Worcester, MA, 01606
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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 |
|---|---|---|---|---|---|---|---|---|---|
| behavioral | |||||||||
| Psychoses | MS-DRG | 885 | 16 | — | — | $11,554 | $12,131 | 0.95× | $29,657 |
| inpatient | |||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 16 | — | — | $16,204 | $17,014 | 0.84× | $41,853 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 16 | — | — | $8,627.24 | $9,058.6 | 0.85× | $21,399 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 16 | — | — | $6,159.65 | $6,467.63 | 0.85× | $14,483 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 16 | — | — | $12,810 | $13,450 | 0.87× | $34,013 |
| COPD w MCC | MS-DRG | 190 | 16 | — | — | $9,364.71 | $9,832.95 | 0.88× | $23,635 |
| COPD w CC | MS-DRG | 191 | 16 | — | — | $7,360.51 | $7,728.54 | 0.88× | $18,076 |
| COPD w/o CC/MCC | MS-DRG | 192 | 16 | — | — | $5,838.62 | $6,130.55 | 0.88× | $13,720 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 16 | — | — | $7,079.6 | $7,433.58 | 0.88× | $17,254 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 16 | — | — | $5,736.4 | $6,023.22 | 0.90× | $13,480 |
| AMI discharged alive w MCC | MS-DRG | 280 | 16 | — | — | $13,123 | $13,779 | 0.88× | $34,539 |
| AMI discharged alive w CC | MS-DRG | 281 | 16 | — | — | $7,936.71 | $8,333.55 | 0.86× | $19,396 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 16 | — | — | $6,452.67 | $6,775.3 | 0.87× | $15,257 |
| Heart failure & shock w MCC | MS-DRG | 291 | 16 | — | — | $10,698 | $11,233 | 0.88× | $27,456 |
| Heart failure & shock w CC | MS-DRG | 292 | 16 | — | — | $7,405.94 | $7,776.24 | 0.87× | $18,123 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 16 | — | — | $5,263.17 | $5,526.33 | 0.89× | $12,368 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 16 | — | — | $10,094 | $10,599 | 0.88× | $25,375 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 16 | — | — | $6,548.07 | $6,875.47 | 0.88× | $15,556 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 16 | — | — | $5,263.93 | $5,527.13 | 0.89× | $12,370 |
| GI hemorrhage w CC | MS-DRG | 378 | 16 | — | — | $8,403.12 | $8,823.28 | 0.88× | $20,744 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 16 | — | — | $5,750.79 | $6,038.33 | 0.88× | $13,514 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 16 | — | — | $6,880.47 | $7,224.49 | 0.90× | $16,418 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 16 | — | — | $12,848 | $13,490 | 0.89× | $32,083 |
| Kidney/UTI w MCC | MS-DRG | 689 | 16 | — | — | $9,762.97 | $10,251 | 0.88× | $24,626 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 16 | — | — | $7,106.86 | $7,462.2 | 0.90× | $16,888 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 16 | — | — | $15,685 | $16,470 | 0.88× | $41,289 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 16 | — | — | $8,725.67 | $9,161.95 | 0.88× | $21,693 |
| surgery | |||||||||
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 5 | — | — | $38,395 | $55,484 | 2.0× | $63,026 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 5 | — | — | $24,476 | $35,370 | 1.9× | $40,178 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 16 | — | — | $35,781 | $37,570 | 0.87× | $96,614 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 16 | — | — | $19,128 | $20,085 | 0.87× | $49,735 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 16 | — | — | $13,720 | $14,406 | 0.88× | $34,739 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 16 | — | — | $13,786 | $14,475 | 0.88× | $34,897 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 16 | — | — | $11,319 | $11,885 | 0.88× | $27,724 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 16 | — | — | $26,775 | $28,114 | 0.87× | $74,258 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 5 | — | — | $85,013 | $122,850 | 2.5× | $139,550 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 5 | — | — | $46,887 | $67,755 | 2.0× | $76,966 |
| Major joint replacement w MCC | MS-DRG | 469 | 16 | — | — | $23,944 | $25,141 | 0.85× | $68,773 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 16 | — | — | $15,583 | $16,362 | 0.87× | $39,673 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 16 | — | — | $23,028 | $24,180 | 0.86× | $61,882 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 16 | — | — | $16,836 | $17,678 | 0.87× | $43,658 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 16 | — | — | $13,327 | $13,993 | 0.88× | $33,379 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 16 | — | — | $22,840 | $23,982 | 0.88× | $57,366 |
| OR procedure for obesity w CC | MS-DRG | 620 | 16 | — | — | $13,094 | $13,749 | 0.85× | $33,600 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 16 | — | — | $12,399 | $13,019 | 0.86× | $30,756 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 16 | — | — | $10,372 | $10,890 | 0.89× | $25,220 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 16 | — | — | $16,493 | $17,317 | 0.91× | $41,112 |
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 47 | $17,721 |
| Blue Cross Blue Shield | 47 | $16,204 |
| Cigna | 47 | $16,384 |
| medical mutual | 47 | $19,128 |
| UnitedHealthcare | 47 | $19,924 |
| custom design benefits inc. | 43 | $25,139 |
| devoted health | 43 | $10,698 |
| Humana | 43 | $10,698 |
| valor health plan | 43 | $10,698 |
| medigold | 43 | $10,698 |
| Molina | 43 | $15,809 |
| optum | 43 | $10,698 |
| perennial advantage | 43 | $11,233 |
| buckeye health plan | 43 | $13,410 |
| CareSource | 43 | $13,109 |
| the health plan | 43 | $10,698 |
