Hospital Costs > In Alaska > Providence Alaska Medical Center, procedure costs
Procedure | Discharges | Avg Covered Charges | Avg Total Payment | Avg Medicare Payment | ||||
---|---|---|---|---|---|---|---|---|
Count | Rank | Amount | Rank | Amount | Rank | Amount | Rank | |
Major Joint Replacement Or Reattachment Of Lower Extremity W/O Mcc | 315 | 256 / 1 | $62.911,60 | 1799 / 3 | $20.044,80 | 2500 / 3 | $17.465,40 | 2454 / 3 |
Septicemia Or Severe Sepsis W/O Mv 96+ Hours W Mcc | 177 | 339 / 1 | $75.852,70 | 2373 / 5 | $19.888,00 | 2667 / 4 | $17.434,80 | 2622 / 3 |
Perc Cardiovasc Proc W Drug-Eluting Stent W/O Mcc | 87 | 109 / 1 | $92.490,30 | 1078 / 2 | $19.969,20 | 1403 / 2 | $17.488,50 | 1395 / 2 |
Heart Failure & Shock W Cc | 74 | 204 / 1 | $47.054,40 | 2504 / 6 | $10.147,40 | 2566 / 2 | $8.804,63 | 2560 / 2 |
Intracranial Hemorrhage Or Cerebral Infarction W Cc Or Tpa In 24 Hrs | 72 | 110 / 1 | $58.020,50 | 1846 / 3 | $14.119,20 | 1998 / 4 | $10.681,90 | 1994 / 3 |
Septicemia Or Severe Sepsis W/O Mv 96+ Hours W/O Mcc | 71 | 136 / 1 | $48.617,80 | 2232 / 5 | $12.784,10 | 2432 / 3 | $9.715,93 | 2422 / 3 |
Heart Failure & Shock W Mcc | 62 | 222 / 1 | $71.272,70 | 2364 / 3 | $15.740,80 | 2518 / 3 | $14.787,50 | 2507 / 2 |
Renal Failure W Cc | 62 | 159 / 1 | $41.463,60 | 2084 / 6 | $10.628,70 | 2285 / 4 | $8.808,58 | 2275 / 3 |
Psychoses | 61 | 220 / 2 | $47.936,40 | 579 / 2 | $11.392,50 | 538 / 1 | $8.918,38 | 538 / 1 |
G.I. Hemorrhage W Cc | 59 | 159 / 1 | $40.596,40 | 1967 / 4 | $10.531,30 | 2302 / 3 | $9.458,75 | 2298 / 2 |
Simple Pneumonia & Pleurisy W Cc | 59 | 144 / 1 | $40.031,40 | 2327 / 5 | $10.341,20 | 2620 / 3 | $8.549,30 | 2611 / 1 |
Esophagitis, Gastroent & Misc Digest Disorders W/O Mcc | 57 | 218 / 1 | $32.602,10 | 2264 / 6 | $8.447,49 | 2527 / 4 | $6.702,75 | 2512 / 4 |
Kidney & Urinary Tract Infections W/O Mcc | 52 | 181 / 1 | $37.314,10 | 2439 / 5 | $8.533,79 | 2558 / 3 | $7.138,73 | 2547 / 3 |
Perc Cardiovasc Proc W Drug-Eluting Stent W Mcc Or 4+ Vessels/Stents | 50 | 50 / 1 | $149.951,00 | 825 / 1 | $32.856,10 | 991 / 1 | $31.876,90 | 986 / 2 |
Spinal Fusion Except Cervical W/O Mcc | 47 | 147 / 2 | $114.860,00 | 888 / 2 | $37.597,80 | 1262 / 1 | $33.182,30 | 1257 / 2 |
Intracranial Hemorrhage Or Cerebral Infarction W Mcc | 44 | 124 / 1 | $91.178,70 | 1447 / 4 | $20.231,40 | 1579 / 2 | $18.968,00 | 1572 / 2 |
Pulmonary Edema & Respiratory Failure | 44 | 159 / 1 | $69.135,60 | 2048 / 3 | $12.619,70 | 2115 / 2 | $11.617,70 | 2109 / 2 |
Revision Of Hip Or Knee Replacement W/O Cc/Mcc | 43 | 26 / 1 | $79.615,00 | 330 / 1 | $25.225,50 | 474 / 2 | $22.538,00 | 473 / 2 |
Major Joint & Limb Reattachment Proc Of Upper Extremity W/O Cc/Mcc | 43 | 53 / 1 | $61.210,10 | 491 / 1 | $20.858,30 | 765 / 2 | $18.350,00 | 761 / 2 |
Intracranial Hemorrhage Or Cerebral Infarction W/O Cc/Mcc | 40 | 62 / 1 | $37.850,10 | 1307 / 1 | $8.058,75 | 1501 / 2 | $6.822,75 | 1497 / 2 |
Simple Pneumonia & Pleurisy W Mcc | 40 | 165 / 1 | $58.586,40 | 2077 / 3 | $14.602,00 | 2404 / 2 | $13.543,20 | 2398 / 2 |
Cervical Spinal Fusion W/O Cc/Mcc | 40 | 64 / 1 | $64.306,80 | 515 / 1 | $20.091,00 | 828 / 2 | $18.900,60 | 825 / 2 |
Cellulitis W/O Mcc | 38 | 151 / 1 | $41.924,20 | 2453 / 6 | $9.194,11 | 2454 / 4 | $7.491,68 | 2446 / 3 |
Chronic Obstructive Pulmonary Disease W Cc | 36 | 143 / 1 | $39.910,20 | 2064 / 3 | $10.083,60 | 2342 / 2 | $9.058,19 | 2335 / 2 |
Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W/O Mcc | 36 | 130 / 1 | $29.785,00 | 2130 / 6 | $7.567,39 | 2375 / 3 | $6.580,06 | 2366 / 3 |
G.I. Hemorrhage W Mcc | 34 | 87 / 1 | $83.007,10 | 1465 / 1 | $18.340,50 | 1585 / 1 | $17.189,90 | 1575 / 1 |
Chronic Obstructive Pulmonary Disease W Mcc | 33 | 169 / 2 | $41.649,00 | 1974 / 5 | $11.438,00 | 2421 / 3 | $10.430,80 | 2413 / 3 |
Circulatory Disorders Except Ami, W Card Cath W/O Mcc | 32 | 156 / 1 | $64.609,90 | 1446 / 1 | $11.973,20 | 1576 / 1 | $10.867,00 | 1573 / 1 |
Renal Failure W Mcc | 31 | 164 / 1 | $70.068,90 | 1890 / 2 | $15.252,00 | 2017 / 2 | $14.175,40 | 2013 / 2 |
Back & Neck Proc Exc Spinal Fusion W/O Cc/Mcc | 29 | 60 / 2 | $42.132,80 | 500 / 1 | $10.753,80 | 720 / 2 | $9.523,72 | 719 / 2 |
Cardiac Valve & Oth Maj Cardiothoracic Proc W/O Card Cath W Mcc | 29 | 87 / 1 | $379.646,00 | 433 / 1 | $92.088,70 | 477 / 2 | $90.779,80 | 477 / 2 |
Other Circulatory System Diagnoses W Mcc | 29 | 87 / 1 | $71.817,70 | 1072 / 1 | $19.696,40 | 1314 / 1 | $18.726,00 | 1306 / 1 |
Cardiac Valve & Oth Maj Cardiothoracic Proc W/O Card Cath W Cc | 28 | 90 / 1 | $250.984,00 | 474 / 1 | $56.719,10 | 529 / 1 | $53.235,00 | 529 / 1 |
Hip & Femur Procedures Except Major Joint W Cc | 27 | 116 / 2 | $83.832,10 | 1753 / 3 | $19.251,90 | 1932 / 1 | $16.767,10 | 1912 / 1 |
Permanent Cardiac Pacemaker Implant W Cc | 26 | 51 / 1 | $94.350,90 | 740 / 1 | $26.299,80 | 893 / 1 | $22.220,00 | 889 / 1 |
Cardiac Arrhythmia & Conduction Disorders W/O Cc/Mcc | 26 | 124 / 1 | $21.940,10 | 1501 / 2 | $6.604,00 | 1871 / 2 | $5.117,23 | 1865 / 2 |
Cardiac Arrhythmia & Conduction Disorders W Cc | 25 | 136 / 1 | $61.533,80 | 2126 / 3 | $15.071,50 | 2158 / 3 | $11.255,60 | 2153 / 3 |
G.I. Obstruction W Cc | 25 | 67 / 1 | $35.334,50 | 1355 / 1 | $9.139,96 | 1650 / 1 | $8.143,64 | 1645 / 1 |
Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W Mcc | 25 | 101 / 1 | $69.893,90 | 1664 / 1 | $16.048,60 | 1721 / 1 | $14.570,10 | 1717 / 1 |
Respiratory System Diagnosis W Ventilator Support <96 Hours | 24 | 107 / 1 | $101.310,00 | 1530 / 2 | $24.481,90 | 1641 / 1 | $19.567,00 | 1627 / 1 |
Permanent Cardiac Pacemaker Implant W Mcc | 24 | 28 / 1 | $145.520,00 | 501 / 1 | $37.246,00 | 584 / 1 | $34.451,40 | 584 / 1 |
Permanent Cardiac Pacemaker Implant W/O Cc/Mcc | 24 | 33 / 1 | $85.637,50 | 607 / 1 | $19.415,00 | 678 / 1 | $18.290,10 | 676 / 1 |
Cardiac Arrhythmia & Conduction Disorders W Mcc | 23 | 100 / 1 | $60.678,80 | 1692 / 3 | $13.488,40 | 1820 / 2 | $11.628,10 | 1817 / 1 |
Infectious & Parasitic Diseases W O.R. Procedure W Mcc | 22 | 102 / 1 | $170.940,00 | 1132 / 1 | $49.229,10 | 1457 / 2 | $48.038,60 | 1447 / 2 |
Other Kidney & Urinary Tract Diagnoses W Mcc | 21 | 80 / 1 | $64.206,20 | 922 / 1 | $17.587,90 | 1068 / 1 | $16.637,10 | 1064 / 1 |
Perc Cardiovasc Proc W/O Coronary Artery Stent W/O Mcc | 21 | 74 / 1 | $126.324,00 | 547 / 1 | $21.962,00 | 547 / 1 | $17.169,80 | 543 / 1 |
Alcohol/Drug Abuse Or Dependence W/O Rehabilitation Therapy W/O Mcc | 21 | 103 / 1 | $33.725,50 | 737 / 2 | $7.493,86 | 753 / 2 | $6.516,33 | 752 / 2 |
Poisoning & Toxic Effects Of Drugs W Mcc | 21 | 51 / 1 | $104.800,00 | 960 / 1 | $21.858,50 | 987 / 1 | $20.945,70 | 984 / 1 |
Major Small & Large Bowel Procedures W Cc | 20 | 88 / 2 | $93.026,40 | 1148 / 3 | $23.093,60 | 1416 / 2 | $21.252,60 | 1402 / 2 |
Acute Myocardial Infarction, Discharged Alive W Mcc | 20 | 105 / 1 | $87.321,80 | 1616 / 2 | $21.974,60 | 1774 / 2 | $18.234,20 | 1761 / 2 |
Back & Neck Proc Exc Spinal Fusion W Cc/Mcc Or Disc Device/Neurostim | 19 | 47 / 1 | $56.302,80 | 322 / 1 | $17.231,40 | 529 / 1 | $15.979,20 | 525 / 2 |
Cardiac Valve & Oth Maj Cardiothoracic Proc W/O Card Cath W/O Cc/Mcc | 19 | 23 / 1 | $190.901,00 | 107 / 1 | $50.919,50 | 121 / 1 | $41.133,90 | 121 / 1 |
Other Vascular Procedures W Cc | 19 | 83 / 1 | $144.361,00 | 1046 / 1 | $29.734,20 | 1126 / 1 | $28.562,40 | 1121 / 1 |
Medical Back Problems W/O Mcc | 19 | 102 / 1 | $37.295,70 | 1194 / 2 | $8.690,58 | 1389 / 2 | $7.569,00 | 1384 / 2 |
Syncope & Collapse | 18 | 151 / 1 | $37.000,70 | 1631 / 1 | $9.078,33 | 1862 / 1 | $8.177,44 | 1854 / 1 |
Major Small & Large Bowel Procedures W Mcc | 18 | 67 / 1 | $159.701,00 | 861 / 1 | $45.308,90 | 1157 / 1 | $43.848,40 | 1155 / 2 |
Signs & Symptoms W/O Mcc | 18 | 73 / 1 | $45.774,70 | 1287 / 3 | $9.433,94 | 1235 / 3 | $6.662,89 | 1232 / 3 |
Poisoning & Toxic Effects Of Drugs W/O Mcc | 18 | 43 / 1 | $41.939,40 | 864 / 1 | $7.107,72 | 825 / 1 | $6.169,72 | 824 / 1 |
Bilateral Or Multiple Major Joint Procs Of Lower Extremity W/O Mcc | 17 | 46 / 2 | $89.325,50 | 147 / 1 | $33.934,10 | 208 / 1 | $25.710,60 | 207 / 2 |
Other Digestive System Diagnoses W Cc | 17 | 80 / 1 | $36.628,80 | 1061 / 1 | $11.495,80 | 1269 / 1 | $8.122,12 | 1265 / 1 |
Coronary Bypass W Cardiac Cath W/O Mcc | 17 | 59 / 1 | $251.800,00 | 556 / 1 | $51.878,50 | 612 / 1 | $50.511,90 | 612 / 1 |
Chronic Obstructive Pulmonary Disease W/O Cc/Mcc | 17 | 103 / 1 | $44.893,70 | 2011 / 3 | $9.097,41 | 2058 / 2 | $7.895,71 | 2046 / 2 |
Major Cardiovasc Procedures W Mcc | 17 | 51 / 1 | $270.508,00 | 597 / 1 | $62.691,70 | 636 / 1 | $61.357,10 | 635 / 1 |
Esophagitis, Gastroent & Misc Digest Disorders W Mcc | 17 | 79 / 1 | $63.000,10 | 1305 / 1 | $12.497,10 | 1378 / 1 | $11.693,10 | 1373 / 1 |
Respiratory Infections & Inflammations W Mcc | 16 | 120 / 1 | $80.960,30 | 1516 / 2 | $20.272,10 | 1767 / 2 | $18.901,30 | 1751 / 2 |
Coronary Bypass W/O Cardiac Cath W/O Mcc | 16 | 72 / 1 | $210.182,00 | 547 / 1 | $50.634,40 | 583 / 1 | $35.938,60 | 582 / 1 |
Disorders Of Liver Except Malig,Cirr,Alc Hepa W Mcc | 16 | 60 / 1 | $80.612,10 | 445 / 1 | $20.707,40 | 529 / 1 | $19.960,90 | 529 / 1 |
Major Joint/Limb Reattachment Procedure Of Upper Extremities | 16 | 53 / 1 | $77.003,60 | 315 / 1 | $23.400,40 | 450 / 1 | $22.242,90 | 450 / 1 |
G.I. Obstruction W/O Cc/Mcc | 16 | 55 / 1 | $31.380,60 | 1136 / 1 | $9.476,12 | 1202 / 1 | $4.944,00 | 1199 / 1 |
Other Vascular Procedures W Mcc | 16 | 81 / 1 | $119.881,00 | 729 / 1 | $29.450,40 | 888 / 1 | $28.389,80 | 885 / 1 |
Hip & Femur Procedures Except Major Joint W/O Cc/Mcc | 15 | 41 / 1 | $57.954,70 | 690 / 1 | $15.695,50 | 833 / 1 | $12.946,90 | 830 / 1 |
Extensive O.R. Procedure Unrelated To Principal Diagnosis W Mcc | 15 | 48 / 1 | $278.825,00 | 715 / 1 | $67.174,90 | 755 / 1 | $62.515,70 | 755 / 1 |
Respiratory Infections & Inflammations W Cc | 15 | 73 / 2 | $64.995,30 | 1292 / 2 | $16.087,10 | 1472 / 2 | $14.973,50 | 1467 / 2 |
Seizures W/O Mcc | 15 | 93 / 1 | $30.703,50 | 979 / 2 | $8.052,00 | 1202 / 1 | $7.110,13 | 1200 / 2 |
Heart Failure & Shock W/O Cc/Mcc | 15 | 95 / 1 | $25.974,30 | 1593 / 2 | $7.362,73 | 1904 / 3 | $6.523,27 | 1891 / 3 |
Coronary Bypass W Cardiac Cath W Mcc | 15 | 41 / 1 | $437.001,00 | 419 / 1 | $103.483,00 | 440 / 1 | $101.825,00 | 440 / 1 |
Peripheral Vascular Disorders W Cc | 15 | 69 / 1 | $51.803,50 | 1161 / 1 | $10.385,90 | 1196 / 1 | $9.638,13 | 1193 / 1 |
Diabetes W Cc | 14 | 78 / 2 | $28.700,30 | 1131 / 2 | $8.615,64 | 1489 / 1 | $7.678,50 | 1484 / 2 |
Cardiac Valve & Oth Maj Cardiothoracic Proc W Card Cath W Mcc | 14 | 55 / 1 | $537.926,00 | 275 / 1 | $133.150,00 | 293 / 1 | $130.549,00 | 293 / 1 |
Extracranial Procedures W/O Cc/Mcc | 14 | 84 / 2 | $40.420,10 | 640 / 1 | $10.371,60 | 903 / 2 | $9.386,50 | 900 / 2 |
Peripheral Vascular Disorders W Mcc | 14 | 35 / 1 | $85.292,20 | 564 / 1 | $18.776,80 | 585 / 1 | $17.228,70 | 585 / 1 |
Laparoscopic Cholecystectomy W/O C.D.E. W Cc | 14 | 42 / 1 | $52.843,30 | 506 / 1 | $15.342,40 | 839 / 1 | $14.135,00 | 835 / 1 |
Major Small & Large Bowel Procedures W/O Cc/Mcc | 13 | 51 / 2 | $55.260,80 | 524 / 1 | $16.206,40 | 630 / 1 | $11.776,60 | 630 / 1 |
Cardiac Defibrillator Implant W/O Cardiac Cath W/O Mcc | 13 | 37 / 1 | $145.319,00 | 125 / 1 | $46.778,40 | 217 / 1 | $45.841,20 | 217 / 1 |
Cervical Spinal Fusion W Cc | 13 | 40 / 2 | $73.493,50 | 184 / 1 | $25.628,00 | 344 / 1 | $24.442,80 | 343 / 2 |
Major Cardiovasc Procedures W/O Mcc | 13 | 88 / 2 | $119.431,00 | 736 / 1 | $31.927,00 | 878 / 2 | $26.877,10 | 877 / 1 |
Other Kidney & Urinary Tract Diagnoses W Cc | 13 | 90 / 1 | $53.707,20 | 781 / 1 | $29.488,50 | 736 / 1 | $8.402,15 | 736 / 1 |
Lower Extrem & Humer Proc Except Hip,Foot,Femur W Cc | 13 | 42 / 1 | $68.474,50 | 423 / 1 | $18.182,40 | 595 / 1 | $16.828,50 | 591 / 1 |
Major Chest Procedures W Mcc | 13 | 36 / 1 | $203.594,00 | 273 / 1 | $50.515,20 | 317 / 1 | $49.361,30 | 316 / 1 |
Seizures W Mcc | 13 | 53 / 1 | $95.874,00 | 721 / 1 | $17.572,70 | 732 / 1 | $16.389,30 | 732 / 1 |
Other Vascular Procedures W/O Cc/Mcc | 13 | 43 / 1 | $78.783,20 | 475 / 1 | $23.565,00 | 513 / 1 | $15.053,80 | 512 / 1 |
Hip & Femur Procedures Except Major Joint W Mcc | 13 | 49 / 1 | $110.124,00 | 754 / 1 | $27.348,60 | 890 / 1 | $25.898,10 | 887 / 1 |
Bronchitis & Asthma W Cc/Mcc | 12 | 64 / 1 | $39.671,20 | 880 / 1 | $8.970,83 | 1020 / 1 | $8.282,83 | 1016 / 1 |
Septicemia Or Severe Sepsis W Mv 96+ Hours | 12 | 80 / 2 | $258.158,00 | 920 / 2 | $60.399,10 | 1045 / 1 | $59.069,80 | 1044 / 1 |
Ecmo Or Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W Maj O.R. | 12 | 69 / 1 | $775.058,00 | 407 / 1 | $205.621,00 | 441 / 1 | $203.668,00 | 440 / 1 |
Other O.R. Procedures For Injuries W Mcc | 12 | 25 / 1 | $144.230,00 | 155 / 1 | $43.421,40 | 183 / 1 | $42.464,90 | 183 / 1 |
Diabetes W Mcc | 12 | 45 / 1 | $95.897,70 | 722 / 1 | $25.478,80 | 745 / 1 | $22.433,60 | 744 / 1 |
Transient Ischemia | 12 | 113 / 1 | $27.771,90 | 1095 / 1 | $8.795,25 | 1487 / 1 | $5.764,75 | 1479 / 1 |
Revision Of Hip Or Knee Replacement W Cc | 12 | 74 / 2 | $102.686,00 | 461 / 1 | $38.420,20 | 528 / 2 | $23.853,20 | 526 / 2 |
Pulmonary Embolism W/O Mcc | 12 | 62 / 1 | $48.746,90 | 1150 / 1 | $9.970,00 | 1237 / 1 | $9.168,00 | 1234 / 1 |
Major Chest Procedures W Cc | 11 | 63 / 1 | $181.591,00 | 488 / 1 | $32.837,20 | 505 / 1 | $31.369,20 | 503 / 1 |
Infectious & Parasitic Diseases W O.R. Procedure W Cc | 11 | 25 / 1 | $91.498,70 | 278 / 1 | $23.229,50 | 339 / 1 | $22.111,00 | 338 / 1 |
Red Blood Cell Disorders W/O Mcc | 11 | 132 / 3 | $57.459,00 | 1964 / 3 | $10.548,50 | 1902 / 2 | $8.083,09 | 1893 / 2 |
Kidney & Ureter Procedures For Neoplasm W Cc | 11 | 33 / 1 | $106.480,00 | 159 / 1 | $21.265,10 | 171 / 1 | $20.090,50 | 171 / 1 |
Perc Cardiovasc Proc W/O Coronary Artery Stent W Mcc | 11 | 43 / 1 | $172.378,00 | 248 / 1 | $32.067,30 | 255 / 1 | $31.374,10 | 255 / 1 |
Amputat Of Lower Limb For Endocrine,Nutrit,& Metabol Dis W Cc | 11 | 19 / 1 | $78.330,50 | 157 / 1 | $18.469,50 | 187 / 1 | $17.060,70 | 186 / 1 |
Acute Myocardial Infarction, Discharged Alive W Cc | 11 | 80 / 1 | $43.314,70 | 1094 / 1 | $10.477,50 | 1357 / 1 | $9.645,64 | 1355 / 1 |
Circulatory Disorders Except Ami, W Card Cath W Mcc | 11 | 82 / 1 | $77.227,70 | 640 / 1 | $18.717,90 | 796 / 1 | $17.623,40 | 789 / 1 |
Major Joint Replacement Or Reattachment Of Lower Extremity W Mcc | 11 | 54 / 1 | $147.835,00 | 834 / 1 | $34.378,60 | 897 / 1 | $32.882,60 | 893 / 1 | Total 109 procedures | 3.195 | discharges |
Source: Medicare Provider Utilization and Payment Data: Inpatient for FY2014
Average Covered Charges: The provider's average charge for services covered by Medicare for all discharges in the MS-DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments: The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments: The average amount that Medicare pays to the provider for Medicare's share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits. Note: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incurred a 2 percent reduction in Medicare payment. This is in response to mandatory across-the-board reductions in Federal spending, also known as sequestration
Hospital Rank: We have calculated the rank for each procedure within a hospital. The left number is the national ranking, the right one is the state ranking. For discharges, ranking is from highest # of discharges to lower (hospital with highest number of discharges ranks first). For charges and payments, lowest means a higher ranking.