Middletown, NY, 10940
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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 | 17 | — | — | $15,119 | $15,119 | 1.2× | $54,042 |
| inpatient | |||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 17 | — | — | $21,592 | $21,592 | 1.1× | $77,806 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 17 | — | — | $11,046 | $11,046 | 1.0× | $39,089 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 17 | — | — | $7,611.79 | $7,611.79 | 1.00× | $26,479 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 17 | — | — | $16,868 | $16,868 | 1.1× | $60,461 |
| COPD w MCC | MS-DRG | 190 | 17 | — | — | $12,073 | $12,073 | 1.1× | $42,857 |
| COPD w CC | MS-DRG | 191 | 17 | — | — | $9,283.15 | $9,283.15 | 1.1× | $32,616 |
| COPD w/o CC/MCC | MS-DRG | 192 | 17 | — | — | $7,164.98 | $7,164.98 | 1.0× | $24,839 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 17 | — | — | $8,892.19 | $8,892.19 | 1.0× | $31,180 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 17 | — | — | $7,022.71 | $7,022.71 | 1.1× | $24,317 |
| AMI discharged alive w MCC | MS-DRG | 280 | 17 | — | — | $17,304 | $17,304 | 1.1× | $62,063 |
| AMI discharged alive w CC | MS-DRG | 281 | 17 | — | — | $10,085 | $10,085 | 1.0× | $35,560 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 17 | — | — | $8,019.62 | $8,019.62 | 1.0× | $27,977 |
| Heart failure & shock w MCC | MS-DRG | 291 | 17 | — | — | $13,928 | $13,928 | 1.1× | $49,670 |
| Heart failure & shock w CC | MS-DRG | 292 | 17 | — | — | $9,346.38 | $9,346.38 | 1.0× | $32,848 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 17 | — | — | $6,364.07 | $6,364.07 | 1.0× | $21,899 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 17 | — | — | $13,087 | $13,087 | 1.1× | $46,583 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 17 | — | — | $8,152.4 | $8,152.4 | 1.0× | $28,464 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 17 | — | — | $6,365.13 | $6,365.13 | 1.0× | $21,902 |
| GI hemorrhage w CC | MS-DRG | 378 | 17 | — | — | $10,734 | $10,734 | 1.1× | $37,943 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 17 | — | — | $7,042.73 | $7,042.73 | 1.0× | $24,390 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 17 | — | — | $8,615.03 | $8,615.03 | 1.1× | $30,163 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 17 | — | — | $16,920 | $16,920 | 1.1× | $60,654 |
| Kidney/UTI w MCC | MS-DRG | 689 | 17 | — | — | $12,627 | $12,627 | 1.1× | $44,892 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 17 | — | — | $8,930.12 | $8,930.12 | 1.1× | $31,320 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 17 | — | — | $20,870 | $20,870 | 1.1× | $75,155 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 17 | — | — | $11,183 | $11,183 | 1.1× | $39,591 |
| surgery | |||||||||
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 5 | — | — | $89,862 | $91,781 | 3.3× | $109,742 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 5 | — | — | $57,285 | $58,508 | 3.2× | $69,958 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 17 | — | — | $48,838 | $48,838 | 1.1× | $177,839 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 17 | — | — | $25,662 | $25,662 | 1.1× | $92,748 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 17 | — | — | $18,134 | $18,134 | 1.1× | $65,111 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 17 | — | — | $18,226 | $18,226 | 1.1× | $65,448 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 17 | — | — | $14,793 | $14,793 | 1.1× | $52,843 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 17 | — | — | $36,304 | $36,304 | 1.1× | $131,821 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 5 | — | — | $198,969 | $203,217 | 4.1× | $242,988 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 5 | — | — | $109,737 | $112,080 | 3.3× | $134,014 |
| Major joint replacement w MCC | MS-DRG | 469 | 17 | — | — | $32,364 | $32,364 | 1.1× | $117,355 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 17 | — | — | $20,727 | $20,727 | 1.1× | $74,629 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 17 | — | — | $31,090 | $31,090 | 1.1× | $112,677 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 17 | — | — | $22,472 | $22,472 | 1.1× | $81,036 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 17 | — | — | $17,587 | $17,587 | 1.1× | $63,103 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 17 | — | — | $30,827 | $30,827 | 1.1× | $111,714 |
| OR procedure for obesity w CC | MS-DRG | 620 | 17 | — | — | $17,264 | $17,264 | 1.1× | $61,916 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 17 | — | — | $16,295 | $16,295 | 1.1× | $58,360 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 17 | — | — | $13,474 | $13,474 | 1.1× | $48,003 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 17 | — | — | $21,993 | $21,993 | 1.1× | $79,280 |
| Payer | Codes covered | Median rate |
|---|---|---|
| local 1199 | 47 | $41,904 |
| Cigna | 47 | $23,011 |
| UnitedHealthcare | 47 | $23,542 |
| Emblem Health | 47 | $26,723 |
| Aetna | 47 | $22,930 |
| health first | 43 | $13,928 |
| Humana | 43 | $13,928 |
| magnacare | 43 | $49,670 |
| mvp | 43 | $13,928 |
| northwell direct | 43 | $28,244 |
| prime health services | 43 | $13,928 |
| upmc | 43 | $13,928 |
| WellCare | 43 | $14,137 |
| Blue Cross Blue Shield | 43 | $13,928 |
| cdphp | 43 | $25,463 |
| fidelis | 43 | $14,207 |
| geisinger health plan | 43 | $20,410 |
