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Oregon Hospital Payment Report

Welcome

This report shows the amounts commercial insurance companies paid different Oregon hospitals for common procedures in 2022 and 2023. Sharing these data provides transparency and public accountability and is an important part of Oregon’s goal to eliminate health inequities.

According to the Centers for Medicare and Medicaid Services (CMS) National Health Expenditure data, the United States spent $4.9 trillion dollars on health care in 2023, the equivalent of more than $14,570 per person. As the largest category of health care spending, hospital care accounts for $1.5 trillion, or 31%, of that spending. In Oregon, total hospital inpatient and outpatient spending grew 6.7% from 2022 to 2023, according to data from the 2025 Sustainable Health Care Cost Growth Target Annual Report.

The dashboard shows:
  • 179 types of procedures, which account for over $2.16 billion in payments from commercial insurance companies to Oregon hospitals in 2023.
  • The variance in commercial payments among hospitals for each procedure on the Median payments tab.
  • Whether commercial payments for many common procedures increased or decreased statewide. For example, on the Change from 2022 tab, selecting the category of “Pregnancy Related Procedures” and the procedure “Normal delivery without complications” shows that the statewide median commercial payment grew $1,272 (12.5%) from 2022 to 2023.
  • How commercial payments for the same procedure differ depending on whether it was performed in the emergency department (ED) or another outpatient setting (OP) on the Compare ED and OP tab.
  • How commercial payments compare to Medicare fee-for-service payments or Medicaid Coordinated Care Organization (CCO) payments for the same procedure on the Compare with Medicare and Compare with Medicaid tabs.
  • Whether a hospital tends to have high or low median commercial payments across all procedures on the All procedures by hospital tab. 
  • How five-year trends in median payments and cumulative payment growth for the same procedure compare between hospitals on the Compare hospital trends tabs. 

Supplemental data is available. To explore the report data in table form, please download the 2023 Hospital Payment Report data file [xlsx]. To look up which procedure codes are included under each procedure type, please download the 2023 Procedure codes look-up file [xlsx].

Questions about this dashboard? Email HDD.Admin@odhsoha.oregon.gov

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The Dashboard

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Use the dropdown filters to modify the data. Learn what the filter options mean under "Terminology" below.



Terminology

This report presents median payments. A median represents the point where half the observations are below and half are above. Payments include what a commercial insurance company paid the hospital performing the procedure, as well as patient paid amounts such as co-pays, deductibles, or co-insurance amounts. Payments reflect the total expected payment to the hospital. They do not reflect the price a patient actually paid for the service, the amount billed by the service provider, or the maximum allowed amount a health insurance plan would pay to cover the procedure. 

Payments presented in this report are median payments from commercial insurance companies to one of Oregon’s 60 acute care general hospitals. Only payments reported to All Payer All Claims (APAC) are included in this report, so those from some small insurance companies or from uninsured individuals are not reflected. ​

In addition to median payments, payment variation is displayed as the interquartile range, which is the middle 50% of payments. In other words, if 100 procedures were done, this range would extend from the 25th highest payment to the 75th highest payment. ​

For more information on payment variation, please refer to the Sources of Payment Variation section below.

Inflation-adjusted payments account for the general increase in the price of goods and services over time by converting all dollar amounts to 2023 dollars. Unadjusted payments represent the raw payment in a given year – for example, the amount that would have been paid in 2021 with 2021 dollars. 

To calculate inflation-adjusted median payments, median payments in a given year are multiplied by that year’s inflation factor. Inflation factors are calculated using annual averages from the US Bureau of Labor Statistics CPI for All Urban Consumers (CPI-U), Series ID CUUR0000SA0L1E.​

Hospital type includes DRG, Type A, and Type B. DRG hospitals are large, urban hospitals. Type A are small hospitals (50 or fewer beds) located more than 30 miles from another hospital. Type B are small hospitals (50 or fewer beds) located within 30 miles of another hospital.

For more information, please refer to the Oregon Hospital Types guide​.

Hospital regions are based on the county where the hospital is located. 
  • Central: Crook, Deschutes, Jefferson, and Wheeler counties
  • Columbia Gorge/Northeast: Gilliam, Hood River, Morrow, Sherman, Umatilla, Union, Wallowa, and Wasco counties
  • Eastern: Baker, Grant, Harney, and Malheur counties
  • Lane County: Lane County 
  • Mid-Willamette Valley: Benton, Linn, Marion, Polk, and Yamhill counties 
  • Northern Coast: Clatsop, Lincoln, and Tillamook counties
  • Portland Metro: Clackamas, Columbia, Multnomah, and Washington counties ​
  • Southern: Coos, Curry, Douglas, Jackson, Josephine, Klamath, and Lake counties

Critical access hospitals are designated by the Centers for Medicare & Medicaid Services (CMS). There are a number of specific criteria a hospital must meet to be considered a critical access hospital, but in general the hospital must be located in a rural area and serve patients with limited access to other hospitals. 

In exchange for providing additional services that these hospitals might not otherwise provide due to cost, critical access hospitals receive higher Medicare fee-for-service reimbursement rates from CMS than other hospitals receive for the same services. ​

On most tabs, data presented for the outpatient categories – Outpatient Surgical Procedures, Diagnostic Imaging and Testing, Outpatient Radiation and Chemotherapy, Outpatient Pathology and Laboratory, and Professional Services – includes procedures performed in both the emergency and non-emergency settings. For example, the median payment for Outpatient Surgical Procedures: Appendectomy on the Median payments tab represents the median payment for all appendectomies performed at each hospital in both the emergency and non-emergency outpatient settings. 

The exception is the Compare ED and OP tab, which compares median payments for the same procedures performed in the emergency setting (ED) and the non-emergency outpatient setting (OP).​

About the Report

The Oregon Hospital Payment Report, codified into Oregon Revised Statutes (ORS) 442.373, is an annual report of the median payments by commercial insurance companies for common procedures performed in Oregon hospitals. 

This report includes common procedures that occurred in 2023 at hospital inpatient and outpatient facilities. Procedures are organized into seven categories: Inpatient Procedures, Outpatient Surgical Procedures, Pregnancy Related Procedures, Diagnostic Imaging and Testing, Outpatient Radiation and Chemotherapy, Outpatient Pathology and Laboratory, and Professional Services.

The data source for this report is Release 23 of the Oregon All Payer All Claims Database (APAC)​, a large database that houses administrative health care data for Oregon’s insured populations. It includes medical and pharmacy claims, enrollment data, premium information, and provider information for Oregonians who are insured through commercial insurance, Medicaid, and Medicare.

Entities identified as mandatory reporters submit health care insurance claims to the APAC Program (see ORS 442.372 and Oregon Administrative Rules (OAR) 409-025-0100 to 409-025-0170). 

Median payments and counts of procedures calculated for a given year may vary depending on which APAC release was used due to claim additions and revisions in updated releases.

New to the 2023 Hospital Payment Report: 

  • Addition of Medicaid Coordinated Care Organization (CCO) payment data under the Compare with Medicaid tabs. ​
  • Addition of the following new procedure types: 
    • Outpatient Surgical Procedures – Lymph Node Biopsy, Mastectomy & Lymph Node Biopsy 
    • Pregnancy Related Procedures – Extremely Premature Newborn Care, Premature Newborn Care with Complications, Premature Newborn Care without Complications 
    • Diagnostic Imaging and Testing – Cardiovascular: Implant Monitoring, Coronary Calcium Scan, MRI with Contrast: Heart
    • Outpatient Pathology and Laboratory – COVID-19 Test 
      • ​In previous reports, COVID-19 Test was included in the COVID-19 Related Procedures category. The COVID-19 Related Procedures category is omitted from the 2023 report because most procedure types in this category were not performed often enough among commercially insured patients in 2023 to be included in the report.
    • Professional Services – Pulmonary Rehabilitation, Wound Care Management 
  • Addition of procedure codes to the following existing procedure types: 
    • Pregnancy Related Procedures – Newborn Care with Complications
    • Diagnostic Imaging and Testing – Cardiovascular: Echo, Sleep Study, Sleep Study in Lab 
    • Outpatient Pathology and Laboratory – Molecular Pathology
    • Professional Services – Cardiac Rehabilitation 
  • Recategorization of Obstetrical: Ultrasound and Fetal NST procedures to the Diagnostic Imaging and Testing category for the Statewide trends tab only. 
    • ​For more information on this change, please refer to the Methodology: Statewide trends section below. 
  • Note: Mid-Columbia Medical Center’s name has been changed to Adventist Health Columbia Gorge in this report to reflect their new name as of June 2023.

​ Note: As detailed below, we do not report data at the hospital level for hospitals that performed a particular procedure fewer than 10 times, and we exclude procedures that were performed at fewer than 5 hospitals and/or have low statewide volume from the report. We do this to ensure patient confidentiality and data reliability. For more information, please refer to the Health Analytics Small Numbers Reporting Guidelines.

Included in the report:​​
  • Payments: Median payments to hospitals including patient paid amounts 
  • Facilities: Oregon acute care hospitals 
  • Outpatient procedure codes: 
    • Codes for the 100 most common outpatient procedures in Oregon among commercially insured patients 
    • Codes for procedures performed 350 times or more statewide among commercially insured patients
  • ​Inpatient procedure codes: 
    • Codes for the 50 most common inpatient procedures in Oregon among commercially insured patients 
    • Codes for procedures performed 100 times or more statewide among commercially insured patients 
  • Insurance types: Most commercial insurance, Medicare fee-for-service, and Medicaid Coordinated Care Organizations (CCO)
  • ​​Service volumes:​ 
    • Procedure was performed 10 or more times at a particular hospital 
    • Procedure was performed at a minimum of 5 hospitals 
Excluded from the report: 
  • Payments: 
    • Amounts billed by hospitals 
    • Allowed amounts (maximum amounts that insurance will pay for covered services) 
  • Facilities: 
    • Non-Oregon facilities 
    • Ambulatory Surgery Centers (ASCs) 
    • Specialized clinics not located within the hospital or that bill as a separate entity 
  • Claims: 
    • Claims with a denied status 
    • Claims with no bill type or revenue code 
    • Claims with a total payment of less than $5 
  • Outpatient procedure codes: 
    • Codes for outpatient procedures not in the top 100 
    • Codes for procedures performed fewer than 350 times statewide among commercially insured patients 
  • ​Inpatient procedure codes: 
    • Codes for inpatient procedures not in the top 50 
    • Codes for procedures performed fewer than 100 times statewide among commercially insured patients 
  • Insurance types: Medicare Advantage, Medicaid fee-for-service (also known as Medicaid Open Card), Veterans Administration (VA), Workers Compensation, ERISA self-insured plans, commercial insurance with fewer than 5,000 covered lives 
  • Service volumes: 
    • Procedure was performed fewer than 10 times at a particular hospital
    • Procedure was performed at 4 or fewer hospitals ​

Sources of Payment Variation

The location of a hospital influences payments for procedures. Hospitals located in areas with higher costs of living, higher utility costs, and higher rent costs have greater operating expenses relative to hospitals located in areas with lower cost of living. Payroll expenses generally make up about 50% of a hospital’s total operating expenses at any given time. When operating expenses for a hospital increase, payments for services provided must also increase to cover costs. A hospital’s location can also affect costs due to competition. Hospitals located in remote service areas generally have higher associated payments than hospitals in close proximity to other hospitals.​

Hospitals that have high patient volumes for particular services can generally accept lower payments than hospitals with lower patient volumes. High volume hospitals are able to accept a lower payment per procedure due to economies of scale. High volume hospitals can make up for accepting lower payments on infrequent procedures by charging slightly more for procedures performed more frequently. Hospitals with low overall patient counts have less flexibility to determine what they must charge for each service and less flexibility to offset losses on some procedures by charging more for other procedures.​

Payments are also affected by patient case mix. Patient case mix refers to the types of services a hospital is most likely to perform, based on the types of patients that populate their service area. It also refers to the severity of illness among the patients the hospital serves. Some hospitals serve populations that have a higher burden of disease than other hospitals. Some hospitals serve a higher proportion of older people and need to provide higher cost procedures such as joint replacements and bypass surgeries. Hospitals that provide more complex procedures have higher payments for similar procedures.​

Negotiated rates also affect payments. Each hospital in Oregon has individual payment arrangements negotiated with every insurance company operating in the state, so the rate an insurance company pays for a procedure varies from hospital to hospital. All of the above factors, including hospital location, patient volume, and patient case mix, influence these rate negotiations.​

Methodology

Claims are assigned to common procedure types based on the inpatient or outpatient procedure codes present on the claim. Procedure types can include multiple procedure codes to group together procedures with similar methods (e.g., X-rays, CT scans, MRIs, etc.) and similar median payments. 

Claims within APAC are identified by a unique claim ID. This unique claim ID can be used to identify all itemized portions of the claim together as one. 

Inpatient Procedures 
Inpatient claims are assigned to inpatient procedure types when the claim has a primary procedure code for a common inpatient procedure. Inpatient procedures follow the ICD-10-PCS coding system. For each unique claim ID that is assigned to a procedure type, the total payment is summed over all claim lines, providing the total payment for the entire hospitalization. 

Outpatient Surgical Procedures 
Outpatient surgical procedures are typically billed as multiple individual components. For example, an arthrogram of the shoulder will generally have four billed items: a bill for the dye injection to the shoulder, a bill for the X-ray guidance used to place the dye, a bill for the CT or MRI imaging after the dye was placed, and sometimes, a bill for additional anesthetics. If the outpatient procedure code on any claim line matches a Current Procedural Terminology (CPT) code for a common outpatient surgery, then that unique claim ID is assigned as an outpatient surgery procedure type. Payment is summed over all claim lines to provide the total payment associated with the outpatient surgery. 

Common co-occurring outpatient surgeries – two distinct outpatient surgeries performed on the same patient on the same day – are reported as their own procedure types to better reflect the payments for multiple surgeries compared with individual surgeries. For 2023, these frequently occurring co-occurring surgery types are colonoscopy & EGD, mastectomy & lymph node biopsy, mastectomy & breast reconstruction, and lesion removal & wound repair - intermediate/complex. Surgeries that are part of a co-occurring surgery type are not also included in the individual surgery types. For example, the individual mastectomy procedure type does not include counts and payments for mastectomies performed with breast reconstruction. 

All other outpatient procedures 
For procedures in the Diagnostic Imaging and Testing, Outpatient Radiation and Chemotherapy, Outpatient Pathology and Laboratory, and Professional Services categories, procedure types are assigned when a relevant Current Procedural Terminology (CPT) code is present on a claim line. The reported payments reflect the total payment each time a procedure was performed.

To calculate the average payments by year that are used in the five-year statewide trends charts, all procedures in a category are assigned a weight based on how often the procedure was performed in year one of the five-year period. For the 2023 report, year one is 2019. Then, the weight is multiplied by the median payment for that procedure. Next, the results for all procedures in the category are added together. Finally, this sum is divided by the total number of procedures in the category. 

In most of the dashboard, Ultrasound: Obstetrical and Fetal Non-Stress Test (NST) are included in the Pregnancy Related Procedures category. Please note that for the Statewide trends tab only, Ultrasound: Obstetrical and Fetal NST are included in the Diagnostic Imaging and Testing category. This is done so that when the weighted average payments are calculated, these outpatient imaging and testing procedures are included in a category with more similar procedures and payments, as opposed to including them with the rest of the higher-payment inpatient procedures in the Pregnancy Related Procedures category.

To calculate potential savings for each procedure type when comparing commercial and Medicare fee-for-service payments or commercial and Medicaid Coordinated Care Organization (CCO) payments, the selected level of Medicare fee-for-service or Medicaid CCO payment rate is multiplied by the number of times the procedure was performed in the commercial market in 2023. This amount is then subtracted from the total statewide commercial payments for that procedure type. These by-procedure savings are then added up for each category to obtain the total savings by category (e.g., savings for Outpatient Surgical Procedures). ​

Potential savings represent a reduction in commercial insurance payments to hospitals compared with the amounts these companies currently pay in the absence of a rate cap. Potential savings do not represent what individual Oregonians would expect to save. However, given commercial insurance may absorb price increases by increasing premiums and patient responsibility amounts, capping commercial rates at a percentage of other established rates would be expected to reduce patient responsibility burden. Individual savings would vary greatly depending on the design of each person’s insurance plan. Implementing these types of rate caps would be expected to generate particular savings for employer-sponsored health plans.​

​On the Compare with Medicaid tabs, the Pregnancy Related Procedures category includes only deliveries (normal delivery and Cesarean section), outpatient fetal non-stress test, and outpatient obstetrical ultrasound. Newborn care procedure types are not included in the comparisons to Medicaid CCO payments due to differences between commercial insurers and CCOs in how newborn care tends to be billed and paid.​

General Information

You can get data from this display in other languages, large print, braille, or a format you prefer. Email HDD.Admin@odhsoha.oregon.gov​.

Oregon Health Authority Hospital Reporting Program. (2025). 2023 Oregon Hospital Payment Report. Interactive display accessed [MM/DD/YYYY]. Salem, OR: Oregon Health Authority.
https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/hospital-payment-report.aspx.

The Oregon Health Authority's Hospital Reporting Program collects and maintains data on utilization, finances, and community benefit activities for Oregon’s general acute care hospitals. The Hospital Reporting Program is the main repository for hospital-related data for state programs, the legislature, and the general public. ​

Please visit our website​ for more information, static reports, additional Oregon hospital resources, data access, and methodology.​