409 S. 2ND STREET, HARRISBURG, PA, 17101
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| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 8 | — | — | $12,032 | $12,761 | $27,872 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 9 | — | — | $10,451 | $18,103 | $43,101 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 9 | — | — | $8,826.75 | $9,450.87 | $22,940 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 9 | — | — | $6,124.08 | $6,557.1 | $16,017 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 9 | — | — | $10,451 | $14,173 | $41,575 |
| COPD w MCC | MS-DRG | 190 | 9 | — | — | $9,634.49 | $10,316 | $25,322 |
| COPD w CC | MS-DRG | 191 | 9 | — | — | $7,439.34 | $7,965.35 | $19,897 |
| COPD w/o CC/MCC | MS-DRG | 192 | 9 | — | — | $5,772.45 | $6,180.61 | $15,656 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 9 | — | — | $7,131.66 | $7,635.93 | $19,444 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 9 | — | — | $5,660.49 | $6,060.73 | $14,983 |
| AMI discharged alive w MCC | MS-DRG | 280 | 9 | — | — | $10,451 | $14,536 | $36,639 |
| AMI discharged alive w CC | MS-DRG | 281 | 9 | — | — | $8,070.43 | $8,641.07 | $21,001 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 9 | — | — | $6,445.03 | $6,900.74 | $16,346 |
| Heart failure & shock w MCC | MS-DRG | 291 | 9 | — | — | $10,451 | $11,728 | $30,211 |
| Heart failure & shock w CC | MS-DRG | 292 | 9 | — | — | $7,489.09 | $8,018.63 | $20,167 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 9 | — | — | $5,142.19 | $5,505.78 | $14,703 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 9 | — | — | $10,433 | $11,029 | $27,021 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 9 | — | — | $6,549.52 | $7,012.62 | $16,884 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 9 | — | — | $5,143.04 | $5,506.69 | $12,581 |
| GI hemorrhage w CC | MS-DRG | 378 | 9 | — | — | $8,581.29 | $9,188.05 | $22,377 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 9 | — | — | $5,676.26 | $6,077.62 | $14,354 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 9 | — | — | $6,913.58 | $7,402.42 | $17,222 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 8 | — | — | $13,449 | $14,264 | $31,826 |
| Kidney/UTI w MCC | MS-DRG | 689 | 8 | — | — | $10,071 | $10,681 | $25,038 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 8 | — | — | $7,161.54 | $7,595.57 | $17,849 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 8 | — | — | $16,557 | $17,561 | $42,091 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 8 | — | — | $8,934.54 | $9,476.03 | $23,017 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 12 | — | — | $169.05 | $977.6 | $2,249.82 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 12 | — | — | $200.58 | $977.6 | $3,485 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 12 | — | — | $71.75 | $950.64 | $2,656.5 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 12 | — | — | $85.95 | $950.64 | $2,656.5 |
| Colonoscopy diagnostic | CPT | 45378 | 12 | — | — | $243.68 | $950.64 | $3,485 |
| Colonoscopy with biopsy | CPT | 45380 | 12 | — | — | $304.32 | $1,229.43 | $3,485 |
| Colonoscopy with polyp removal | CPT | 45385 | 12 | — | — | $361.91 | $1,230.02 | $3,485 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 9 | — | — | $1,016.56 | $18,044 | $23,764 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $10,451 | $10,451 | $10,451 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $10,451 | $10,451 | $10,451 |
| Total hip replacement | CPT | 27130 | 8 | — | — | $1,016.56 | $12,719 | $23,764 |
| Total knee replacement | CPT | 27447 | 9 | — | — | $1,016.56 | $12,878 | $23,764 |
| Knee revision arthroplasty single component | CPT | 27486 | 5 | — | — | $1,016.56 | $8,662.41 | $23,764 |
| Knee revision arthroplasty all components | CPT | 27487 | 5 | — | — | $1,140.36 | $10,059 | $23,764 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 6 | — | — | $711.99 | $3,737 | $11,128 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 9 | — | — | $1,016.56 | $7,009.22 | $11,128 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 12 | — | — | $733.73 | $3,340.07 | $9,755.55 |
| ACL reconstruction | CPT | 29888 | 9 | — | — | $1,016.56 | $7,009.22 | $11,128 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 9 | — | — | $10,451 | $40,768 | $109,279 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 9 | — | — | $10,451 | $21,488 | $57,205 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 9 | — | — | $10,451 | $15,227 | $38,529 |
| CABG single arterial graft | CPT | 33533 | 4 | — | — | $1,310 | $14,111 | $23,764 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 9 | — | — | $10,451 | $15,303 | $38,034 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 9 | — | — | $10,451 | $12,447 | $29,632 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 9 | — | — | $10,451 | $30,341 | $79,174 |
| Open appendectomy | CPT | 44950 | 9 | — | — | $1,016.56 | $6,361.96 | $23,764 |
| Laparoscopic appendectomy | CPT | 44970 | 9 | — | — | $1,016.56 | $5,948.62 | $11,520 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $10,451 | $10,451 | $10,451 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $10,451 | $10,451 | $10,451 |
| Major joint replacement w MCC | MS-DRG | 469 | 9 | — | — | $10,451 | $27,064 | $69,493 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 9 | — | — | $10,451 | $17,607 | $42,806 |
| Laparoscopic cholecystectomy | CPT | 47562 | 9 | — | — | $1,016.56 | $6,006.01 | $9,755.55 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 9 | — | — | $1,016.56 | $6,006.01 | $9,755.55 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 9 | — | — | $10,451 | $26,004 | $68,143 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 9 | — | — | $10,451 | $18,835 | $47,212 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 9 | — | — | $10,451 | $14,772 | $37,103 |
| Lap inguinal hernia repair | CPT | 49650 | 9 | — | — | $856.39 | $5,724.51 | $11,128 |
| Vaginal hysterectomy | CPT | 58260 | 9 | — | — | $1,016.56 | $5,147.24 | $7,348.95 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 9 | — | — | $1,016.56 | $6,169.58 | $15,489 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 9 | — | — | $1,016.56 | $10,215 | $11,128 |
| Lap salpingo-oophorectomy | CPT | 58661 | 9 | — | — | $1,016.56 | $5,839.29 | $9,755.55 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 8 | — | — | $24,393 | $25,872 | $68,968 |
| OR procedure for obesity w CC | MS-DRG | 620 | 8 | — | — | $13,720 | $14,551 | $39,678 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 8 | — | — | $12,957 | $13,743 | $35,968 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 8 | — | — | $10,737 | $11,388 | $25,511 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 8 | — | — | $17,441 | $18,498 | $40,420 |
| Payer | Codes covered | Median rate |
|---|---|---|
| keystone health plan | 69 | $15,306 |
| Blue Cross Blue Shield | 69 | $11,128 |
| UnitedHealthcare | 69 | $6,238.91 |
| Aetna | 68 | $5,971.84 |
| Humana | 65 | $8,928.01 |
| Cigna | 65 | $9,101.37 |
| pa health & wellness | 65 | $7,812.59 |
| upmc health plan | 65 | $10,053 |
| upmc work partners | 62 | $10,451 |
| amerihealth caritas | 8 | $222.13 |
| health partners plans (jefferson health plan) | 8 | $224.11 |
| geisinger | 8 | $239.67 |
