164 SUMMIT AVENUE, PROVIDENCE, RI, 410012
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| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 10 | — | — | $8,811.57 | $14,036 | $27,548 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 10 | — | — | $13,561 | $15,639 | $36,855 |
| COPD w MCC | MS-DRG | 190 | 10 | — | — | $8,771.79 | $11,242 | $26,124 |
| COPD w CC | MS-DRG | 191 | 10 | — | — | $6,732.63 | $8,683.78 | $19,881 |
| COPD w/o CC/MCC | MS-DRG | 192 | 10 | — | — | $5,334.39 | $6,741.3 | $15,141 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 10 | — | — | $6,631.7 | $8,325.25 | $19,006 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 10 | — | — | $5,059.6 | $6,610.83 | $14,823 |
| AMI discharged alive w MCC | MS-DRG | 280 | 10 | — | — | $12,208 | $16,039 | $37,831 |
| AMI discharged alive w CC | MS-DRG | 281 | 10 | — | — | $7,216.63 | $9,419.22 | $21,676 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 10 | — | — | $5,517.82 | $7,525.06 | $17,054 |
| Heart failure & shock w MCC | MS-DRG | 291 | 10 | — | — | $9,911.45 | $12,944 | $30,277 |
| Heart failure & shock w CC | MS-DRG | 292 | 10 | — | — | $6,776.09 | $8,741.77 | $20,023 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 10 | — | — | $4,903.42 | $6,006.82 | $13,349 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 10 | — | — | $8,866.82 | $12,173 | $28,395 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 10 | — | — | $5,624.64 | $7,646.82 | $17,351 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 10 | — | — | $4,142.42 | $6,007.79 | $13,351 |
| GI hemorrhage w CC | MS-DRG | 378 | 10 | — | — | $7,295.46 | $10,015 | $23,129 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 10 | — | — | $4,812.07 | $6,629.19 | $14,867 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 10 | — | — | $5,564.97 | $8,071.08 | $18,386 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 10 | — | — | $11,275 | $15,687 | $36,973 |
| Kidney/UTI w MCC | MS-DRG | 689 | 10 | — | — | $8,189.07 | $11,750 | $27,365 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 10 | — | — | $5,850.07 | $8,360.04 | $19,091 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 10 | — | — | $13,676 | $19,309 | $45,812 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 10 | — | — | $7,756.63 | $10,426 | $24,134 |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 10 | — | — | $36,781 | $44,958 | $108,404 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 10 | — | — | $18,589 | $23,704 | $56,536 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 10 | — | — | $12,485 | $16,801 | $39,690 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 10 | — | — | $12,260 | $16,885 | $39,895 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 10 | — | — | $9,607.94 | $13,736 | $32,211 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 10 | — | — | $25,914 | $33,464 | $80,353 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $47,036 | $47,036 | $47,036 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $29,744 | $29,744 | $29,744 |
| Major joint replacement w MCC | MS-DRG | 469 | 10 | — | — | $23,384 | $29,850 | $71,535 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 10 | — | — | $14,659 | $19,178 | $45,491 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 10 | — | — | $22,325 | $28,682 | $68,684 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 10 | — | — | $15,193 | $20,778 | $49,397 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 10 | — | — | $12,262 | $16,299 | $38,466 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 10 | — | — | $21,517 | $28,441 | $68,096 |
| OR procedure for obesity w CC | MS-DRG | 620 | 10 | — | — | $13,331 | $16,002 | $37,741 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 10 | — | — | $11,627 | $15,114 | $35,574 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 10 | — | — | $8,218.54 | $12,527 | $29,261 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 10 | — | — | $12,452 | $20,340 | $48,326 |
| Payer | Codes covered | Median rate |
|---|---|---|
| Blue Cross Blue Shield | 42 | $11,961 |
| Cigna | 40 | $13,340 |
| commonwealth care alliance | 40 | $13,340 |
| harvard pilgrim health care | 40 | $13,340 |
| neighborhood health plan - ri | 40 | $14,523 |
| tufts health plan | 40 | $13,340 |
| UnitedHealthcare | 40 | $15,687 |
| va community care | 40 | $13,340 |
| Aetna | 40 | $19,091 |
| WellCare | 40 | $13,340 |
