Community Regional Medical Center - Fresno Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Community Regional Medical Center - Fresno, Fresno, CA in 2024, from traditional Medicare claims. Back to the Community Regional Medical Center - Fresno profile, with quality ratings, finances and negotiated rates.
4,785
Medicare inpatient discharges
In 148 published DRGs
2.13
Case mix index
IPPS FY 2027
27%
Surgical stays
68%
Stays with complications
In DRGs with a CC or MCC
3,697
Medicare outpatient services
In 38 service groups
Inpatient stays by major diagnostic category
Circulatory system1,045 discharges in 36 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 270 | $67,516 | $13,173 | $11,883 | 1.28 |
| Syncope and collapseMS-DRG 312, medical | 64 | $52,381 | $8,404 | $9,219 | 0.86 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 46 | $96,486 | $15,156 | $16,982 | 1.59 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 41 | $201,716 | $50,649 | $35,502 | 4.88 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 37 | $252,335 | $41,369 | $44,411 | 4.04 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 34 | $109,470 | $32,169 | $19,267 | 3.24 |
| Chest painMS-DRG 313, medical | 32 | $45,853 | $7,004 | $8,070 | 0.72 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 32 | $125,620 | $20,704 | $22,109 | 2.09 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 27 | $68,540 | $9,808 | $12,063 | 0.97 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 26 | $128,922 | $36,575 | $22,690 | 3.35 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 25 | $45,229 | $7,039 | $7,960 | 0.74 |
| Other vascular procedures with CCMS-DRG 253, surgical | 24 | $127,646 | $26,217 | $22,466 | 2.55 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 23 | $125,540 | $18,813 | $22,095 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 21 | $152,862 | $23,346 | $26,904 | 2.16 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 20 | $65,390 | $9,486 | $11,509 | 0.91 |
| Hypertension with MCCMS-DRG 304, medical | 20 | $131,825 | $14,672 | $23,201 | 1.15 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 19 | $508,244 | $87,110 | $89,451 | 7.71 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 19 | $343,594 | $53,707 | $60,472 | 5.24 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 19 | $221,651 | $66,702 | $39,011 | 6.25 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 19 | $78,680 | $9,588 | $13,848 | 1.08 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 18 | $64,646 | $11,664 | $11,378 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 18 | $199,110 | $31,180 | $35,043 | 2.87 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 16 | $331,878 | $52,601 | $58,410 | 5.20 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 16 | $324,490 | $54,171 | $57,110 | 5.88 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 16 | $33,505 | $4,763 | $5,897 | 0.55 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 15 | $166,086 | $38,945 | $29,231 | 4.16 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 15 | $167,777 | $31,974 | $29,529 | 3.46 |
| Hypertension without MCCMS-DRG 305, medical | 15 | $69,621 | $6,587 | $12,253 | 0.75 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 14 | $105,327 | $22,405 | $18,537 | 2.28 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 13 | $281,637 | $46,051 | $49,568 | 4.81 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 13 | $123,086 | $26,549 | $21,663 | 2.81 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 13 | $88,906 | $18,142 | $15,647 | 1.74 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 12 | $35,396 | $10,621 | $6,230 | 1.07 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 11 | $441,388 | $80,714 | $77,684 | 7.80 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 11 | $112,283 | $33,893 | $19,762 | 3.27 |
| Heart failure and shock with CCMS-DRG 292, medical | 11 | $62,733 | $8,063 | $11,041 | 0.86 |
Nervous system814 discharges in 27 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 116 | $112,655 | $19,914 | $19,827 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 79 | $60,891 | $9,957 | $10,717 | 1.02 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 67 | $295,048 | $46,115 | $51,929 | 4.42 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 64 | $304,536 | $59,061 | $53,598 | 5.67 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 44 | $67,310 | $13,022 | $11,846 | 1.36 |
| Seizures without MCCMS-DRG 101, medical | 44 | $52,072 | $9,298 | $9,165 | 0.91 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 41 | $70,031 | $10,334 | $12,325 | 1.03 |
| Seizures with MCCMS-DRG 100, medical | 35 | $163,326 | $24,388 | $28,745 | 1.98 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 23 | $66,256 | $19,086 | $11,661 | 1.81 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 23 | $40,689 | $10,959 | $7,161 | 1.14 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 22 | $205,187 | $41,356 | $36,113 | 3.79 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 21 | $214,938 | $32,161 | $37,829 | 2.95 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 21 | $50,533 | $6,323 | $8,894 | 0.69 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 21 | $121,401 | $14,020 | $21,367 | 1.36 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 21 | $84,457 | $13,067 | $14,864 | 1.32 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 20 | $117,446 | $14,784 | $20,670 | 1.47 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 19 | $327,352 | $90,397 | $57,614 | 8.45 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 16 | $101,229 | $19,130 | $17,816 | 1.79 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 15 | $49,906 | $7,906 | $8,783 | 0.80 |
| Extracranial procedures with CCMS-DRG 038, surgical | 14 | $89,055 | $15,792 | $15,674 | 1.60 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 14 | $94,127 | $16,497 | $16,566 | 1.79 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 14 | $147,166 | $20,771 | $25,901 | 2.28 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 13 | $135,275 | $23,140 | $23,808 | 2.39 |
| Traumatic stupor and coma >1 hour without cc/mccMS-DRG 084, medical | 13 | $72,607 | $9,194 | $12,779 | 0.92 |
| Headaches without MCCMS-DRG 103, medical | 12 | $66,905 | $7,494 | $11,775 | 0.84 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 11 | $246,084 | $25,770 | $43,311 | 2.43 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 11 | $323,152 | $35,903 | $56,875 | 1.51 |
Infectious and parasitic diseases636 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Septicemia or severe sepsis without MV >96 hours with MCCMS-DRG 871, medical | 414 | $123,713 | $19,999 | $21,773 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 77 | $334,829 | $53,333 | $58,930 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 64 | $63,519 | $10,302 | $11,179 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 34 | $327,401 | $72,545 | $57,623 | 6.96 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 18 | $291,147 | $52,153 | $51,242 | 4.43 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 17 | $141,550 | $19,722 | $24,913 | 2.04 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 12 | $183,433 | $22,732 | $32,284 | 1.84 |
Respiratory system402 discharges in 12 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 75 | $88,998 | $13,182 | $15,664 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 58 | $78,741 | $13,280 | $13,858 | 1.23 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 56 | $92,593 | $17,132 | $16,296 | 1.70 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 45 | $66,303 | $11,085 | $11,669 | 1.10 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 30 | $62,244 | $7,323 | $10,955 | 0.82 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 29 | $156,373 | $28,796 | $27,522 | 2.70 |
| Major chest trauma with CCMS-DRG 184, medical | 27 | $95,874 | $10,596 | $16,874 | 1.05 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 25 | $84,673 | $9,818 | $14,902 | 0.99 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 16 | $56,412 | $9,536 | $9,928 | 0.96 |
| Major chest procedures with MCCMS-DRG 163, surgical | 15 | $323,267 | $53,774 | $56,895 | 4.71 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 14 | $267,929 | $61,223 | $47,155 | 6.91 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 12 | $42,668 | $8,528 | $7,510 | 0.85 |
Kidney and urinary tract346 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Renal failure with CCMS-DRG 683, medical | 75 | $50,062 | $9,096 | $8,811 | 0.90 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 68 | $52,282 | $7,858 | $9,202 | 0.81 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 55 | $116,930 | $16,493 | $20,580 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 45 | $56,956 | $9,975 | $10,024 | 1.02 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 44 | $76,237 | $11,840 | $13,418 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 36 | $95,387 | $15,585 | $16,788 | 1.50 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 12 | $127,184 | $16,294 | $22,384 | 1.35 |
| Renal failure without cc/mccMS-DRG 684, medical | 11 | $56,632 | $2,413 | $9,967 | 0.61 |
Digestive system309 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 52 | $50,214 | $7,473 | $8,838 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 45 | $67,230 | $9,186 | $11,833 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 39 | $89,367 | $18,648 | $15,729 | 1.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 37 | $170,028 | $24,113 | $29,925 | 2.37 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 28 | $75,364 | $12,658 | $13,264 | 1.28 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 24 | $353,267 | $52,730 | $62,175 | 4.52 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 20 | $61,364 | $9,719 | $10,800 | 0.94 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 19 | $119,096 | $15,406 | $20,961 | 1.67 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 17 | $76,154 | $7,383 | $13,403 | 0.80 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 16 | $84,048 | $21,383 | $14,792 | 2.50 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 12 | $60,241 | $9,983 | $10,602 | 1.04 |
Musculoskeletal system and connective tissue294 discharges in 13 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Medical back problems without MCCMS-DRG 552, medical | 64 | $81,085 | $9,408 | $14,271 | 0.97 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 51 | $137,494 | $21,269 | $24,199 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 24 | $131,605 | $22,128 | $23,162 | 2.11 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 21 | $181,648 | $31,082 | $31,970 | 2.96 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 18 | $197,085 | $46,927 | $34,687 | 4.61 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 18 | $242,167 | $27,050 | $42,621 | 2.95 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 16 | $192,468 | $33,638 | $33,874 | 3.66 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 16 | $140,626 | $25,367 | $24,750 | 2.40 |
| Medical back problems with MCCMS-DRG 551, medical | 15 | $117,549 | $16,622 | $20,689 | 1.70 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 14 | $251,546 | $61,713 | $44,272 | 6.12 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 14 | $69,473 | $8,693 | $12,227 | 0.90 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 12 | $109,197 | $16,178 | $19,219 | 1.59 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 11 | $161,318 | $18,652 | $28,392 | 1.97 |
Endocrine, nutritional and metabolic270 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 82 | $68,927 | $13,636 | $12,131 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 53 | $49,021 | $7,679 | $8,628 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 43 | $52,249 | $8,435 | $9,196 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 25 | $80,643 | $14,779 | $14,193 | 1.45 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 19 | $90,616 | $18,166 | $15,948 | 1.98 |
| O.r. procedures for obesity with CCMS-DRG 620, surgical | 19 | $59,462 | $15,722 | $10,465 | 1.62 |
| Endocrine disorders with CCMS-DRG 644, medical | 15 | $71,126 | $10,224 | $12,518 | 1.06 |
| O.r. procedures for obesity without cc/mccMS-DRG 621, surgical | 14 | $54,007 | $14,102 | $9,505 | 1.52 |
Mental diseases and disorders226 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 197 | $52,235 | $13,746 | $9,193 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 29 | $62,713 | $16,723 | $11,038 | 1.76 |
Liver, gallbladder and pancreas142 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 21 | $116,032 | $18,615 | $20,422 | 1.83 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 21 | $43,892 | $9,934 | $7,725 | 0.95 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 19 | $81,595 | $10,962 | $14,361 | 1.09 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 16 | $122,893 | $17,483 | $21,629 | 1.76 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 15 | $52,231 | $8,874 | $9,193 | 0.86 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 14 | $107,324 | $15,965 | $18,889 | 1.63 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 13 | $109,262 | $19,062 | $19,230 | 1.92 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 12 | $88,851 | $17,372 | $15,638 | 1.67 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 11 | $104,015 | $16,053 | $18,307 | 1.63 |
Injuries, poisonings and toxic effects of drugs89 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 36 | $131,217 | $18,742 | $23,094 | 1.60 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 20 | $250,217 | $42,042 | $44,038 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 11 | $146,796 | $21,557 | $25,836 | 2.00 |
| Poisoning and toxic effects of drugs without MCCMS-DRG 918, medical | 11 | $65,416 | $8,725 | $11,513 | 0.86 |
| Complications of treatment with MCCMS-DRG 919, medical | 11 | $100,171 | $14,568 | $17,630 | 1.82 |
Other64 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 36 | $296,887 | $53,755 | $52,252 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 16 | $151,043 | $27,449 | $26,584 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 12 | $195,352 | $32,275 | $34,382 | 3.38 |
Transplants, ECMO and tracheostomy (pre-MDC)43 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and necMS-DRG 003, surgical | 28 | $1,090,489 | $229,637 | $191,926 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 15 | $782,496 | $142,485 | $137,719 | 14.70 |
Skin, subcutaneous tissue and breast42 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 42 | $44,994 | $8,566 | $7,919 | 0.88 |
Alcohol and drug use36 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 25 | $70,110 | $8,831 | $12,339 | 0.86 |
| Alcohol, drug abuse or dependence without rehabilitation therapy with MCCMS-DRG 896, medical | 11 | $79,572 | $17,718 | $14,005 | 1.78 |
Factors influencing health status14 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Signs and symptoms without MCCMS-DRG 948, medical | 14 | $65,805 | $7,299 | $11,582 | 0.80 |
Blood and immune system13 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 13 | $55,718 | $9,100 | $9,806 | 0.90 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
Outpatient services
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 2 Upper GI ProceduresAPC 5302 | 578 | 504 | $15,587 | $1,861 | $1,445 |
| Comprehensive Observation ServicesAPC 8011 | 511 | 484 | $25,646 | $2,661 | $2,090 |
| Level 1 Endovascular ProceduresAPC 5191 | 412 | 410 | $25,932 | $2,878 | $2,208 |
| Level 3 Vascular ProceduresAPC 5183 | 253 | 236 | $22,552 | $3,118 | $2,405 |
| Level 3 Endovascular ProceduresAPC 5193 | 187 | 169 | $69,518 | $11,867 | $8,874 |
| Level 4 Vascular ProceduresAPC 5184 | 175 | 157 | $29,336 | $5,379 | $3,946 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 153 | 140 | $35,737 | $5,651 | $4,358 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 129 | 123 | $140,506 | $27,478 | $21,117 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 90 | 90 | $90,308 | $10,944 | $8,164 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 80 | 78 | $9,121 | $1,544 | $1,220 |
| Level 5 ENT ProceduresAPC 5165 | 77 | 76 | $32,378 | $5,736 | $4,436 |
| Level 2 Endovascular ProceduresAPC 5192 | 76 | 73 | $34,644 | $5,501 | $4,338 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 64 | 59 | $15,183 | $2,783 | $2,141 |
| Level 5 Airway EndoscopyAPC 5155 | 63 | 60 | $26,516 | $6,676 | $5,183 |
| Level 4 Airway EndoscopyAPC 5154 | 61 | 60 | $21,194 | $3,668 | $2,833 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 55 | 55 | $48,060 | $11,476 | $8,569 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 52 | 44 | $21,580 | $3,346 | $2,636 |
| Level 3 Upper GI ProceduresAPC 5303 | 49 | 46 | $21,876 | $3,712 | $2,888 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 48 | 47 | $62,109 | $7,158 | $5,339 |
| Level 3 Airway EndoscopyAPC 5153 | 44 | 39 | $13,746 | $1,663 | $1,264 |
| Level 2 Vascular ProceduresAPC 5182 | 43 | 41 | $9,280 | $1,569 | $1,204 |
| Level 5 Urology and Related ServicesAPC 5375 | 43 | 39 | $41,868 | $5,062 | $3,918 |
| Level 3 Urology and Related ServicesAPC 5373 | 42 | 31 | $14,617 | $1,965 | $1,516 |
| Level 3 Lower GI ProceduresAPC 5313 | 41 | 39 | $22,262 | $2,758 | $2,176 |
| Level 4 Endovascular ProceduresAPC 5194 | 40 | 35 | $98,903 | $18,518 | $14,606 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 38 | 37 | $156,218 | $38,684 | $29,375 |
| Level 1 Intraocular ProceduresAPC 5491 | 35 | 29 | $20,770 | $2,278 | $1,752 |
| Level 4 Gynecologic ProceduresAPC 5414 | 33 | 33 | $25,780 | $2,971 | $2,389 |
| Complex GI ProceduresAPC 5331 | 31 | 24 | $28,768 | $5,583 | $4,263 |
| Level 4 Urology and Related ServicesAPC 5374 | 30 | 28 | $25,739 | $3,409 | $2,629 |
| Level 4 ENT ProceduresAPC 5164 | 29 | 11 | $15,401 | $1,196 | $2,217 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 28 | 27 | $139,426 | $35,120 | $26,719 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 22 | 22 | $84,363 | $14,516 | $10,772 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 22 | 20 | $41,698 | $6,593 | $4,524 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 18 | 18 | $119,787 | $21,219 | $15,763 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 17 | 17 | $13,372 | $1,552 | $1,196 |
| Level 2 Urology and Related ServicesAPC 5372 | 15 | $4,907 | $669 | $502 | |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 13 | 13 | $19,483 | $3,171 | $2,373 |
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.