Edward Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Edward Hospital, Naperville, IL in 2024, from traditional Medicare claims. Back to the Edward Hospital profile, with quality ratings, finances and negotiated rates.
5,324
Medicare inpatient discharges
In 142 published DRGs
1.85
Case mix index
IPPS FY 2027
25%
Surgical stays
67%
Stays with complications
In DRGs with a CC or MCC
5,076
Medicare outpatient services
In 43 service groups
Inpatient stays by major diagnostic category
Circulatory system1,358 discharges in 33 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 352 | $48,430 | $7,700 | $9,153 | 1.28 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 96 | $163,518 | $20,684 | $30,905 | 3.24 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 81 | $29,020 | $3,676 | $5,485 | 0.74 |
| Syncope and collapseMS-DRG 312, medical | 68 | $38,944 | $4,623 | $7,361 | 0.86 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 51 | $229,503 | $32,112 | $43,376 | 4.88 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 51 | $47,221 | $6,833 | $8,925 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 48 | $106,346 | $9,956 | $20,099 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 45 | $105,360 | $12,797 | $19,913 | 2.16 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 45 | $25,369 | $2,005 | $4,795 | 0.55 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 41 | $55,241 | $8,957 | $10,441 | 1.59 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 37 | $146,174 | $17,601 | $27,627 | 2.87 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 33 | $230,711 | $27,970 | $43,604 | 3.35 |
| Other vascular procedures with CCMS-DRG 253, surgical | 32 | $144,719 | $15,529 | $27,352 | 2.55 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 32 | $53,541 | $4,990 | $10,119 | 1.08 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 30 | $115,423 | $13,494 | $21,815 | 2.28 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 24 | $304,293 | $31,648 | $57,511 | 5.24 |
| Hypertension without MCCMS-DRG 305, medical | 24 | $38,932 | $3,837 | $7,358 | 0.75 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 23 | $337,879 | $47,306 | $63,859 | 6.25 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 22 | $67,688 | $12,891 | $12,793 | 2.09 |
| Chest painMS-DRG 313, medical | 20 | $33,251 | $3,412 | $6,284 | 0.72 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 19 | $572,811 | $69,176 | $108,261 | 7.71 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 19 | $268,341 | $25,618 | $50,716 | 5.20 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 19 | $188,618 | $21,070 | $35,649 | 4.04 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 18 | $225,526 | $36,080 | $42,624 | 5.06 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 17 | $42,667 | $6,181 | $8,064 | 1.07 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 16 | $183,269 | $22,219 | $34,638 | 3.46 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 15 | $90,199 | $10,785 | $17,048 | 1.83 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 15 | $31,017 | $5,380 | $5,862 | 0.97 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 14 | $256,316 | $27,787 | $48,444 | 4.16 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 14 | $73,548 | $10,356 | $13,901 | 1.58 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 13 | $120,855 | $21,083 | $22,842 | 3.27 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 13 | $39,105 | $5,079 | $7,391 | 0.91 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 11 | $175,162 | $20,945 | $33,106 | 3.18 |
Respiratory system768 discharges in 15 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 155 | $67,247 | $10,019 | $12,710 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 151 | $54,894 | $7,638 | $10,375 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 109 | $63,208 | $7,443 | $11,946 | 1.23 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 78 | $31,555 | $4,203 | $5,964 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 53 | $46,360 | $6,654 | $8,762 | 1.10 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 49 | $33,859 | $5,474 | $6,399 | 0.99 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 35 | $62,909 | $8,631 | $11,890 | 1.40 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 25 | $44,687 | $4,439 | $8,446 | 0.82 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 23 | $39,412 | $5,503 | $7,449 | 0.96 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 19 | $33,181 | $4,660 | $6,271 | 0.85 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 17 | $48,902 | $11,161 | $9,242 | 1.74 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 17 | $135,400 | $18,264 | $25,591 | 2.70 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 15 | $104,283 | $10,207 | $19,709 | 1.88 |
| Pleural effusion with MCCMS-DRG 186, medical | 11 | $64,820 | $9,883 | $12,251 | 1.55 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 11 | $57,747 | $11,651 | $10,914 | 1.81 |
Digestive system614 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 114 | $47,987 | $5,572 | $9,070 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 102 | $36,008 | $4,081 | $6,805 | 0.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 51 | $30,899 | $4,020 | $5,840 | 0.80 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 48 | $116,076 | $13,578 | $21,938 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 34 | $72,240 | $10,158 | $13,653 | 1.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 33 | $155,417 | $24,387 | $29,374 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 32 | $61,984 | $7,884 | $11,715 | 1.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 30 | $36,440 | $5,768 | $6,887 | 1.04 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 27 | $101,216 | $8,952 | $19,130 | 1.67 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 27 | $25,169 | $2,378 | $4,757 | 0.56 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 25 | $37,346 | $5,361 | $7,058 | 0.94 |
| Digestive malignancy with CCMS-DRG 375, medical | 24 | $46,521 | $6,806 | $8,792 | 1.20 |
| Digestive malignancy with MCCMS-DRG 374, medical | 19 | $86,092 | $12,418 | $16,271 | 2.10 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 18 | $54,231 | $10,474 | $10,250 | 1.75 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 15 | $76,948 | $11,399 | $14,543 | 2.11 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 15 | $55,972 | $10,411 | $10,579 | 1.62 |
Infectious and parasitic diseases552 discharges in 5 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 | 374 | $78,479 | $11,667 | $14,833 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 85 | $32,881 | $5,390 | $6,214 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 61 | $175,730 | $30,496 | $33,213 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 20 | $69,734 | $11,304 | $13,180 | 2.04 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $177,545 | $29,369 | $33,556 | 4.43 |
Kidney and urinary tract543 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 132 | $29,706 | $4,203 | $5,614 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 91 | $43,847 | $6,801 | $8,287 | 1.17 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 85 | $50,513 | $9,558 | $9,547 | 1.65 |
| Renal failure with CCMS-DRG 683, medical | 64 | $34,150 | $5,111 | $6,454 | 0.90 |
| Renal failure with MCCMS-DRG 682, medical | 54 | $63,356 | $9,081 | $11,974 | 1.50 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 45 | $30,124 | $5,812 | $5,693 | 1.02 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 19 | $50,113 | $8,023 | $9,471 | 1.35 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 16 | $80,338 | $10,820 | $15,184 | 1.84 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 13 | $64,777 | $15,569 | $12,243 | 2.59 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 13 | $48,022 | $5,567 | $9,076 | 1.05 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 11 | $140,865 | $25,890 | $26,623 | 3.70 |
Nervous system401 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 69 | $54,101 | $5,552 | $10,225 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 55 | $84,926 | $11,376 | $16,051 | 2.00 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 46 | $39,280 | $3,277 | $7,424 | 0.69 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 30 | $66,948 | $9,934 | $12,653 | 1.32 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 25 | $220,771 | $25,304 | $41,726 | 4.42 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 23 | $45,761 | $4,291 | $8,649 | 0.80 |
| Seizures with MCCMS-DRG 100, medical | 19 | $84,304 | $12,538 | $15,934 | 1.98 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 18 | $90,280 | $8,202 | $17,063 | 1.14 |
| Traumatic stupor and coma <1 hour without cc/mccMS-DRG 087, medical | 16 | $28,003 | $4,339 | $5,293 | 0.89 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 16 | $38,979 | $5,498 | $7,367 | 1.03 |
| Extracranial procedures with CCMS-DRG 038, surgical | 15 | $89,198 | $9,590 | $16,858 | 1.60 |
| Seizures without MCCMS-DRG 101, medical | 13 | $61,347 | $5,477 | $11,595 | 0.91 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 12 | $67,674 | $13,215 | $12,790 | 2.27 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 11 | $286,773 | $34,730 | $54,200 | 5.67 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 11 | $65,140 | $7,850 | $12,312 | 1.36 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 11 | $42,292 | $9,838 | $7,993 | 1.79 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 11 | $57,473 | $11,042 | $10,862 | 1.79 |
Musculoskeletal system and connective tissue390 discharges in 14 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 72 | $68,832 | $10,449 | $13,009 | 1.88 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 49 | $83,363 | $12,013 | $15,756 | 2.07 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 40 | $126,824 | $21,687 | $23,970 | 3.66 |
| Medical back problems without MCCMS-DRG 552, medical | 36 | $33,817 | $5,024 | $6,391 | 0.97 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 30 | $232,732 | $30,713 | $43,986 | 4.61 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 28 | $252,330 | $37,619 | $47,690 | 6.12 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 26 | $146,151 | $16,852 | $27,622 | 2.96 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 24 | $82,650 | $13,034 | $15,621 | 2.11 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 18 | $26,214 | $3,819 | $4,954 | 0.79 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 17 | $69,510 | $8,944 | $13,137 | 1.59 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 13 | $128,622 | $18,021 | $24,309 | 2.95 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 13 | $99,520 | $14,380 | $18,809 | 2.40 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 13 | $28,195 | $4,686 | $5,329 | 0.90 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 11 | $53,490 | $8,016 | $10,110 | 1.49 |
Endocrine, nutritional and metabolic203 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 86 | $27,951 | $3,704 | $5,283 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 52 | $46,512 | $7,895 | $8,791 | 1.32 |
| Diabetes with CCMS-DRG 638, medical | 23 | $38,024 | $4,664 | $7,186 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 15 | $66,699 | $9,037 | $12,606 | 1.45 |
| Endocrine disorders with CCMS-DRG 644, medical | 14 | $32,634 | $5,985 | $6,168 | 1.06 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 13 | $92,127 | $10,481 | $17,412 | 1.98 |
Liver, gallbladder and pancreas139 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 26 | $74,322 | $9,958 | $14,047 | 1.76 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 25 | $63,132 | $6,457 | $11,932 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 23 | $84,539 | $9,488 | $15,978 | 1.63 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 17 | $97,673 | $11,271 | $18,460 | 1.63 |
| Disorders of the biliary tract without cc/mccMS-DRG 446, medical | 13 | $46,157 | $3,804 | $8,724 | 0.80 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 12 | $80,113 | $6,439 | $15,141 | 1.31 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 12 | $36,228 | $4,104 | $6,847 | 0.86 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 11 | $42,678 | $6,650 | $8,066 | 1.03 |
Skin, subcutaneous tissue and breast102 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 72 | $26,388 | $4,565 | $4,987 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 30 | $33,018 | $8,705 | $6,240 | 1.49 |
Blood and immune system83 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 49 | $43,693 | $5,367 | $8,258 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 22 | $74,352 | $9,674 | $14,052 | 1.40 |
| Coagulation disordersMS-DRG 813, medical | 12 | $156,433 | $15,705 | $29,566 | 1.56 |
Injuries, poisonings and toxic effects of drugs59 discharges in 4 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 | 18 | $55,823 | $8,827 | $10,551 | 1.60 |
| Complications of treatment with MCCMS-DRG 919, medical | 17 | $75,912 | $11,071 | $14,347 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 12 | $149,488 | $21,694 | $28,253 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 12 | $64,990 | $12,440 | $12,283 | 2.00 |
Other35 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Single level combined anterior and posterior spinal fusion except cervicalMS-DRG 402 | 12 | $210,395 | $24,766 | $39,765 | |
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 12 | $200,004 | $30,126 | $37,801 | 4.74 |
| Single level spinal fusion except cervical without MCCMS-DRG 451 | 11 | $174,171 | $21,264 | $32,918 |
Male reproductive system24 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Transurethral prostatectomy with cc/mccMS-DRG 713, surgical | 13 | $51,791 | $7,371 | $9,788 | 1.45 |
| Major male pelvic procedures with cc/mccMS-DRG 707, surgical | 11 | $94,799 | $10,034 | $17,917 | 1.96 |
Factors influencing health status20 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 | 20 | $42,577 | $4,470 | $8,047 | 0.80 |
Blood cancers and poorly differentiated neoplasms18 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 18 | $63,657 | $8,009 | $12,031 | 1.21 |
Alcohol and drug use15 discharges in 1 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 | 15 | $36,038 | $5,110 | $6,811 | 0.86 |
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 |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 992 | 927 | $24,730 | $2,030 | $2,090 |
| Level 2 Upper GI ProceduresAPC 5302 | 364 | 331 | $14,906 | $1,415 | $1,445 |
| Level 1 Endovascular ProceduresAPC 5191 | 340 | 332 | $26,204 | $2,194 | $2,208 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 286 | 273 | $12,437 | $1,201 | $1,220 |
| Level 2 Urology and Related ServicesAPC 5372 | 257 | 147 | $5,545 | $360 | $502 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 249 | 239 | $61,897 | $10,556 | $10,772 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 183 | 181 | $40,835 | $4,293 | $4,358 |
| Level 5 Urology and Related ServicesAPC 5375 | 171 | 159 | $35,932 | $3,837 | $3,918 |
| Level 3 Endovascular ProceduresAPC 5193 | 167 | 151 | $77,083 | $8,696 | $8,874 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 166 | 163 | $176,861 | $20,600 | $21,117 |
| Level 3 Vascular ProceduresAPC 5183 | 163 | 155 | $21,776 | $2,379 | $2,405 |
| Level 4 Urology and Related ServicesAPC 5374 | 127 | 103 | $25,212 | $2,613 | $2,629 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 104 | 102 | $48,312 | $5,351 | $5,339 |
| Level 4 Airway EndoscopyAPC 5154 | 103 | 101 | $29,235 | $2,748 | $2,833 |
| Level 1 Nerve ProceduresAPC 5431 | 102 | 89 | $10,664 | $1,449 | $1,407 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 78 | 75 | $24,397 | $2,882 | $2,930 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 77 | 77 | $65,583 | $8,495 | $8,569 |
| Level 3 Urology and Related ServicesAPC 5373 | 73 | 42 | $16,688 | $1,518 | $1,516 |
| Level 5 Airway EndoscopyAPC 5155 | 70 | 69 | $46,250 | $5,096 | $5,183 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 69 | 67 | $26,391 | $2,017 | $2,141 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 65 | 65 | $41,007 | $4,804 | $4,982 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 61 | 61 | $130,633 | $15,494 | $15,763 |
| Level 4 Gynecologic ProceduresAPC 5414 | 57 | 57 | $17,432 | $2,280 | $2,389 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 55 | 55 | $53,939 | $6,303 | $6,514 |
| Level 4 Endovascular ProceduresAPC 5194 | 54 | 53 | $111,884 | $14,973 | $14,606 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 53 | 51 | $15,474 | $1,185 | $1,196 |
| Level 5 ENT ProceduresAPC 5165 | 50 | 49 | $32,044 | $4,332 | $4,436 |
| Level 2 Vascular ProceduresAPC 5182 | 48 | 46 | $7,221 | $1,182 | $1,204 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 47 | 45 | $20,542 | $2,446 | $2,373 |
| Level 2 Endovascular ProceduresAPC 5192 | 47 | 42 | $55,093 | $4,320 | $4,338 |
| Level 3 Upper GI ProceduresAPC 5303 | 46 | 44 | $24,652 | $2,834 | $2,888 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 43 | 41 | $26,436 | $2,603 | $2,636 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 41 | 41 | $184,126 | $29,504 | $29,375 |
| Level 3 Lower GI ProceduresAPC 5313 | 37 | 35 | $20,556 | $2,105 | $2,176 |
| Level 4 Vascular ProceduresAPC 5184 | 34 | 34 | $53,000 | $4,151 | $3,946 |
| Complex GI ProceduresAPC 5331 | 34 | 25 | $43,055 | $4,309 | $4,263 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 34 | 34 | $67,513 | $8,127 | $8,164 |
| Level 1 Intraocular ProceduresAPC 5491 | 29 | 18 | $18,169 | $1,702 | $1,752 |
| Level 5 Gynecologic ProceduresAPC 5415 | 27 | 27 | $29,360 | $3,492 | $3,792 |
| Level 3 Airway EndoscopyAPC 5153 | 24 | 24 | $14,487 | $1,284 | $1,264 |
| Level 4 ENT ProceduresAPC 5164 | 19 | 19 | $20,169 | $2,327 | $2,217 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 16 | 16 | $146,804 | $16,825 | $17,052 |
| Level 6 Gynecologic ProceduresAPC 5416 | 14 | 14 | $34,892 | $5,716 | $5,836 |
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.