Lahey Clinic Hospital Inc. Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Lahey Clinic Hospital Inc., Burlington, MA in 2024, from traditional Medicare claims. Back to the Lahey Clinic Hospital Inc. profile, with quality ratings, finances and negotiated rates.
7,899
Medicare inpatient discharges
In 186 published DRGs
2.19
Case mix index
IPPS FY 2027
29%
Surgical stays
76%
Stays with complications
In DRGs with a CC or MCC
11,317
Medicare outpatient services
In 56 service groups
Inpatient stays by major diagnostic category
Circulatory system1,830 discharges in 34 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 381 | $25,717 | $11,447 | $11,933 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 133 | $35,402 | $14,253 | $16,426 | 1.59 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 117 | $16,137 | $5,724 | $7,487 | 0.74 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 102 | $96,104 | $44,863 | $44,592 | 4.88 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 100 | $69,518 | $29,152 | $32,256 | 3.24 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 78 | $116,434 | $58,312 | $54,026 | 6.25 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 77 | $68,136 | $15,505 | $31,615 | 1.82 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 63 | $109,056 | $66,179 | $50,602 | 7.71 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 60 | $27,870 | $7,738 | $12,932 | 0.91 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 60 | $49,358 | $19,601 | $22,902 | 2.16 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 60 | $42,264 | $18,931 | $19,610 | 2.09 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 55 | $20,708 | $10,043 | $9,608 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 49 | $90,559 | $26,134 | $42,019 | 2.87 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 44 | $12,478 | $3,678 | $5,790 | 0.55 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 37 | $78,724 | $45,678 | $36,528 | 5.88 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 36 | $71,820 | $31,724 | $33,324 | 3.46 |
| Syncope and collapseMS-DRG 312, medical | 35 | $22,830 | $7,218 | $10,593 | 0.86 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 34 | $99,832 | $46,094 | $46,322 | 5.06 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 34 | $30,043 | $8,661 | $13,940 | 1.08 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 29 | $117,254 | $58,670 | $54,406 | 7.80 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 29 | $62,917 | $21,540 | $29,194 | 2.28 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 25 | $23,103 | $14,513 | $10,720 | 1.58 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 22 | $48,026 | $17,969 | $22,284 | 1.97 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 20 | $18,663 | $8,219 | $8,660 | 0.97 |
| Other vascular procedures with CCMS-DRG 253, surgical | 19 | $48,649 | $21,471 | $22,573 | 2.55 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 18 | $104,495 | $37,273 | $48,486 | 3.35 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 18 | $20,393 | $9,569 | $9,462 | 1.07 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 16 | $95,332 | $38,752 | $44,234 | 3.90 |
| Cardiac defibrillator implant with cardiac catheterization and MCCMS-DRG 275, surgical | 14 | $215,799 | $77,424 | $100,131 | 7.04 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 14 | $23,195 | $5,603 | $10,762 | 0.72 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 14 | $103,034 | $29,848 | $47,808 | 2.97 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 13 | $56,493 | $16,836 | $26,213 | 1.83 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 13 | $96,159 | $39,625 | $44,618 | 4.14 |
| Atherosclerosis without MCCMS-DRG 303, medical | 11 | $14,516 | $5,818 | $6,735 | 0.66 |
Infectious and parasitic diseases1,159 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 | 819 | $38,279 | $17,672 | $17,761 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 127 | $105,827 | $47,272 | $49,104 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 123 | $20,656 | $8,580 | $9,584 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 46 | $159,254 | $64,853 | $73,894 | 6.96 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 20 | $40,242 | $17,865 | $18,672 | 2.04 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 12 | $45,128 | $17,098 | $20,940 | 1.84 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 12 | $18,215 | $9,048 | $8,452 | 1.01 |
Digestive system903 discharges in 24 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 | 103 | $16,082 | $6,141 | $7,462 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 97 | $23,673 | $8,373 | $10,984 | 0.98 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 91 | $68,924 | $37,945 | $31,981 | 4.52 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 82 | $40,915 | $19,974 | $18,985 | 2.37 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 64 | $17,587 | $8,258 | $8,160 | 0.94 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 60 | $16,144 | $6,448 | $7,491 | 0.80 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 58 | $52,169 | $17,746 | $24,207 | 1.79 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 49 | $40,434 | $16,693 | $18,761 | 1.62 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 40 | $34,424 | $13,706 | $15,973 | 1.28 |
| Digestive malignancy with MCCMS-DRG 374, medical | 29 | $32,536 | $18,635 | $15,097 | 2.10 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 27 | $123,443 | $48,673 | $57,278 | 5.08 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 25 | $10,857 | $3,722 | $5,037 | 0.56 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 19 | $30,487 | $13,077 | $14,146 | 1.72 |
| Digestive malignancy with CCMS-DRG 375, medical | 19 | $34,818 | $10,020 | $16,156 | 1.20 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 17 | $28,257 | $13,146 | $13,111 | 1.67 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 17 | $41,070 | $17,161 | $19,056 | 2.11 |
| Inflammatory bowel disease with CCMS-DRG 386, medical | 17 | $16,211 | $7,405 | $7,522 | 0.97 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 14 | $19,709 | $9,425 | $9,145 | 1.04 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 13 | $31,221 | $22,174 | $14,487 | 2.50 |
| Peritoneal adhesiolysis with MCCMS-DRG 335, surgical | 13 | $43,318 | $28,552 | $20,100 | 3.58 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 13 | $28,568 | $13,244 | $13,255 | 1.45 |
| Other digestive system diagnoses without cc/mccMS-DRG 395, medical | 13 | $11,428 | $5,007 | $5,303 | 0.65 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 12 | $21,501 | $14,139 | $9,976 | 1.60 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 11 | $22,585 | $12,419 | $10,479 | 1.36 |
Respiratory system881 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 | 203 | $30,607 | $14,795 | $14,202 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 126 | $22,943 | $11,007 | $10,645 | 1.23 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 90 | $23,879 | $11,287 | $11,080 | 1.33 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 51 | $21,571 | $8,334 | $10,009 | 0.99 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 45 | $33,091 | $11,892 | $15,354 | 1.40 |
| Major chest procedures with MCCMS-DRG 163, surgical | 43 | $81,188 | $41,590 | $37,671 | 4.71 |
| Major chest procedures with CCMS-DRG 164, surgical | 40 | $43,947 | $19,372 | $20,391 | 2.55 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 38 | $16,831 | $6,569 | $7,809 | 0.82 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 26 | $18,668 | $6,265 | $8,662 | 0.82 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 24 | $38,106 | $15,647 | $17,681 | 1.74 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 24 | $31,352 | $15,405 | $14,547 | 1.90 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 23 | $63,783 | $25,297 | $29,596 | 2.70 |
| Major chest trauma with CCMS-DRG 184, medical | 21 | $26,031 | $9,433 | $12,078 | 1.05 |
| Major chest trauma with MCCMS-DRG 183, medical | 19 | $30,846 | $14,378 | $14,312 | 1.57 |
| Pneumothorax with MCCMS-DRG 199, medical | 18 | $41,119 | $14,454 | $19,079 | 1.77 |
| Pneumothorax with CCMS-DRG 200, medical | 18 | $22,637 | $8,737 | $10,503 | 1.08 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 17 | $30,959 | $15,603 | $14,365 | 1.88 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 16 | $20,413 | $9,639 | $9,472 | 1.10 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 15 | $17,034 | $7,849 | $7,904 | 0.96 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 12 | $16,014 | $7,660 | $7,430 | 0.85 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 12 | $15,987 | $7,799 | $7,418 | 0.91 |
Musculoskeletal system and connective tissue783 discharges in 26 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 | 79 | $32,856 | $15,733 | $15,245 | 1.88 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 76 | $42,320 | $18,614 | $19,636 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 65 | $23,019 | $7,962 | $10,681 | 0.97 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 54 | $65,174 | $26,574 | $30,241 | 2.95 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 40 | $42,258 | $18,762 | $19,608 | 2.11 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 38 | $25,894 | $8,991 | $12,015 | 1.09 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 33 | $73,823 | $56,252 | $34,254 | 6.12 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 32 | $31,840 | $15,014 | $14,774 | 1.82 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 31 | $19,207 | $7,363 | $8,912 | 0.90 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 29 | $71,798 | $27,976 | $33,314 | 2.99 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 28 | $49,412 | $18,520 | $22,927 | 2.04 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 27 | $58,977 | $30,372 | $27,365 | 3.66 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 27 | $46,952 | $22,457 | $21,786 | 2.48 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 25 | $30,318 | $17,170 | $14,068 | 1.97 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 24 | $47,135 | $22,034 | $21,870 | 2.40 |
| Medical back problems with MCCMS-DRG 551, medical | 22 | $35,762 | $15,498 | $16,594 | 1.70 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 20 | $52,203 | $23,230 | $24,222 | 2.96 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 19 | $57,061 | $27,084 | $26,476 | 3.49 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 18 | $58,202 | $35,990 | $27,006 | 4.61 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 17 | $14,013 | $6,974 | $6,502 | 0.82 |
| Lower extremity and humerus procedures except hip, foot and femur with MCCMS-DRG 492, surgical | 16 | $103,304 | $42,463 | $47,933 | 3.46 |
| Other musculoskeletal system and connective tissue o.r. procedures with MCCMS-DRG 515, surgical | 14 | $66,687 | $23,370 | $30,943 | 3.16 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 13 | $47,104 | $27,826 | $21,856 | 3.33 |
| Fractures of hip and pelvis with MCCMS-DRG 535, medical | 13 | $28,841 | $11,496 | $13,382 | 1.30 |
| Combined anterior and posterior spinal fusion with MCCMS-DRG 453, surgical | 12 | $119,080 | $84,831 | $55,253 | 8.86 |
| Back and neck procedures except spinal fusion without cc/mccMS-DRG 520, surgical | 11 | $35,962 | $10,474 | $16,686 | 1.43 |
Nervous system704 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 132 | $42,382 | $17,585 | $19,665 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 75 | $24,408 | $8,366 | $11,325 | 1.02 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 62 | $104,081 | $36,233 | $48,294 | 4.42 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 54 | $27,699 | $11,007 | $12,852 | 1.36 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 48 | $46,494 | $17,408 | $21,573 | 1.79 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 41 | $20,781 | $9,203 | $9,642 | 1.03 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 35 | $49,187 | $22,179 | $22,823 | 2.28 |
| Seizures with MCCMS-DRG 100, medical | 29 | $66,382 | $23,615 | $30,801 | 1.98 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 27 | $128,659 | $55,920 | $59,698 | 5.67 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 27 | $34,070 | $20,569 | $15,808 | 2.39 |
| Seizures without MCCMS-DRG 101, medical | 25 | $20,782 | $7,198 | $9,643 | 0.91 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 23 | $47,383 | $18,543 | $21,986 | 1.36 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 21 | $29,759 | $15,141 | $13,808 | 1.79 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 18 | $24,197 | $8,910 | $11,227 | 1.03 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 17 | $49,933 | $19,379 | $23,169 | 2.27 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 16 | $26,329 | $9,018 | $12,217 | 1.06 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 15 | $29,163 | $11,543 | $13,532 | 1.32 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 14 | $51,578 | $21,249 | $23,932 | 2.43 |
| Extracranial procedures with CCMS-DRG 038, surgical | 13 | $31,093 | $14,748 | $14,427 | 1.60 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 12 | $20,603 | $4,611 | $9,560 | 0.69 |
Kidney and urinary tract646 discharges in 14 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 122 | $30,761 | $14,092 | $14,273 | 1.65 |
| Renal failure with CCMS-DRG 683, medical | 118 | $19,294 | $7,232 | $8,952 | 0.90 |
| Renal failure with MCCMS-DRG 682, medical | 91 | $33,725 | $13,221 | $15,649 | 1.50 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 64 | $21,725 | $10,000 | $10,080 | 1.17 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 58 | $23,491 | $8,932 | $10,900 | 1.02 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 51 | $16,468 | $6,311 | $7,641 | 0.81 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 24 | $35,666 | $15,841 | $16,549 | 1.84 |
| Kidney transplantMS-DRG 652, surgical | 23 | $206,378 | $28,748 | $95,759 | 3.00 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 22 | $33,473 | $11,015 | $15,532 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 18 | $80,316 | $36,982 | $37,267 | 3.70 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 17 | $66,956 | $24,284 | $31,068 | 2.59 |
| Major bladder procedures with CCMS-DRG 654, surgical | 15 | $65,549 | $25,597 | $30,415 | 2.74 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 12 | $29,196 | $9,620 | $13,547 | 1.48 |
| Kidney and ureter procedures for neoplasm with MCCMS-DRG 656, surgical | 11 | $46,271 | $26,865 | $21,470 | 3.14 |
Endocrine, nutritional and metabolic224 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 with MCCMS-DRG 640, medical | 57 | $27,697 | $11,439 | $12,852 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 56 | $17,987 | $6,442 | $8,346 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 40 | $18,539 | $7,621 | $8,602 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 34 | $38,400 | $12,954 | $17,818 | 1.45 |
| Endocrine disorders with CCMS-DRG 644, medical | 19 | $25,141 | $8,892 | $11,665 | 1.06 |
| Endocrine disorders with MCCMS-DRG 643, medical | 18 | $27,270 | $13,139 | $12,653 | 1.65 |
Liver, gallbladder and pancreas221 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 | 45 | $54,636 | $19,866 | $25,351 | 1.83 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 38 | $26,619 | $9,641 | $12,351 | 1.09 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 28 | $61,936 | $19,683 | $28,738 | 1.92 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 25 | $38,276 | $13,603 | $17,760 | 1.63 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 22 | $18,221 | $6,452 | $8,454 | 0.86 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 21 | $50,294 | $15,664 | $23,336 | 1.63 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 16 | $87,418 | $51,444 | $40,562 | 5.51 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 15 | $52,004 | $15,586 | $24,130 | 1.76 |
| Disorders of the biliary tract without cc/mccMS-DRG 446, medical | 11 | $25,159 | $5,643 | $11,674 | 0.80 |
Blood and immune system132 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 50 | $32,484 | $13,100 | $15,072 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 43 | $24,354 | $7,388 | $11,300 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 15 | $53,847 | $15,599 | $24,985 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 12 | $55,909 | $23,305 | $25,942 | 2.19 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 12 | $23,060 | $11,277 | $10,700 | 1.20 |
Injuries, poisonings and toxic effects of drugs102 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 | 29 | $45,998 | $15,554 | $21,343 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 23 | $23,526 | $8,622 | $10,916 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 21 | $46,542 | $17,116 | $21,596 | 1.60 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 17 | $79,997 | $36,487 | $37,119 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 12 | $30,222 | $15,961 | $14,023 | 2.00 |
Skin, subcutaneous tissue and breast84 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 54 | $17,331 | $6,832 | $8,042 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 18 | $20,117 | $12,715 | $9,334 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 12 | $14,657 | $7,681 | $6,801 | 0.91 |
Other69 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 | 38 | $113,559 | $49,201 | $52,691 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 19 | $54,845 | $20,417 | $25,448 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 12 | $82,912 | $33,837 | $38,471 | 3.38 |
Mental diseases and disorders44 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 33 | $32,909 | $14,768 | $15,270 | 1.76 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 11 | $24,337 | $7,540 | $11,293 | 0.95 |
Transplants, ECMO and tracheostomy (pre-MDC)44 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 27 | $391,564 | $101,575 | $181,685 | 10.35 |
| ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and necMS-DRG 003, surgical | 17 | $523,254 | $208,717 | $242,790 | 21.32 |
Multiple significant trauma31 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other multiple significant trauma with MCCMS-DRG 963, medical | 16 | $80,559 | $31,040 | $37,379 | 2.73 |
| Other multiple significant trauma with CCMS-DRG 964, medical | 15 | $36,112 | $13,509 | $16,756 | 1.50 |
Factors influencing health status16 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 | 16 | $18,596 | $6,020 | $8,629 | 0.80 |
Alcohol and drug use14 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 | 14 | $19,291 | $7,632 | $8,951 | 0.86 |
Blood cancers and poorly differentiated neoplasms12 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 12 | $96,396 | $37,496 | $44,728 | 3.13 |
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 Urology and Related ServicesAPC 5372 | 1,577 | 1,051 | $2,898 | $580 | $502 |
| Level 1 Intraocular ProceduresAPC 5491 | 1,526 | 1,022 | $4,319 | $1,990 | $1,752 |
| Level 3 Urology and Related ServicesAPC 5373 | 907 | 621 | $5,386 | $1,726 | $1,516 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 725 | 662 | $4,852 | $1,378 | $1,220 |
| Level 1 Nerve ProceduresAPC 5431 | 518 | 472 | $10,458 | $1,632 | $1,407 |
| Level 2 Upper GI ProceduresAPC 5302 | 494 | 431 | $8,223 | $1,606 | $1,445 |
| Level 1 Endovascular ProceduresAPC 5191 | 423 | 417 | $12,806 | $2,492 | $2,208 |
| Comprehensive Observation ServicesAPC 8011 | 380 | 371 | $13,065 | $2,287 | $2,090 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 359 | 349 | $79,946 | $23,389 | $21,117 |
| Level 5 Urology and Related ServicesAPC 5375 | 281 | 263 | $13,394 | $4,374 | $3,918 |
| Level 4 Urology and Related ServicesAPC 5374 | 269 | 227 | $9,677 | $2,960 | $2,629 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 262 | 249 | $8,817 | $2,385 | $2,141 |
| Level 3 Vascular ProceduresAPC 5183 | 243 | 221 | $8,307 | $2,693 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 210 | 203 | $19,482 | $6,122 | $5,339 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 199 | 195 | $22,587 | $12,291 | $10,772 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 193 | 174 | $8,454 | $2,960 | $2,636 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 171 | 166 | $5,289 | $1,363 | $1,196 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 170 | 164 | $8,171 | $2,721 | $2,373 |
| Level 2 Intraocular ProceduresAPC 5492 | 163 | 153 | $8,006 | $3,402 | $3,116 |
| Level 4 Airway EndoscopyAPC 5154 | 150 | 140 | $16,399 | $3,172 | $2,833 |
| Level 3 Lower GI ProceduresAPC 5313 | 142 | 137 | $9,337 | $2,446 | $2,176 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 138 | 137 | $12,720 | $4,848 | $4,358 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 136 | 130 | $4,230 | $2,000 | $1,780 |
| Level 3 Airway EndoscopyAPC 5153 | 116 | 99 | $5,888 | $1,452 | $1,264 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 105 | 105 | $46,854 | $9,822 | $8,569 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 100 | 98 | $22,452 | $9,175 | $8,164 |
| Level 3 Intraocular ProceduresAPC 5493 | 100 | 73 | $9,077 | $4,472 | $4,004 |
| Level 3 Endovascular ProceduresAPC 5193 | 94 | 89 | $43,777 | $10,167 | $8,874 |
| Level 4 Vascular ProceduresAPC 5184 | 91 | 64 | $21,084 | $3,462 | $3,946 |
| Level 2 Vascular ProceduresAPC 5182 | 86 | 73 | $4,236 | $1,357 | $1,204 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 82 | 76 | $10,531 | $3,262 | $2,930 |
| Level 5 Airway EndoscopyAPC 5155 | 76 | 75 | $26,161 | $5,857 | $5,183 |
| Level 3 Upper GI ProceduresAPC 5303 | 65 | 60 | $18,700 | $3,226 | $2,888 |
| Level 4 Gynecologic ProceduresAPC 5414 | 64 | 62 | $6,606 | $2,675 | $2,389 |
| Level 8 Urology and Related ServicesAPC 5378 | 62 | 59 | $42,049 | $19,976 | $17,428 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 61 | 61 | $37,277 | $7,481 | $6,514 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 59 | 58 | $15,925 | $5,580 | $4,982 |
| Level 5 ENT ProceduresAPC 5165 | 58 | 57 | $13,381 | $4,838 | $4,436 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 57 | 57 | $134,532 | $33,589 | $29,375 |
| Complex GI ProceduresAPC 5331 | 50 | 43 | $22,802 | $4,584 | $4,263 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 41 | 41 | $31,825 | $18,334 | $15,763 |
| Level 3 ENT ProceduresAPC 5163 | 36 | 25 | $7,999 | $1,305 | $1,106 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 33 | 32 | $38,348 | $21,799 | $18,465 |
| Level 6 Urology and Related ServicesAPC 5376 | 31 | 31 | $17,594 | $8,254 | $7,291 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 31 | 29 | $20,556 | $5,475 | $4,524 |
| Level 2 Endovascular ProceduresAPC 5192 | 28 | 26 | $20,034 | $4,716 | $4,338 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 24 | 24 | $76,704 | $19,242 | $17,052 |
| Level 4 Endovascular ProceduresAPC 5194 | 21 | 21 | $70,467 | $17,156 | $14,606 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 19 | 19 | $58,937 | $31,614 | $26,719 |
| Level 4 ENT ProceduresAPC 5164 | 16 | 14 | $7,042 | $2,669 | $2,217 |
| Level 5 Gynecologic ProceduresAPC 5415 | 15 | 15 | $11,003 | $4,256 | $3,792 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 13 | 13 | $24,698 | $5,899 | $5,682 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 13 | 13 | $100,757 | $21,796 | $21,011 |
| Cochlear Implant ProcedureAPC 5166 | 12 | 12 | $63,645 | $34,269 | $29,489 |
| Level 2 Nerve ProceduresAPC 5432 | 11 | $10,861 | $3,627 | $4,674 | |
| Level 7 Radiation TherapyAPC 5627 | 11 | $28,556 | $6,730 | $6,121 |
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.