Bradford, MA, 01835
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vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | vs nat'l | Neg max |
|---|---|---|---|---|---|---|---|---|---|
| emergency | |||||||||
| Critical care, first hour | CPT | 99291 | 0 | $531 | $531 | — | — | — | — |
| imaging | |||||||||
| Chest X-ray single view | CPT | 71045 | 0 | $199.53 | $199.53 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $199.53 | $199.53 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $199.53 | $199.53 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 1 | $374.85 | $374.85 | $124.68 | $124.68 | 1.2× | $124.68 |
| Shoulder X-ray | CPT | 73030 | 1 | $199.53 | $199.53 | $103.78 | $103.78 | 1.1× | $103.78 |
| Humerus X-ray | CPT | 73060 | 0 | $199.53 | $199.53 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 1 | $199.53 | $199.53 | $103.78 | $103.78 | 1.1× | $103.78 |
| Knee X-ray 1-2 views | CPT | 73560 | 1 | $199.53 | $199.53 | $103.78 | $103.78 | 1.1× | $103.78 |
| Ankle X-ray 3 views | CPT | 73610 | 4 | $199.53 | $199.53 | $8.87 | $64.18 | 0.70× | $103.78 |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $280.2 | $280.2 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $280.2 | $280.2 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $280.2 | $280.2 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $112.08 | $112.08 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $280.2 | $280.2 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $280.2 | $280.2 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $280.2 | $280.2 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $137.53 | $137.53 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,203.95 | $1,203.95 | — | — | — | — |
| inpatient | |||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $39,933 | $39,933 | 2.6× | $39,933 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $33,188 | $33,188 | 3.0× | $33,188 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $26,805 | $26,805 | 3.2× | $26,805 |
| AMI discharged alive w MCC | MS-DRG | 280 | 2 | — | — | $1,108.03 | $1,422.66 | 0.09× | $46,596 |
| Heart failure & shock w MCC | MS-DRG | 291 | 2 | — | — | $1,108.03 | $1,422.66 | 0.11× | $39,740 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $38,622 | $38,622 | 4.3× | $38,622 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $41,107 | $41,107 | 3.4× | $41,107 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $36,019 | $36,019 | 4.6× | $36,019 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $26,566 | $26,566 | 2.7× | $26,566 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $23,837 | $23,837 | 2.9× | $23,837 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 3 | — | — | $1,108.03 | $1,536.33 | 0.08× | $41,940 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 2 | — | — | $1,108.03 | $1,422.66 | 0.14× | $28,050 |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $267.45 | $267.45 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $361.55 | $361.55 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $531.05 | $531.05 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $192.1 | $192.1 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $281.68 | $281.68 | — | — | — | — |
| lab | |||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $30.45 | $30.45 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $25.25 | $25.25 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $38 | $38 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $48.2 | $48.2 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $31.25 | $31.25 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $29.4 | $29.4 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $8.1 | $8.1 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $14.15 | $14.15 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $34.95 | $34.95 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $60.5 | $60.5 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $27.95 | $27.95 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $23.3 | $23.3 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $29.05 | $29.05 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $269.4 | $269.4 | — | — | — | — |
| office | |||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $550 | $550 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 2 | $550 | $550 | $84.43 | $121.61 | 0.99× | $158.78 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 12 | $550 | $550 | $20 | $137.88 | 0.79× | $175.24 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 7 | $550 | $550 | $20 | $147.68 | 0.67× | $209.51 |
| Office visit, established patient, 5 min | CPT | 99211 | 3 | $550 | $550 | $6.61 | $89.39 | 1.4× | $158.78 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $550 | $550 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 6 | $550 | $550 | $20 | $78.35 | 0.68× | $158.78 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 14 | $550 | $550 | $20 | $108.23 | 0.71× | $158.78 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $550 | $550 | $20 | $152.79 | 0.81× | $189.05 |
| Payer | Codes covered | Median rate |
|---|---|---|
| Medicare | 24 | $158.78 |
| Blue Cross Blue Shield | 7 | $20 |
| tufts | 6 | $141.82 |
| UnitedHealthcare | 5 | $143.36 |
| Aetna | 5 | $106.59 |
| masshealth | 4 | $1,265.35 |
| cca | 4 | $148 |
| hphc | 3 | $135.02 |
| fallon | 3 | $100 |
| health plan inc | 3 | $135.02 |
| wellpoint [gic - unicare] | 3 | $104.2 |
| mgb [allways] | 3 | $129.47 |
| Humana | 2 | $158.78 |
| tufts public | 2 | $158.78 |
| Cigna | 2 | $137.88 |
| wellsense [bmc] | 1 | $109.8 |
| aarp | 1 | $158.78 |
