Hoag Memorial Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Hoag Memorial Hospital, Newport Beach, CA in 2024, from traditional Medicare claims. Back to the Hoag Memorial Hospital profile, with quality ratings, finances and negotiated rates.
8,303
Medicare inpatient discharges
In 175 published DRGs
1.86
Case mix index
IPPS FY 2027
24%
Surgical stays
72%
Stays with complications
In DRGs with a CC or MCC
7,670
Medicare outpatient services
In 47 service groups
Inpatient stays by major diagnostic category
Infectious and parasitic diseases1,537 discharges in 8 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 | 1,082 | $82,100 | $16,272 | $25,123 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 235 | $45,733 | $8,317 | $13,994 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 106 | $224,053 | $45,215 | $68,560 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 34 | $70,267 | $16,111 | $21,502 | 2.04 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 23 | $45,382 | $7,808 | $13,887 | 0.88 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 22 | $106,178 | $17,015 | $32,490 | 1.84 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 18 | $228,247 | $51,289 | $69,843 | 6.96 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 17 | $36,080 | $7,395 | $11,040 | 1.01 |
Circulatory system1,344 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 | 341 | $55,678 | $10,598 | $17,038 | 1.28 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 71 | $157,196 | $43,968 | $48,102 | 4.88 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 62 | $84,137 | $15,135 | $25,746 | 1.82 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 59 | $82,236 | $18,107 | $25,164 | 2.09 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 56 | $39,340 | $6,157 | $12,038 | 0.74 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 55 | $134,966 | $24,024 | $41,299 | 2.87 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 52 | $67,394 | $13,714 | $20,623 | 1.59 |
| Syncope and collapseMS-DRG 312, medical | 52 | $39,233 | $7,199 | $12,005 | 0.86 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 48 | $102,596 | $28,227 | $31,394 | 3.24 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 43 | $49,847 | $8,970 | $15,253 | 1.07 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 36 | $229,541 | $35,382 | $70,240 | 4.04 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 31 | $85,974 | $20,368 | $26,308 | 2.28 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 31 | $45,875 | $9,983 | $14,038 | 1.20 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 29 | $448,671 | $83,405 | $137,293 | 7.71 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 28 | $75,075 | $14,350 | $22,973 | 1.58 |
| Heart failure and shock with CCMS-DRG 292, medical | 26 | $41,912 | $7,105 | $12,825 | 0.86 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 25 | $318,107 | $49,070 | $97,341 | 5.24 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 24 | $152,242 | $31,660 | $46,586 | 3.46 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 23 | $99,493 | $19,952 | $30,445 | 2.16 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 22 | $135,936 | $29,466 | $41,596 | 3.18 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 22 | $265,637 | $42,364 | $81,285 | 5.20 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 22 | $173,725 | $33,257 | $53,160 | 3.35 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 22 | $197,571 | $46,596 | $60,457 | 5.06 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 20 | $124,955 | $28,989 | $38,236 | 3.46 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 20 | $58,629 | $7,980 | $17,941 | 0.97 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 19 | $40,872 | $7,567 | $12,507 | 0.91 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 19 | $36,056 | $4,376 | $11,033 | 0.55 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 18 | $59,471 | $9,163 | $18,198 | 1.08 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 17 | $65,799 | $15,909 | $20,135 | 1.83 |
| Hypertension without MCCMS-DRG 305, medical | 14 | $35,481 | $6,118 | $10,857 | 0.75 |
| Other vascular procedures with CCMS-DRG 253, surgical | 13 | $106,355 | $23,142 | $32,544 | 2.55 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 12 | $365,711 | $70,212 | $111,908 | 7.80 |
| Chest painMS-DRG 313, medical | 12 | $47,670 | $5,805 | $14,587 | 0.72 |
Digestive system1,146 discharges in 25 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 162 | $43,762 | $8,271 | $13,391 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 156 | $39,767 | $6,060 | $12,169 | 0.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 103 | $157,299 | $20,734 | $48,133 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 82 | $81,167 | $15,137 | $24,837 | 1.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 77 | $36,742 | $6,433 | $11,243 | 0.80 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 73 | $44,480 | $7,748 | $13,611 | 0.94 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 51 | $262,718 | $45,441 | $80,392 | 4.52 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 51 | $51,605 | $8,646 | $15,791 | 1.04 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 49 | $57,984 | $11,178 | $17,743 | 1.28 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 40 | $69,630 | $14,201 | $21,307 | 1.62 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 37 | $139,215 | $14,291 | $42,600 | 1.67 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 37 | $27,928 | $3,824 | $8,546 | 0.56 |
| Digestive malignancy with CCMS-DRG 375, medical | 26 | $61,350 | $10,190 | $18,773 | 1.20 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 26 | $78,076 | $12,316 | $23,891 | 1.45 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 22 | $112,204 | $19,876 | $34,335 | 2.50 |
| Digestive malignancy with MCCMS-DRG 374, medical | 19 | $100,151 | $16,974 | $30,646 | 2.10 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 18 | $194,895 | $46,487 | $59,638 | 5.08 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 18 | $110,536 | $17,259 | $33,824 | 1.75 |
| Complicated peptic ulcer with CCMS-DRG 381, medical | 18 | $49,980 | $9,134 | $15,294 | 1.07 |
| Peritoneal adhesiolysis with MCCMS-DRG 335, surgical | 16 | $183,263 | $34,683 | $56,079 | 3.58 |
| Other digestive system o.r. procedures with CCMS-DRG 357, surgical | 16 | $90,576 | $18,603 | $27,716 | 2.20 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 13 | $94,464 | $13,589 | $28,906 | 1.60 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 12 | $135,614 | $18,907 | $41,498 | 2.11 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 12 | $233,166 | $40,551 | $71,349 | 4.28 |
| Gastrointestinal hemorrhage without cc/mccMS-DRG 379, medical | 12 | $30,888 | $4,957 | $9,452 | 0.63 |
Respiratory system1,055 discharges in 21 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 269 | $80,340 | $13,898 | $24,584 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 135 | $70,271 | $11,491 | $21,503 | 1.33 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 94 | $45,357 | $6,534 | $13,879 | 0.82 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 87 | $44,347 | $7,953 | $13,570 | 0.99 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 79 | $56,095 | $10,852 | $17,165 | 1.23 |
| Major chest procedures with CCMS-DRG 164, surgical | 50 | $132,544 | $21,404 | $40,558 | 2.55 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 40 | $142,851 | $26,540 | $43,712 | 2.70 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 32 | $54,504 | $8,969 | $16,678 | 1.10 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 30 | $59,119 | $11,100 | $18,090 | 1.40 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 29 | $112,544 | $15,796 | $34,439 | 1.88 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 27 | $43,280 | $6,888 | $13,244 | 0.82 |
| Major chest procedures with MCCMS-DRG 163, surgical | 26 | $169,656 | $37,715 | $51,915 | 4.71 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 25 | $85,677 | $15,211 | $26,217 | 1.90 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 24 | $91,556 | $15,788 | $28,016 | 1.74 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 24 | $55,437 | $8,228 | $16,964 | 0.96 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 21 | $40,348 | $7,152 | $12,347 | 0.85 |
| Respiratory neoplasms with CCMS-DRG 181, medical | 14 | $60,839 | $9,901 | $18,617 | 1.10 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 14 | $72,530 | $14,826 | $22,194 | 1.81 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 13 | $28,461 | $3,952 | $8,709 | 0.63 |
| Pneumothorax with CCMS-DRG 200, medical | 11 | $49,328 | $8,533 | $15,095 | 1.08 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 11 | $40,864 | $7,871 | $12,504 | 0.91 |
Kidney and urinary tract802 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 157 | $35,136 | $6,538 | $10,752 | 0.81 |
| Renal failure with CCMS-DRG 683, medical | 153 | $39,992 | $7,424 | $12,238 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 136 | $61,407 | $13,308 | $18,791 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 99 | $66,591 | $12,206 | $20,377 | 1.50 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 88 | $44,884 | $9,473 | $13,735 | 1.17 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 83 | $33,262 | $8,221 | $10,178 | 1.02 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 34 | $65,178 | $11,680 | $19,945 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 22 | $131,721 | $35,220 | $40,307 | 3.70 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 16 | $125,572 | $12,064 | $38,425 | 1.48 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 14 | $86,500 | $21,586 | $26,469 | 2.38 |
Nervous system675 discharges in 23 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 | 87 | $49,548 | $8,515 | $15,162 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 84 | $82,246 | $16,197 | $25,167 | 2.00 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 58 | $186,785 | $35,445 | $57,156 | 4.42 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 45 | $117,637 | $22,551 | $35,997 | 2.43 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 34 | $44,337 | $5,026 | $13,567 | 0.69 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 34 | $44,388 | $6,339 | $13,583 | 0.80 |
| Seizures without MCCMS-DRG 101, medical | 34 | $32,885 | $7,355 | $10,063 | 0.91 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 33 | $115,695 | $24,671 | $35,403 | 2.95 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 29 | $207,757 | $32,981 | $63,574 | 3.79 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 28 | $50,230 | $10,952 | $15,370 | 1.36 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 24 | $44,990 | $8,483 | $13,767 | 1.03 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 20 | $39,230 | $9,011 | $12,004 | 1.06 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 19 | $53,824 | $11,317 | $16,470 | 1.32 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 18 | $63,560 | $20,953 | $19,449 | 2.28 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 17 | $225,327 | $48,749 | $68,950 | 5.67 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 17 | $71,275 | $13,983 | $21,810 | 1.79 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 16 | $50,814 | $12,756 | $15,549 | 1.47 |
| Seizures with MCCMS-DRG 100, medical | 15 | $76,956 | $17,645 | $23,549 | 1.98 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 14 | $58,923 | $9,764 | $18,030 | 1.14 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 13 | $93,048 | $13,172 | $28,473 | 1.51 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 13 | $60,353 | $10,881 | $18,468 | 1.36 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 12 | $81,466 | $14,658 | $24,929 | 1.79 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 11 | $75,813 | $16,177 | $23,199 | 1.81 |
Musculoskeletal system and connective tissue545 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 111 | $82,186 | $18,018 | $25,149 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 65 | $36,952 | $8,090 | $11,307 | 0.97 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 61 | $94,405 | $18,220 | $28,888 | 2.11 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 41 | $33,640 | $6,412 | $10,294 | 0.79 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 38 | $70,516 | $13,770 | $21,578 | 1.59 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 32 | $38,020 | $7,535 | $11,634 | 0.90 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 27 | $149,022 | $26,663 | $45,601 | 2.96 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 27 | $101,501 | $24,101 | $31,059 | 2.95 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 20 | $369,856 | $61,214 | $113,176 | 6.12 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 20 | $129,261 | $31,169 | $39,554 | 3.66 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 19 | $93,875 | $17,940 | $28,726 | 2.04 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 19 | $42,515 | $9,031 | $13,009 | 1.09 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 17 | $102,406 | $20,038 | $31,336 | 2.38 |
| Aftercare, musculoskeletal system and connective tissue with CCMS-DRG 560, medical | 17 | $42,639 | $9,409 | $13,048 | 1.13 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 16 | $123,518 | $25,469 | $37,797 | 2.99 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 15 | $80,843 | $19,307 | $24,738 | 2.40 |
Endocrine, nutritional and metabolic326 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 | 99 | $33,435 | $6,142 | $10,231 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 87 | $53,672 | $11,420 | $16,424 | 1.32 |
| Endocrine disorders with CCMS-DRG 644, medical | 54 | $40,885 | $8,753 | $12,511 | 1.06 |
| Endocrine disorders with MCCMS-DRG 643, medical | 42 | $46,639 | $11,499 | $14,272 | 1.65 |
| Diabetes with CCMS-DRG 638, medical | 28 | $40,434 | $7,681 | $12,373 | 0.90 |
| Endocrine disorders without cc/mccMS-DRG 645, medical | 16 | $24,870 | $5,487 | $7,610 | 0.76 |
Liver, gallbladder and pancreas317 discharges in 12 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 52 | $101,848 | $14,104 | $31,165 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 37 | $57,310 | $9,360 | $17,537 | 1.09 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 33 | $82,327 | $14,899 | $25,192 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 31 | $82,423 | $10,694 | $25,221 | 1.31 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 29 | $75,842 | $15,222 | $23,208 | 1.76 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 27 | $133,605 | $20,727 | $40,883 | 2.32 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 22 | $224,228 | $26,977 | $68,614 | 2.89 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 20 | $81,780 | $16,340 | $25,025 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 20 | $40,476 | $8,090 | $12,386 | 0.95 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 19 | $46,002 | $6,848 | $14,077 | 0.86 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 14 | $67,584 | $13,723 | $20,681 | 1.83 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 13 | $718,601 | $128,217 | $219,892 | 5.51 |
Skin, subcutaneous tissue and breast140 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 103 | $32,975 | $7,269 | $10,090 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 20 | $55,637 | $12,318 | $17,025 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 17 | $39,954 | $7,344 | $12,226 | 0.91 |
Injuries, poisonings and toxic effects of drugs104 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 33 | $63,640 | $16,152 | $19,474 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 27 | $45,433 | $8,973 | $13,902 | 1.03 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 19 | $189,403 | $36,707 | $57,957 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 14 | $147,995 | $22,924 | $45,286 | 2.00 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 11 | $44,666 | $12,899 | $13,668 | 1.60 |
Alcohol and drug use92 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Alcohol, drug abuse or dependence with rehabilitation therapyMS-DRG 895, medical | 61 | $26,809 | $13,604 | $8,203 | 1.61 |
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 31 | $32,286 | $7,410 | $9,879 | 0.86 |
Blood and immune system91 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Coagulation disordersMS-DRG 813, medical | 31 | $73,836 | $15,164 | $22,594 | 1.56 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 22 | $44,625 | $7,971 | $13,655 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 21 | $68,520 | $12,291 | $20,967 | 1.40 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 17 | $61,112 | $10,559 | $18,700 | 1.20 |
Blood cancers and poorly differentiated neoplasms42 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 19 | $143,980 | $29,492 | $44,058 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 12 | $65,700 | $11,258 | $20,104 | 1.21 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 11 | $58,061 | $13,333 | $17,767 | 1.57 |
Factors influencing health status32 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 | 32 | $38,728 | $6,557 | $11,851 | 0.80 |
Other20 discharges in 1 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 | 20 | $221,535 | $42,594 | $67,790 | 4.74 |
Mental diseases and disorders18 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 18 | $42,887 | $13,653 | $13,123 | 1.76 |
Male reproductive system17 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Transurethral prostatectomy with cc/mccMS-DRG 713, surgical | 17 | $64,131 | $11,737 | $19,624 | 1.45 |
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 | 905 | 869 | $24,574 | $2,663 | $2,090 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 890 | 791 | $11,486 | $1,579 | $1,220 |
| Level 2 Upper GI ProceduresAPC 5302 | 660 | 566 | $9,801 | $1,855 | $1,445 |
| Level 1 Endovascular ProceduresAPC 5191 | 414 | 414 | $24,025 | $2,872 | $2,208 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 348 | 345 | $51,581 | $5,600 | $4,358 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 321 | 319 | $83,420 | $11,005 | $8,164 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 305 | 282 | $102,088 | $27,482 | $21,117 |
| Level 3 Vascular ProceduresAPC 5183 | 297 | 286 | $18,603 | $3,122 | $2,405 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 258 | 236 | $15,426 | $2,778 | $2,141 |
| Level 3 Endovascular ProceduresAPC 5193 | 251 | 233 | $68,109 | $11,871 | $8,874 |
| Level 5 Urology and Related ServicesAPC 5375 | 219 | 210 | $34,874 | $5,069 | $3,918 |
| Level 3 Urology and Related ServicesAPC 5373 | 192 | 164 | $14,603 | $1,993 | $1,516 |
| Level 4 Urology and Related ServicesAPC 5374 | 182 | 157 | $22,840 | $3,396 | $2,629 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 178 | 175 | $48,040 | $11,380 | $8,569 |
| Level 2 Vascular ProceduresAPC 5182 | 166 | 156 | $8,946 | $1,564 | $1,204 |
| Level 4 Airway EndoscopyAPC 5154 | 155 | 149 | $20,079 | $3,668 | $2,833 |
| Level 3 Airway EndoscopyAPC 5153 | 153 | 120 | $12,747 | $1,661 | $1,264 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 139 | 136 | $29,092 | $3,734 | $2,930 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 134 | 134 | $51,907 | $6,386 | $4,982 |
| Level 7 Radiation TherapyAPC 5627 | 115 | 106 | $94,028 | $7,936 | $6,121 |
| Complex GI ProceduresAPC 5331 | 102 | 76 | $28,372 | $5,528 | $4,263 |
| Level 4 Endovascular ProceduresAPC 5194 | 101 | 76 | $64,739 | $15,344 | $14,606 |
| Level 4 Vascular ProceduresAPC 5184 | 97 | 82 | $42,084 | $4,662 | $3,946 |
| Level 3 Upper GI ProceduresAPC 5303 | 84 | 77 | $19,125 | $3,732 | $2,888 |
| Level 1 Intraocular ProceduresAPC 5491 | 83 | 62 | $17,351 | $2,283 | $1,752 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 79 | 79 | $46,413 | $7,070 | $5,339 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 79 | 72 | $29,543 | $3,389 | $2,636 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 76 | 76 | $12,025 | $1,574 | $1,196 |
| Level 2 Endovascular ProceduresAPC 5192 | 73 | 71 | $44,758 | $5,598 | $4,338 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 73 | 72 | $103,520 | $22,259 | $17,052 |
| Level 3 Lower GI ProceduresAPC 5313 | 70 | 68 | $15,962 | $2,720 | $2,176 |
| Level 4 Gynecologic ProceduresAPC 5414 | 68 | 68 | $17,237 | $3,060 | $2,389 |
| Level 5 ENT ProceduresAPC 5165 | 66 | 66 | $40,807 | $5,736 | $4,436 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 49 | 49 | $141,181 | $38,353 | $29,375 |
| Level 5 Airway EndoscopyAPC 5155 | 41 | 41 | $27,494 | $6,698 | $5,183 |
| Level 6 Urology and Related ServicesAPC 5376 | 32 | 32 | $45,858 | $9,681 | $7,291 |
| Level 6 Gynecologic ProceduresAPC 5416 | 32 | 32 | $50,440 | $7,653 | $5,836 |
| Level 1 Nerve ProceduresAPC 5431 | 31 | 29 | $13,517 | $1,891 | $1,407 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 26 | 26 | $94,175 | $14,516 | $10,772 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 24 | 24 | $41,304 | $8,797 | $6,514 |
| Level 5 Gynecologic ProceduresAPC 5415 | 20 | 20 | $32,098 | $4,872 | $3,792 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 17 | 17 | $64,983 | $9,943 | $7,546 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 15 | 15 | $65,965 | $25,186 | $18,465 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 13 | 13 | $67,428 | $36,422 | $26,719 |
| Level 2 Intraocular ProceduresAPC 5492 | 13 | 12 | $31,701 | $3,968 | $3,116 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 12 | $22,373 | $3,171 | $2,373 | |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 12 | 12 | $45,878 | $7,545 | $5,682 |
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.