0
$855
($490)
($1)
$183


















A Total
6075.92
472
$35,004
$33,715
$1,289
$29,993
$5,011
$11



















Q1
M
99244
22.98
472
$9,045
$8,491
$554
$4,228
$4,817
$10
$185


Q1
M
99214
118.66
472
$14,891
$14,013
$878
$10,445
$4,446
$9
$89


Q1
M
95145
74.02
472
$1,730
$1,730
$0
$1,590
$140
$0
$22


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.


Q1
M
99211
35.03
472
$253
$0
$253
$782
($529)
($1)
$0


Q1
M
99212
22.04
472
$308
$120
$188
$883
($575)
($1)
$40


Q1
M
99243
42.38
472
$4,546
$4,546
$0
$5,451
($905)
($2)
$130


Q1
M
99213
278.00
472
$14,137
$7,000
$7,137
$15,176
($1,039)
($2)
$56


Q1
M
95147
50.67
472
$782
$782
$0
$1,954
($1,172)
($2)
$39


Q1
M
95115
537.55
472
$3,408
$2,736
$672
$8,582
($5,174)
($11)
$16


Q1
M
95165
8690.38
472
$60,093
$56,357
$3,736
$91,309
($31,216)
($66)
$11


Q1
M
95117
4796.85
472
$63,856
$50,048
$13,808
$100,110
($36,254)
($77)
$21


















M Total
14680.78
472
$173,957
$145,823
$28,134
$241,259
($67,302)
($143)



















Q1
P
Q7P
15141.29
472
$51,580
$45,801
$5,779
$31,968
$19,612
$42
$2


Q1
P
Z4B
1168.51
472
$5,781
$4,616
$1,165
$3,136
$2,645
$6
$3


Q1
P
Z2A
20214.82
472
$43,162
$33,287
$9,875
$40,682
$2,480
$5
$2


Q1
P
Q7E
530.20
472
$1,108
$1,108
$0
$1,059
$49
$0
$2


Q1
P
Q7A
56.50
472
$86
$86
$0
$88
($2)
($0)
$3


Q1
P
B3J
80.42
472
$41
$0
$41
$76
($35)
($0)
$0


Q1
P
P5A
85.13
472
$42
$31
$11
$110
($68)
($0)
$1


Q1
P
Q6R
499.69
472
$1,479
$1,076
$403
$1,618
($139)
($0)
$3


Q1
P
B3K
233.55
472
$181
$58
$123
$491
($310)
($1)
$2


















P Total
38010.13
472
$103,460
$86,063
$17,397
$79,227
$24,233
$51



















Q1
R
76375
.19
472
$147
$0
$147
$28
$119
$0
$0


Q1
R
70210
.38
472
$68
$34
$34
$13
$55
$0
$34


Q1
R
70486
1.13
472
$249
$0
$249
$234
$15
$0
$0


Q1
R
71020
2.64
472
$88
$0
$88
$81
$7
$0
$0


















R Total
4.33
472
$552
$34
$518
$356
$196
$0



















Q1
S
31231
.94
472
$258
$258
$0
$121
$137
$0
$129
















S Total
.94

$258
$258
$0
$121

















Q1 Total
58772.10

$313,231
$265,893
$47,338
$350,956





















Q2
A
95004
3008.14
349
$15,167
$15,167
$0
$11,811
$3,356
$10
$4


Q2
A
95010
17.13
349
$2,158
$2,158
$0
$412
$1,746
$5
$24


Q2
A
95024
1307.98
349
$9,338
$9,338
$0
$7,797
$1,541
$4
$6


Q2
A
95015
20.89
349
$1,779
$1,779
$0
$461
$1,318
$4
$22


Q2
A
87799
.14
349
$110
$110
$0
$15
$95
$0
$110


Q2
A
95070
.14
349
$91
$91
$0
$13
$78
$0
$91


Q2
A
90782
6.82
349
$121
$0
$121
$55
$66
$0
$0


Q2
A
85025
6.27
349
$56
$26
$30
$22
$34
$0
$26


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.


Q2
A
CL
.70
349
$10
$0
$10
$81
($71)
($0)
$0


Q2
A
94010
11.00
349
$200
$166
$34
$428
($228)
($1)
$42


Q2
A
ER
3.76
349
$128
$0
$128
$632
($504)
($1)
$0


















A Total
4487.84
349
$29,690
$28,939
$751
$22,156
$7,534
$22



















Q2
M
95165
6425.72
349
$71,708
$70,368
$1,340
$67,514
$4,194
$12
$11


Q2
M
95115
397.46
349
$8,695
$3,658
$5,037
$6,346
$2,349
$7
$16


Q2
M
99242
3.76
349
$2,146
$2,146
$0
$367
$1,779
$5
$98


Q2
M
99215
1.81
349
$649
$520
$129
$235
$414
$1
$130


Q2
M
99205
.14
349
$187
$187
$0
$26
$161
$0
$187


Q2
M
99396
2.65
349
$280
$0
$280
$148
$132
$0
$0


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.


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.
.
.


Q2
M
95145
54.73
349
$618
$437
$181
$1,175
($557)
($2)
$22


Q2
M
95147
37.46
349
$723
$391
$332
$1,444
($721)
($2)
$39


Q2
M
99214
87.74
349
$5,906
$4,260
$1,646
$7,723
($1,817)
($5)
$89


Q2
M
99213
205.56
349
$9,260
$3,176
$6,084
$11,221
($1,961)
($6)
$56


Q2
M
99244
16.99
349
$1,107
$1,107
$0
$3,126
($2,019)
($6)
$185


Q2
M
95117
3546.82
349
$57,343
$21,437
$35,906
$74,022
($16,679)
($48)
$20


















M Total
10864.68
349
$164,820
$111,782
$53,038
$179,759
($14,939)
($43)



















Q2
P
Z4B
864.00
349
$2,943
$1,738
$1,205
$2,318
$625
$2
$3


Q2
P
Q6R
369.47
349
$1,354
$687
$667
$1,197
$157
$0
$4


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.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


Q2
P
B3J
59.47
349
$49
$12
$37
$56
($7)
($0)
$0


Q2
P
P5A
62.95
349
$5
$0
$5
$81
($76)
($0)
$0


Q2
P
Z2A
14946.98
349
$27,153
$18,039
$9,114
$30,080
($2,927)
($8)
$2


Q2
P
Q7P
11195.57
349
$16,959
$9,813
$7,146
$23,637
($6,678)
($19)
$2


















P Total
28107.31
349
$50,034
$31,259
$18,775
$58,583
($8,549)
($24)



















Q2
R
70486
.84
349
$673
$305
$368
$173
$500
$1
$305


Q2
R
70250
.14
349
$36
$36
$0
$5
$31
$0
$36


Q2
R
71020
1.95
349
$86
$37
$49
$60
$26
$0
$37
















R Total
2.92

$795
$378
$417
$238

















Q2 Total
43462.76

$245,339
$172,358
$72,981
$260,737





















Q3
A
94010
29.73
943
$1,477
$1,304
$173
$1,156
$321
$0
$41


Q3
A
A0427
.38
943
$509
$509
$0
$192
$317
$0
$509


Q3
A
A0429
.38
943
$450
$450
$0
$169
$281
$0
$450


Q3
A
A0432
.38
943
$320
$320
$0
$120
$200
$0
$320


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.
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.
.
.
.


Q3
A
94150
5.27
943
$56
$0
$56
$118
($62)
($0)
$0


Q3
A
82785
7.90
943
$39
$26
$13
$103
($64)
($0)
$13


Q3
A
ER
10.16
943
$1,605
$1,081
$524
$1,708
($103)
($0)
$216


Q3
A
86003
147.51
943
$84
$64
$20
$305
($221)
($0)
$2


Q3
A
95015
56.44
943
$134
$134
$0
$1,244
($1,110)
($1)
$22


Q3
A
95024
3534.18
943
$17,535
$17,005
$530
$21,068
($3,533)
($4)
$6


Q3
A
95004
8128.01
943
$21,809
$21,047
$762
$31,912
($10,103)
($11)
$4


















A Total
12131.44
943
$45,294
$42,185
$3,109
$59,238
($13,944)
($15)



















Q3
M
95117
9583.53
943
$238,744
$155,699
$83,045
$200,007
$38,737
$41
$21


Q3
M
95165
17362.34
943
$189,364
$183,700
$5,664
$182,424
$6,940
$7
$10


Q3
M
95115
1073.95
943
$20,048
$7,790
$12,258
$17,146
$2,902
$3
$16


Q3
M
99212
44.03
943
$2,948
$2,280
$668
$1,764
$1,184
$1
$40


Q3
M
99213
555.41
943
$31,343
$17,307
$14,036
$30,320
$1,023
$1
$55


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.
.
.


Q3
M
99211
69.99
943
$1,206
$92
$1,114
$1,563
($357)
($0)
$23


Q3
M
99215
4.89
943
$259
$259
$0
$634
($375)
($0)
$130


Q3
M
99242
10.16
943
$97
$0
$97
$990
($893)
($1)
$0


Q3
M
99243
84.67
943
$9,639
$9,120
$519
$10,891
($1,252)
($1)
$127


Q3
M
99244
45.91
943
$6,240
$5,501
$739
$8,447
($2,207)
($2)
$183


Q3
M
95145
147.88
943
$712
$428
$284
$3,176
($2,464)
($3)
$21


Q3
M
95147
101.22
943
$1,115
$1,115
$0
$3,903
($2,788)
($3)
$38


Q3
M
99214
237.07
943
$7,871
$4,463
$3,408
$20,868
($12,997)
($14)
$86


















M Total
29354.17
943
$511,821
$387,754
$124,067
$484,315
$27,506
$29



















Q3
P
B3J
160.68
943
$246
$37
$209
$152
$94
$0
$1


Q3
P
B3K
466.61
943
$815
$482
$333
$981
($166)
($0)
$2


Q3
P
P5A
170.09
943
$25
$9
$16
$219
($194)
($0)
$0


Q3
P
Q6R
998.32
943
$2,220
$1,830
$390
$3,234
($1,014)
($1)
$4


Q3
P
Q7E
1059.28
943
$961
$855
$106
$2,115
($1,154)
($1)
$2


Q3
P
Z4B
2334.55
943
$4,271
$1,984
$2,287
$6,265
($1,994)
($2)
$3


Q3
P
Q7P
30250.51
943
$45,664
$31,993
$13,671
$63,868
($18,204)
($19)
$2


Q3
P
Z2A
40386.82
943
$61,825
$40,014
$21,811
$81,277
($19,452)
($21)
$2


















P Total
75826.83
943
$116,027
$77,204
$38,823
$158,111
($42,084)
($45)



















Q3
R
70450
.75
943
$97
$0
$97
$37
$60
$0
$0


Q3
R
70160
.38
943
$31
$0
$31
$12
$19
$0
$0


Q3
R
71020
5.27
943
$100
$37
$63
$161
($61)
($0)
$37


Q3
R
70486
2.26
943
$65
$0
$65
$468
($403)
($0)
$0


















R Total
8.65
943
$293
$37
$256
$678
($385)
($0)















Q3 Total
117321.09

$673,435
$507,180
$166,255
$702,341



















Q4
A
95004
4964.72
576
$22,180
$21,854
$326
$19,493
$2,687
$5
$4


Q4
A
CL
1.15
576
$397
$397
$0
$134
$263
$0
$397


Q4
A
86003
90.10
576
$252
$34
$218
$186
$66
$0
$2


Q4
A
94010
18.16
576
$751
$714
$37
$706
$45
$0
$42


Q4
A
92557
.23
576
$50
$0
$50
$11
$39
$0
$0


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.


Q4
A
80053
10.80
576
$30
$5
$25
$58
($28)
($0)
$5


Q4
A
80050
5.06
576
$28
$14
$14
$71
($43)
($0)
$14


Q4
A
90782
11.26
576
$40
$8
$32
$90
($50)
($0)
$8


Q4
A
95015
34.48
576
$437
$437
$0
$760
($323)
($1)
$22


Q4
A
95010
28.27
576
$240
$240
$0
$680
($440)
($1)
$24


Q4
A
95024
2158.74
576
$11,920
$11,873
$47
$12,869
($949)
($2)
$6


















A Total
7431.00
576
$37,998
$36,194
$1,804
$36,730
$1,268
$2



















Q4
M
99214
144.80
576
$22,778
$19,093
$3,685
$12,746
$10,032
$17
$88


Q4
M
95147
61.83
576
$5,015
$4,267
$748
$2,384
$2,631
$5
$39


Q4
M
95145
90.33
576
$2,803
$2,589
$214
$1,940
$863
$1
$21


Q4
M
99243
51.72
576
$7,502
$7,373
$129
$6,653
$849
$1
$129


Q4
M
99211
42.75
576
$1,353
$46
$1,307
$955
$398
$1
$23


Q4
M
99215
2.99
576
$648
$518
$130
$388
$260
$0
$130


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


Q4
M
99213
339.26
576
$18,313
$8,455
$9,858
$18,520
($207)
($0)
$56


Q4
M
99242
6.21
576
$194
$97
$97
$605
($411)
($1)
$97


Q4
M
99212
26.89
576
$410
$116
$294
$1,078
($668)
($1)
$39


Q4
M
ER
6.21
576
$253
$0
$253
$1,043
($790)
($1)
$0


Q4
M
95115
655.99
576
$7,881
$3,440
$4,441
$10,473
($2,592)
($5)
$16


Q4
M
95165
10605.20
576
$108,460
$99,200
$9,260
$111,428
($2,968)
($5)
$11


Q4
M
95117
5853.78
576
$118,104
$67,266
$50,838
$122,168
($4,064)
($7)
$21


















M Total
17931.85
576
$300,507
$217,833
$82,674
$296,672
$3,835
$7



















Q4
P
Z2A
24668.94
576
$61,796
$46,892
$14,904
$49,646
$12,150
$21
$2


Q4
P
Q7E
647.02
576
$1,704
$1,388
$316
$1,292
$412
$1
$2


Q4
P
Q6R
609.79
576
$2,151
$1,717
$434
$1,975
$176
$0
$3


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


Q4
P
B3J
98.15
576
$49
$8
$41
$93
($44)
($0)
$1


Q4
P
B3K
285.01
576
$307
$141
$166
$599
($292)
($1)
$3


Q4
P
Z4B
1425.98
576
$2,445
$1,860
$585
$3,827
($1,382)
($2)
$3


Q4
P
Q7P
18477.51
576
$33,632
$22,787
$10,845
$39,011
($5,379)
($9)
$2


















P Total
46390.75
576
$102,446
$75,013
$27,433
$96,705
$5,741
$10



















Q4
R
71020
3.22
576
$155
$117
$38
$99
$56
$0
$39


Q4
R
70220
.46
576
$45
$0
$45
$21
$24
$0
$0


Q4
R
70486
1.38
576
$258
$0
$258
$286
($28)
($0)
$0


















R Total
5.06
576
$458
$117
$341
$405
$53
$0



















Q4
S
31231
1.15
576
$257
$0
$257
$148
$109
$0
$0


















S Total
1.15
576
$257
$0
$257
$148
$109
$0















Q4 Total
71759.81

$441,666
$329,157
$112,509
$430,660



















Q5
A
95024
888.23
237
$6,250
$6,250
$0
$5,295
$955
$4
$6


Q5
A
95015
14.19
237
$601
$601
$0
$313
$288
$1
$22


Q5
A
ER
2.55
237
$697
$569
$128
$429
$268
$1
$190


Q5
A
CL
.47
237
$174
$0
$174
$55
$119
$1
$0


Q5
A
90782
4.63
237
$80
$0
$80
$37
$43
$0
$0


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


Q5
A
95010
11.63
237
$171
$171
$0
$280
($109)
($0)
$24


Q5
A
94010
7.47
237
$43
$43
$0
$290
($247)
($1)
$43


Q5
A
95004
2042.78
237
$4,974
$4,974
$0
$8,020
($3,046)
($13)
$4


















A Total
3057.36
237
$13,582
$12,720
$862
$15,113
($1,531)
($6)



















Q5
M
95165
4363.60
237
$55,163
$53,070
$2,093
$45,848
$9,315
$39
$11


Q5
M
95117
2408.59
237
$53,467
$40,047
$13,420
$50,267
$3,200
$14
$21


Q5
M
95145
37.17
237
$2,577
$2,363
$214
$798
$1,779
$8
$21


Q5
M
95147
25.44
237
$2,737
$2,737
$0
$981
$1,756
$7
$39


Q5
M
95115
269.91
237
$5,533
$4,560
$973
$4,309
$1,224
$5
$16


Q5
M
99243
21.28
237
$3,243
$2,724
$519
$2,737
$506
$2
$130


Q5
M
99211
17.59
237
$759
$0
$759
$393
$366
$2
$0


Q5
M
99212
11.07
237
$714
$520
$194
$443
$271
$1
$40


Q5
M
99204
.47
237
$147
$0
$147
$77
$70
$0
$0


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.
.
.
.


Q5
M
99213
139.59
237
$7,521
$4,220
$3,301
$7,620
($99)
($0)
$55


Q5
M
99214
59.58
237
$4,009
$2,568
$1,441
$5,245
($1,236)
($5)
$89


Q5
M
99244
11.54
237
$738
$553
$185
$2,123
($1,385)
($6)
$184


















M Total
7373.67
237
$137,274
$113,687
$23,587
$121,517
$15,757
$66



















Q5
P
Q7P
7602.73
237
$21,892
$17,648
$4,244
$16,052
$5,840
$25
$2


Q5
P
Z2A
10150.24
237
$22,057
$14,835
$7,222
$20,427
$1,630
$7
$2


Q5
P
Q6R
250.90
237
$1,389
$1,293
$96
$813
$576
$2
$3


Q5
P
B3K
117.27
237
$815
$609
$206
$246
$569
$2
$3


Q5
P
Q7E
266.22
237
$918
$759
$159
$532
$386
$2
$2


Q5
P
P5A
42.75
237
$405
$381
$24
$55
$350
$1
$1


Q5
P
Q7A
28.37
237
$75
$75
$0
$44
$31
$0
$2


Q5
P
B3J
40.38
237
$20
$0
$20
$38
($18)
($0)
$0


Q5
P
Z4B
586.73
237
$1,208
$736
$472
$1,574
($366)
($2)
$3


















P Total
19085.59
237
$48,779
$36,336
$12,443
$39,781
$8,998
$38



















Q5
R
70220
.19
237
$45
$0
$45
$9
$36
$0
$0


















R Total
.19
237
$45
$0
$45
$9
$36
$0



















Q5
S
30520
.09
237
$487
$0
$487
$46
$441
$2
$0


Q5
S
31231
.47
237
$129
$0
$129
$61
$68
$0
$0


















S Total
.57
237
$616
$0
$616
$107
$509
$2















Q5 Total
29517.38

$200,296
$162,743
$37,553
$176,527



Grand Total
320833.13

$1,873,967
$1,437,331
$436,636
$1,921,220























Total Costs per
Your Avg Cost per
other costs per
total episodes


quintile
category
services
Other costs per svc
Spec Costs per svc
episode
Episode
episode
this service occurred





Q1
A
95004
$0
$4
$44
$44
$0
147


Q1
A
95024
$0
$6
$23
$23
$0
85


Q1
A
94150
$26
$22
$1
$0
$1
1


Q1
A
86003
$2
$2
$1
$0
$1
14


Q1
A
82785
$13
$13
$0
$0
$0
13


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q1
A
80053
$5
$5
$0
$0
$0
5


Q1
A
90782
$9
$8
$0
$0
$0
1


Q1
A
95010
$0
$24
$1
$1
$0
2


Q1
A
95015
$0
$22
$1
$1
$0
2


Q1
A
ER
$0
$168
$1
$1
$0
2










A Total
















Q1
M
99244
$185
$184
$19
$18
$1
47


Q1
M
99214
$88
$88
$32
$30
$2
124


Q1
M
95145
$0
$21
$4
$4
$0
5


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q1
M
99211
$23
$22
$1
$0
$1
1


Q1
M
99212
$38
$40
$1
$0
$0
7


Q1
M
99243
$0
$129
$10
$10
$0
35


Q1
M
99213
$53
$55
$30
$15
$15
148


Q1
M
95147
$0
$39
$2
$2
$0
2


Q1
M
95115
$13
$16
$7
$6
$1
18


Q1
M
95165
$11
$11
$127
$119
$8
176


Q1
M
95117
$21
$21
$135
$106
$29
167










M Total
















Q1
P
Q7P
$2
$2
$109
$97
$12
209


Q1
P
Z4B
$3
$3
$12
$10
$2
13


Q1
P
Z2A
$2
$2
$91
$71
$21
194


Q1
P
Q7E
$0
$2
$2
$2
$0
5


Q1
P
Q7A
$0
$2
$0
$0
$0
1


Q1
P
B3J
$1
$1
$0
$0
$0
3


Q1
P
P5A
$1
$1
$0
$0
$0
3


Q1
P
Q6R
$3
$3
$3
$2
$1
19


Q1
P
B3K
$2
$2
$0
$0
$0
6










P Total
















Q1
R
76375
$147
$147
$0
$0
$0
1


Q1
R
70210
$34
$34
$0
$0
$0
2


Q1
R
70486
$249
$208
$1
$0
$1
1


Q1
R
71020
$29
$31
$0
$0
$0
3










R Total
















Q1
S
31231
$0
$129
$1
$1
$0
2










S Total









Q1 Total
















Q2
A
95004
$0
$4
$43
$43
$0
63


Q2
A
95010
$0
$24
$6
$6
$0
6


Q2
A
95024
$0
$6
$27
$27
$0
44


Q2
A
95015
$0
$22
$5
$5
$0
6


Q2
A
87799
$0
$110
$0
$0
$0
1


Q2
A
95070
$0
$91
$0
$0
$0
1


Q2
A
90782
$8
$8
$0
$0
$0
8


Q2
A
85025
$3
$4
$0
$0
$0
5


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q2
A
CL
$10
$116
$0
$0
$0
1


Q2
A
94010
$34
$39
$1
$0
$0
5


Q2
A
ER
$128
$168
$0
$0
$0
1










A Total
















Q2
M
95165
$11
$11
$205
$202
$4
249


Q2
M
95115
$15
$16
$25
$10
$14
47


Q2
M
99242
$0
$97
$6
$6
$0
22


Q2
M
99215
$129
$130
$2
$1
$0
5


Q2
M
99205
$0
$187
$1
$1
$0
1


Q2
M
99396
$56
$56
$1
$0
$1
5


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q2
M
95145
$18
$21
$2
$1
$1
2


Q2
M
95147
$33
$39
$2
$1
$1
2


Q2
M
99214
$87
$88
$17
$12
$5
64


Q2
M
99213
$53
$55
$27
$9
$17
128


Q2
M
99244
$0
$184
$3
$3
$0
6


Q2
M
95117
$21
$21
$164
$61
$103
195










M Total
















Q2
P
Z4B
$3
$3
$8
$5
$3
12


Q2
P
Q6R
$3
$3
$4
$2
$2
14


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q2
P
B3J
$1
$1
$0
$0
$0
7


Q2
P
P5A
$1
$1
$0
$0
$0
1


Q2
P
Z2A
$2
$2
$78
$52
$26
102


Q2
P
Q7P
$2
$2
$49
$28
$20
81










P Total
















Q2
R
70486
$184
$208
$2
$1
$1
2


Q2
R
70250
$0
$36
$0
$0
$0
1


Q2
R
71020
$25
$31
$0
$0
$0
2










R Total









Q2 Total
















Q3
A
94010
$43
$39
$2
$1
$0
36


Q3
A
A0427
$0
$509
$1
$1
$0
1


Q3
A
A0429
$0
$450
$0
$0
$0
1


Q3
A
A0432
$0
$320
$0
$0
$0
1


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q3
A
94150
$14
$22
$0
$0
$0
2


Q3
A
82785
$13
$13
$0
$0
$0
3


Q3
A
ER
$131
$168
$2
$1
$1
9


Q3
A
86003
$2
$2
$0
$0
$0
7


Q3
A
95015
$0
$22
$0
$0
$0
1


Q3
A
95024
$6
$6
$19
$18
$1
101


Q3
A
95004
$4
$4
$23
$22
$1
110










A Total
















Q3
M
95117
$21
$21
$253
$165
$88
689


Q3
M
95165
$11
$11
$201
$195
$6
768


Q3
M
95115
$17
$16
$21
$8
$13
110


Q3
M
99212
$42
$40
$3
$2
$1
60


Q3
M
99213
$54
$55
$33
$18
$15
381


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q3
M
99211
$22
$22
$1
$0
$1
15


Q3
M
99215
$0
$130
$0
$0
$0
2


Q3
M
99242
$97
$97
$0
$0
$0
1


Q3
M
99243
$130
$129
$10
$10
$1
75


Q3
M
99244
$185
$184
$7
$6
$1
34


Q3
M
95145
$24
$21
$1
$0
$0
3


Q3
M
95147
$0
$39
$1
$1
$0
3


Q3
M
99214
$87
$88
$8
$5
$4
77










M Total
















Q3
P
B3J
$2
$1
$0
$0
$0
20


Q3
P
B3K
$2
$2
$1
$1
$0
17


Q3
P
P5A
$1
$1
$0
$0
$0
5


Q3
P
Q6R
$3
$3
$2
$2
$0
29


Q3
P
Q7E
$2
$2
$1
$1
$0
8


Q3
P
Z4B
$3
$3
$5
$2
$2
10


Q3
P
Q7P
$2
$2
$48
$34
$14
232


Q3
P
Z2A
$2
$2
$66
$42
$23
290










P Total
















Q3
R
70450
$49
$49
$0
$0
$0
2


Q3
R
70160
$31
$31
$0
$0
$0
1


Q3
R
71020
$21
$31
$0
$0
$0
4


Q3
R
70486
$65
$208
$0
$0
$0
1










R Total









Q3 Total
















Q4
A
95004
$4
$4
$39
$38
$1
117


Q4
A
CL
$0
$116
$1
$1
$0
1


Q4
A
86003
$2
$2
$0
$0
$0
12


Q4
A
94010
$19
$39
$1
$1
$0
18


Q4
A
92557
$50
$50
$0
$0
$0
1


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q4
A
80053
$5
$5
$0
$0
$0
5


Q4
A
80050
$14
$14
$0
$0
$0
2


Q4
A
90782
$8
$8
$0
$0
$0
2


Q4
A
95015
$0
$22
$1
$1
$0
2


Q4
A
95010
$0
$24
$0
$0
$0
2


Q4
A
95024
$6
$6
$21
$21
$0
85










A Total
















Q4
M
99214
$88
$88
$40
$33
$6
188


Q4
M
95147
$37
$39
$9
$7
$1
6


Q4
M
95145
$21
$21
$5
$4
$0
8


Q4
M
99243
$129
$129
$13
$13
$0
58


Q4
M
99211
$22
$22
$2
$0
$2
8


Q4
M
99215
$130
$130
$1
$1
$0
5


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q4
M
99213
$54
$55
$32
$15
$17
225


Q4
M
99242
$97
$97
$0
$0
$0
2


Q4
M
99212
$42
$40
$1
$0
$1
9


Q4
M
ER
$253
$168
$0
$0
$0
1


Q4
M
95115
$16
$16
$14
$6
$8
53


Q4
M
95165
$11
$11
$188
$172
$16
360


Q4
M
95117
$21
$21
$205
$117
$88
331










M Total
















Q4
P
Z2A
$2
$2
$107
$81
$26
233


Q4
P
Q7E
$2
$2
$3
$2
$1
12


Q4
P
Q6R
$3
$3
$4
$3
$1
22


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q4
P
B3J
$1
$1
$0
$0
$0
7


Q4
P
B3K
$2
$2
$1
$0
$0
14


Q4
P
Z4B
$2
$3
$4
$3
$1
11


Q4
P
Q7P
$2
$2
$58
$40
$19
189










P Total
















Q4
R
71020
$38
$31
$0
$0
$0
4


Q4
R
70220
$45
$45
$0
$0
$0
1


Q4
R
70486
$258
$208
$0
$0
$0
1










R Total
















Q4
S
31231
$129
$129
$0
$0
$0
2










S Total









Q4 Total
















Q5
A
95024
$0
$6
$26
$26
$0
42


Q5
A
95015
$0
$22
$3
$3
$0
1


Q5
A
ER
$128
$168
$3
$2
$1
4


Q5
A
CL
$58
$116
$1
$0
$1
1


Q5
A
90782
$8
$8
$0
$0
$0
2


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q5
A
95010
$0
$24
$1
$1
$0
1


Q5
A
94010
$0
$39
$0
$0
$0
1


Q5
A
95004
$0
$4
$21
$21
$0
42










A Total
















Q5
M
95165
$11
$11
$233
$224
$9
149


Q5
M
95117
$21
$21
$226
$169
$57
137


Q5
M
95145
$21
$21
$11
$10
$1
7


Q5
M
95147
$0
$39
$12
$12
$0
6


Q5
M
95115
$16
$16
$23
$19
$4
32


Q5
M
99243
$130
$129
$14
$11
$2
24


Q5
M
99211
$23
$22
$3
$0
$3
3


Q5
M
99212
$39
$40
$3
$2
$1
15


Q5
M
99204
$147
$163
$1
$0
$1
1


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


.
.
.
.
.
.
.
.
.


Q5
M
99213
$52
$55
$32
$18
$14
98


Q5
M
99214
$85
$88
$17
$11
$6
40


Q5
M
99244
$185
$184
$3
$2
$1
4










M Total
















Q5
P
Q7P
$2
$2
$92
$74
$18
93


Q5
P
Z2A
$2
$2
$93
$63
$30
97


Q5
P
Q6R
$3
$3
$6
$5
$0
14


Q5
P
B3K
$3
$2
$3
$3
$1
10


Q5
P
Q7E
$2
$2
$4
$3
$1
10


Q5
P
P5A
$2
$1
$2
$2
$0
7


Q5
P
Q7A
$0
$2
$0
$0
$0
2


Q5
P
B3J
$0
$1
$0
$0
$0
4


Q5
P
Z4B
$3
$3
$5
$3
$2
5










P Total
















Q5
R
70220
$45
$45
$0
$0
$0
1










R Total
















Q5
S
30520
$487
$487
$2
$0
$2
1


Q5
S
31231
$129
$129
$1
$0
$1
1










S Total









Q5 Total



Grand Total
















TABLE B3







Allergy


Dates of service Jan. 1, 2003-Dec. 31, 2004 paid Dec. 31, 2004


Total Role Allergic Rhinitis ETGno 0332 by quintile


Each doctor with greater than or equal to 50 episodes


(3 doctors per Quintile, 4 in Q4)















Total Cost






Difference






per Quintile


quintile
category
services
PROC_DESC
Episode





Q1
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
$10





NUMBER












A Total

$10











Q1
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
$10





COMPREHENSIVE E



Q1
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX: DETAILED
 $9





EXAM;



Q1
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
 ($2)





EXAM; MED



Q1
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND
 ($2)





PROB



Q1
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
 ($2)





IMMUNOTHER



Q1
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
($11)





EXTRACTS; SINGLE



Q1
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
($66)





IMMUNOTHER



Q1
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
($77)





EXTRACTS; 2+ INJ












M Total

($141) 











Q1
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
$42


Q1
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
 $6


Q1
P
Z2A
ANTIHISTAMINES
 $5











P Total

$52








Q1 Total












Q2
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
$10





NUMBER



Q2
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
 $5





NUMBER



Q2
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY NUMBER
 $4


Q2
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
 $4





NUMBER












A Total

$23











Q2
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
$12





IMMUNOTHER



Q2
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION 
 $7





EXTRACTS; SINGLE



Q2
M
99242
OFFICE CONSULTATION, 3 KEY COMPONENTS: EXPAND PROB FOCUS HX;
 $5





EXPAND PROB



Q2
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
 ($2)





IMMUNOTHERA



Q2
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
 ($2)





IMMUNOTHER



Q2
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
 ($5)





EXAM;



Q2
M
99213
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND
 ($6)





PROB



Q2
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
 ($6)





COMPREHENSIVE E



Q2
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
($48)





EXTRACTS; 2+ INJ












M Total

($44)











Q2
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
 $2


Q2
P
Z2A
ANTIHISTAMINES
 ($8)


Q2
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
($19)











P Total

($26)








Q2 Total












Q3
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
 ($1)





NUMBER



Q3
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY NUMBER
 ($4)


Q3
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
($11)





NUMBER












A Total

($16)











Q3
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
$41





EXTRACTS; 2+ INJ



Q3
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
 $7





IMMUNOTHER



Q3
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
 $3





EXTRACTS; SINGLE



Q3
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
 ($2)





COMPREHENSIVE E



Q3
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
 ($3)





IMMUNOTHERA



Q3
M
95147
PROFESSIONAL SVC, SUPERVISION. PROVISION. ANTIGENS, ALLERGEN
 ($3)





IMMUNOTHER



Q3
M
99214
OFFICE/OP VlSIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
($14)





EXAM;












M Total

$30











Q3
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
 ($2)


Q3
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
($19)


Q3
P
Z2A
ANTIHISTAMINES
($21)











P Total

($42)








Q3 Total












Q4
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
 $5





NUMBER



Q4
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIALINCREMENTAL, SPECIFY
 ($1)





NUMBER



Q4
A
95010
ALLERGY TESTS, PERCUTANEOUS, SEQUENTIAL/INCREMENTAL, SPECIFY
 ($1)





NUMBER



Q4
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY NUMBER
 ($2)











A Total

 $2











Q4
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
$17





EXAM;



Q4
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
 $5





IMMUNOTHER



Q4
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION. ANTIGEN, ALLERGEN
 $1





IMMUNOTHERA



Q4
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
 ($5)





EXTRACTS; SINGLE



Q4
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS, ALLERGEN
 ($5)





IMMUNOTHER



Q4
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
 ($7)





EXTRACTS; 2+ INJ












M Total

 $7











Q4
P
Z2A
ANTIHISTAMINES
$21


Q4
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
 ($2)


Q4
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
 ($9)











P Total

 $9








Q4 Total












Q5
A
95024
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, SPECIFY NUMBER
 $4


Q5
A
95015
ALLERGY TESTS, INTRADERMAL, SEQUENTIAL/INCREMENTAL, SPECIFY
 $1





NUMBER



Q5
A
95004
ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC EXTRACTS, SPECIFY
($13)





NUMBER












A Total

 ($8)











Q5
M
95165
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS. ALLERGEN
$39





IMMUNOTHER



Q5
M
95117
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION
$14





EXTRACTS; 2+ INJ



Q5
M
95145
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN, ALLERGEN
 $8





IMMUNOTHERA



Q5
M
95147
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS, ALLERGEN
 $7





IMMUNOTHER



Q5
M
95115
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVISION 
 $5





EXTRACTS; SINGLE



Q5
M
99243
OFFICE CONSULTATION, 3 KEY COMPONENTS: DETAILED HX; DETAILED
 $2





EXAM; MED



Q5
M
99211
OFFICE/OP VISIT, EST PT, NOT REQUIRING PHYSICIAN PRESENCE, 
 $2





TYPICALLY 5



Q5
M
99214
OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: DETAILED HX; DETAILED
 ($5)





EXAM;



Q5
M
99244
OFFICE CONSULTATION, 3 KEY COMPONENTS: COMPREHENSIVE HX;
 ($6)





COMPREHENSIVE E












M Total

$66











Q5
P
Q7P
NASAL ANTI-INFLAMMATORY STEROIDS
$25


Q5
P
Z2A
ANTIHISTAMINES
 $7


Q5
P
Q6R
EYE ANTIHISTAMINES
 $2


Q5
P
B3K
COUGH AND/OR COLD PREPARATIONS
 $2


Q5
P
Q7E
NASAL ANTIHISTAMINE
 $2


Q5
P
Z4B
LEUKOTRIENE RECEPTOR ANTAGONISTS
 ($2)











P Total

$36







Q5 Total

## Claims

1. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:
compiling a plurality of episodes of care, each episode including services performed for that episode by medical practitioners;
selecting for analysis the episodes of care from the plurality of the episodes of care that correspond to a given condition;
preserving, with a computer, those services having a service value above a service value threshold defined such that only services that have a predetermined level of impact on the selected episodes of care are preserved;
sorting, with the computer, the medical practitioners into the two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes at least one medical practitioner who provided at least one service performed in the selected episodes of care, the strata including a lower-cost practitioner stratum and higher-cost practitioner stratum;
listing the services associated with the medical practitioners for the selected episodes of care in each stratum with a service value being included with each of the services;
comparing the service values of the preserved services within the lower-cost practitioner stratum to the service values of corresponding preserved services within the higher-cost practitioner stratum; and
identifying the services which are cost drivers associated with the selected episodes of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the preserved selected service values.

2. The method of managing medical care of claim 1, the step of preserving services comprising the steps of:
a) determining the service value threshold for each service by dividing the service values by the number of episodes in that stratum;
b) setting a minimum threshold for the service value threshold; and
c) preserving the services having a service value above the minimum threshold in a potential cost drivers table.

3. The method of managing medical care of claim 2, further comprising the step of generating a report comparing the service values for the services in the potential cost drivers table between the strata.

4. The method of managing medical care of claim 3, further comprising the step of listing services that differentiates the strata.

5. The method of managing medical care of claim 4, further comprising the step of providing the medical practitioners with a description of how to reduce the difference between the strata.

6. The method of claim 5, wherein the step of providing the medical practitioners with a description includes providing a medical practice pattern analysis report, comprising a table of a selected service value for a service for a plurality of strata, wherein the selected service value is greater than a threshold set to remove a plurality of other services having a lesser affect on a particular difference between the strata.

7. The method of claim 5, wherein the step of providing the medical practitioners with a description includes providing a medical method blueprint, comprising a plurality of cells, wherein each cell describes a treatment recommendation for a particular type of episode of care, wherein the recommendation is based on the medical practice pattern analysis that revealed a service as a driver for a difference between a plurality of stratified medical practitioners.

8. The method of managing medical care of claim 1, the service value being selected from the group consisting of the service cost total and the service utilization total.

9. The method of managing medical care of claim 1, the step of preserving services comprising the steps of:
a) determining an expected service value for each of the services in each strata; and
b) determining the service value threshold by subtracting the service values in each stratum from the expected service value and dividing the difference by the number of episodes in that stratum;
c) setting a minimum threshold for the service value threshold; and
d) preserving the services having a service value above the minimum threshold in a potential cost drivers table.

10. The method of managing medical care of claim 9, further comprising the step of generating a report that compares service values for the services in the potential cost drivers table between the strata.

11. The method of managing medical care of claim 10, further comprising the step of providing the medical practitioners with a description of how to reduce the difference between the strata.

12. The method of managing medical care of claim 9, the expected service value determination step comprising the steps of:
a) totaling the service values for each service for all the episodes to provide an analysis total of the service value;
b) determining an analysis average for the service values of each service by dividing the analysis total by the sum of the episodes in the analysis; and
c) multiplying the analysis average of the service value by the number of episodes in each stratum for each service to provide the expected service value.

13. The method of managing medical care of claim 1, wherein said step of compiling a plurality of episodes comprises:
a) tracking each service by episodes of care performed by a group of medical practitioners;
b) aggregating the services according to given characteristics; and
c) sorting the episodes of care into predefined conditions.

14. The method of managing medical care according to claim 13, wherein the cost criterion for separating the medical practitioners into strata further includes a criterion selected from the group consisting of the number of services performed, geographic region, specialty, type of practice, size of practice, and performance in another condition.

15. The method of managing medical care according to claim 1, the compiled episodes being selected from the group consisting of a complete episode treatment group, a combination of episode treatment groups, a subset of an episode treatment group, and a combination of subsets of a plurality of episode treatment groups.

16. The method of managing medical care according to claim 1, each of the medical practitioners being sorted into a separate stratum to provide an analysis comparing individual practitioners.

17. The method of managing medical care according to claim 16, wherein all the episodes related to a particular medical specialty are selected in the episode compiling step.

18. The method of managing medical care according to claim 1, wherein the medical practitioners having a particular service value are removed from the group.

19. The method of managing medical care according to claim 1, wherein the practitioners being attributed to the episodes are selected from the group consisting of the practitioner with the highest percentage cost of the episode, all practitioners in the episode responsible for costs that, in total, contributed more than a preset percentage of the total cost to the episode, all practitioners in the episode having professional fees that contributed more than a preset percentage of the total cost to the episode, a primary care physician associated with the episode, all practitioners with any involvement in the episode, the practitioner that performed a significant procedure in the episode, the practitioner that had the most face-to-face encounters with a patient associated with the episode, and combinations thereof.

20. The method of managing medical care according to claim 1, further comprising the step of analyzing the practice pattern of an individual practitioner in a total role drilldown analysis of a single medical condition.

21. The method of managing medical care according to claim 1, further comprising the step of analyzing the practice pattern of an individual practitioner in a total role meta-drilldown analysis including data from a plurality of medical conditions.

22. The method of managing medical care according to claim 1, the episodes being grouped into conditions by a grouper program and the compiled episodes being selected from the group consisting of a complete condition, a combination of conditions, a subset of a condition, and a combination of subsets of a plurality of conditions.

23. The method of managing medical care of claim 1, the step of preserving services comprising the steps of:
a) equating the service value threshold for each service in each stratum to the selected service value in that stratum;
b) setting the minimum threshold for the threshold parameter; and
c) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

24. The method of managing medical care of claim 1, the service value being the service cost total.

25. The method of managing medical care of claim 24, the step of preserving services comprising the steps of:
a) determining the service value threshold for each service in each stratum by dividing the service cost total for all the episodes in that stratum by the service utilization total for all the episodes in that stratum;
b) setting a minimum threshold for the service value threshold; and
c) storing the services having a service value above the minimum threshold in a potential cost drivers table.

26. The method of managing medical care of claim 1, the step of preserving services comprising the steps of:
a) determining an expected service value for each of the services; and
b) determining the service value threshold by subtracting the service values from the expected service value;
c) setting a minimum threshold for the service value threshold; and
d) preserving the services having a service value above the minimum threshold in a potential cost drivers table.

27. The method of managing medical care of claim 26, further comprising the steps of:
a) generating a report comparing the service values for the services in the potential cost drivers table between the strata;
b) identifying the services that differentiate the strata; and
c) providing the medical practitioners with a description of how to reduce the difference between the strata.

28. The method of managing medical care of claim 26, the service value being selected from the group consisting of the service cost total and the service utilization total.

29. The method of managing medical care of claim 26, the expected service value determination step comprising the steps of:
a) totaling the service value for each service for all the episodes to provide an analysis total of the service value;
b) determining an analysis average for the service value of each service by dividing the analysis total of the service value by the sum of the episodes in the analysis; and
c) multiplying the analysis average of the service value by the number of episodes in each stratum for each service to provide the expected service value.

30. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:
compiling a plurality of episodes of care, each episode including a plurality of services performed for that episode by medical practitioners;
selecting for analysis the episodes of care from the plurality of episodes of care that correspond to a given condition;
sorting, with a computer, the medical practitioners into two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes at least one medical practitioner who provided at least one service performed in the selected episodes of care, the strata including a lower-cost practitioner stratum and a higher-cost practitioner stratum;
listing the services associated with the medical practitioners for the selected episodes of care in each stratum; and
comparing, with the computer, an actual service value for the each service within the lower-cost and higher-cost practitioner strata to an expected service value for the service;
identifying the services which are cost drivers associated with the selected episode of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the actual service values within the lower-cost and higher-cost practitioner strata to the expected service value.

31. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:
compiling a plurality of episodes of care, each episode including services performed for that episode by medical practitioners;
selecting for analysis the episodes of care from the plurality of episodes of care that correspond to a given condition;
sorting, with a computer, the medical practitioners into the two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes multiple medical practitioners who provided at least one service performed in the selected episode of care, the strata including a lower-cost practitioner stratum and a higher-cost practitioner stratum;
associating, with the computer, each of the medical practitioners with all the services in the episodes that the medical practitioner had a role; and
listing the services associated with the medical practitioners in each stratum;
comparing the service values of the selected services within the lower-cost practitioner stratum to the service values of corresponding services within the higher-cost practitioner stratum;
identifying the services which are cost drivers associated with the selected episodes of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the service values.