Santa Barbara Cottage Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Santa Barbara Cottage Hospital, Santa Barbara, CA in 2024, from traditional Medicare claims. Back to the Santa Barbara Cottage Hospital profile, with quality ratings, finances and negotiated rates.
5,582
Medicare inpatient discharges
In 163 published DRGs
2.07
Case mix index
IPPS FY 2027
30%
Surgical stays
67%
Stays with complications
In DRGs with a CC or MCC
4,167
Medicare outpatient services
In 41 service groups
Inpatient stays by major diagnostic category
Circulatory system1,072 discharges in 30 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 231 | $84,708 | $12,898 | $19,483 | 1.28 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 133 | $140,451 | $31,785 | $32,304 | 3.24 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 88 | $220,433 | $47,568 | $50,700 | 4.88 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 49 | $50,720 | $6,489 | $11,666 | 0.74 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 44 | $125,359 | $17,350 | $28,833 | 1.82 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 43 | $182,607 | $28,584 | $42,000 | 2.87 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 35 | $69,739 | $11,064 | $16,040 | 1.20 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 34 | $107,072 | $15,770 | $24,627 | 1.59 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 32 | $312,436 | $60,809 | $71,860 | 6.25 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 28 | $106,237 | $21,226 | $24,434 | 2.16 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 25 | $118,224 | $21,980 | $27,192 | 2.28 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 24 | $176,985 | $33,839 | $40,707 | 3.46 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 23 | $138,853 | $25,537 | $31,936 | 2.09 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 22 | $333,760 | $59,213 | $76,765 | 5.06 |
| Other vascular procedures with CCMS-DRG 253, surgical | 20 | $152,136 | $26,880 | $34,991 | 2.55 |
| Syncope and collapseMS-DRG 312, medical | 20 | $52,718 | $7,655 | $12,125 | 0.86 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 19 | $194,105 | $36,032 | $44,644 | 3.46 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 19 | $199,163 | $39,517 | $45,807 | 3.90 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 18 | $267,646 | $51,928 | $61,559 | 5.20 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 18 | $54,851 | $8,140 | $12,616 | 0.91 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 17 | $226,243 | $36,135 | $52,036 | 3.35 |
| Heart failure and shock with CCMS-DRG 292, medical | 17 | $50,134 | $7,820 | $11,531 | 0.86 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 17 | $46,582 | $8,932 | $10,714 | 0.97 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 16 | $269,610 | $53,577 | $62,010 | 5.24 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 16 | $99,574 | $15,521 | $22,902 | 1.58 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 14 | $68,685 | $9,883 | $15,798 | 1.08 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 13 | $337,105 | $77,904 | $77,534 | 7.80 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 13 | $194,347 | $37,389 | $44,700 | 4.04 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 12 | $236,353 | $38,168 | $54,361 | 4.16 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 12 | $33,091 | $4,474 | $7,611 | 0.55 |
Infectious and parasitic diseases871 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 | 578 | $120,225 | $20,222 | $27,652 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 124 | $60,815 | $9,420 | $13,987 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 90 | $325,531 | $58,319 | $74,872 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 23 | $99,951 | $17,998 | $22,989 | 2.04 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 16 | $93,945 | $18,623 | $21,607 | 1.84 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 14 | $120,343 | $21,804 | $27,679 | 2.14 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 14 | $61,832 | $9,479 | $14,221 | 1.01 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $289,822 | $57,458 | $66,659 | 4.43 |
Respiratory system650 discharges in 18 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 185 | $103,235 | $16,187 | $23,744 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 80 | $81,541 | $12,795 | $18,754 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 50 | $97,467 | $11,857 | $22,417 | 1.23 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 49 | $73,226 | $8,912 | $16,842 | 0.99 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 41 | $59,982 | $7,333 | $13,796 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 30 | $70,865 | $10,117 | $16,299 | 1.10 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 27 | $89,192 | $13,575 | $20,514 | 1.40 |
| Major chest trauma with CCMS-DRG 184, medical | 27 | $65,324 | $9,499 | $15,024 | 1.05 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 22 | $195,814 | $24,476 | $45,037 | 1.74 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 20 | $64,093 | $7,208 | $14,741 | 0.82 |
| Major chest procedures with CCMS-DRG 164, surgical | 18 | $177,170 | $24,752 | $40,749 | 2.55 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 17 | $59,785 | $8,612 | $13,751 | 0.96 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 17 | $178,499 | $28,039 | $41,055 | 2.70 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 15 | $211,315 | $45,283 | $48,602 | 4.06 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 15 | $119,599 | $17,827 | $27,508 | 1.81 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 13 | $82,925 | $8,906 | $19,073 | 0.85 |
| Respiratory infections and inflammations without cc/mccMS-DRG 179, medical | 12 | $53,795 | $6,619 | $12,373 | 0.76 |
| Major chest trauma with MCCMS-DRG 183, medical | 12 | $114,389 | $18,300 | $26,309 | 1.57 |
Nervous system618 discharges in 23 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 97 | $137,051 | $19,650 | $31,522 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 88 | $72,323 | $9,246 | $16,634 | 1.02 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 40 | $381,151 | $63,734 | $87,665 | 5.67 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 40 | $65,535 | $12,685 | $15,073 | 1.36 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 39 | $263,231 | $49,725 | $60,543 | 4.42 |
| Seizures without MCCMS-DRG 101, medical | 36 | $63,707 | $8,349 | $14,653 | 0.91 |
| Seizures with MCCMS-DRG 100, medical | 28 | $127,014 | $21,270 | $29,213 | 1.98 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 24 | $61,964 | $9,859 | $14,252 | 1.03 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 21 | $77,175 | $5,312 | $17,750 | 0.69 |
| Carotid artery stent procedures with CCMS-DRG 035, surgical | 18 | $174,590 | $22,576 | $40,156 | 2.30 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 18 | $129,932 | $17,544 | $29,884 | 1.81 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 17 | $250,258 | $41,589 | $57,559 | 3.79 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 17 | $75,495 | $12,508 | $17,364 | 1.32 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 16 | $186,324 | $24,332 | $42,854 | 2.43 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 15 | $67,510 | $9,354 | $15,527 | 1.06 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 15 | $130,010 | $23,776 | $29,902 | 2.28 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 15 | $96,372 | $22,128 | $22,165 | 2.27 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 13 | $613,849 | $104,988 | $141,185 | 8.45 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 13 | $101,936 | $10,597 | $23,445 | 1.14 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 13 | $87,865 | $16,124 | $20,209 | 1.79 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 12 | $74,419 | $9,375 | $17,116 | 1.03 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 12 | $78,672 | $13,147 | $18,094 | 1.36 |
| Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent witMS-DRG 062, medical | 11 | $117,705 | $17,917 | $27,072 | 1.87 |
Musculoskeletal system and connective tissue594 discharges in 22 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 | 100 | $110,477 | $17,980 | $25,410 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 63 | $53,270 | $8,429 | $12,252 | 0.97 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 53 | $120,472 | $20,607 | $27,709 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 34 | $112,420 | $20,285 | $25,856 | 2.11 |
| Back and neck procedures except spinal fusion without cc/mccMS-DRG 520, surgical | 29 | $66,220 | $12,871 | $15,231 | 1.43 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 25 | $80,496 | $19,240 | $18,514 | 1.97 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 24 | $51,017 | $8,004 | $11,734 | 0.90 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 23 | $247,121 | $55,686 | $56,838 | 6.12 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 23 | $221,221 | $45,608 | $50,881 | 4.61 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 23 | $87,141 | $19,439 | $20,042 | 2.04 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 22 | $44,110 | $6,903 | $10,145 | 0.79 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 22 | $84,913 | $9,660 | $19,530 | 1.09 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 20 | $157,774 | $28,423 | $36,288 | 2.95 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 19 | $215,990 | $34,088 | $49,678 | 3.66 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 18 | $86,727 | $14,973 | $19,947 | 1.59 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 17 | $174,063 | $29,028 | $40,034 | 2.99 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 15 | $138,051 | $23,572 | $31,752 | 2.40 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 14 | $129,318 | $23,402 | $29,743 | 2.38 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 14 | $73,404 | $13,912 | $16,883 | 1.49 |
| Medical back problems with MCCMS-DRG 551, medical | 13 | $82,525 | $15,539 | $18,981 | 1.70 |
| Lower extremity and humerus procedures except hip, foot and femur without cc/mccMS-DRG 494, surgical | 12 | $123,785 | $18,083 | $28,471 | 1.87 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 11 | $150,070 | $28,891 | $34,516 | 2.96 |
Digestive system566 discharges in 18 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 103 | $54,861 | $8,651 | $12,618 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 87 | $47,887 | $6,946 | $11,014 | 0.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 46 | $134,312 | $22,696 | $30,892 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 42 | $108,794 | $17,457 | $25,023 | 1.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 34 | $281,555 | $47,762 | $64,758 | 4.52 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 33 | $62,019 | $8,586 | $14,264 | 0.94 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 30 | $94,199 | $16,014 | $21,666 | 1.67 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 30 | $31,189 | $4,546 | $7,174 | 0.56 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 28 | $73,231 | $12,433 | $16,843 | 1.28 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 25 | $48,346 | $7,137 | $11,120 | 0.80 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 18 | $84,777 | $16,088 | $19,499 | 1.62 |
| Digestive malignancy with MCCMS-DRG 374, medical | 17 | $218,911 | $25,269 | $50,350 | 2.10 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 14 | $227,006 | $44,702 | $52,211 | 4.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 14 | $50,024 | $9,641 | $11,505 | 1.04 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 12 | $132,471 | $24,134 | $30,468 | 2.50 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 11 | $171,434 | $46,328 | $39,430 | 5.08 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 11 | $99,062 | $20,368 | $22,784 | 2.11 |
| Digestive malignancy with CCMS-DRG 375, medical | 11 | $74,932 | $11,563 | $17,234 | 1.20 |
Kidney and urinary tract324 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 71 | $45,454 | $7,067 | $10,454 | 0.81 |
| Renal failure with CCMS-DRG 683, medical | 52 | $51,239 | $8,087 | $11,785 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 48 | $94,673 | $16,806 | $21,775 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 38 | $82,228 | $14,225 | $18,912 | 1.50 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 35 | $47,765 | $10,090 | $10,986 | 1.02 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 33 | $72,030 | $10,970 | $16,567 | 1.17 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 18 | $79,520 | $12,560 | $18,290 | 1.35 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 17 | $111,080 | $25,439 | $25,548 | 2.59 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 12 | $197,190 | $42,996 | $45,354 | 3.70 |
Liver, gallbladder and pancreas160 discharges in 10 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 | 28 | $134,913 | $17,000 | $31,030 | 1.76 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 19 | $112,896 | $20,202 | $25,966 | 2.32 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 16 | $91,001 | $15,915 | $20,930 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 15 | $73,130 | $10,501 | $16,820 | 1.31 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 15 | $103,187 | $18,782 | $23,733 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 15 | $73,908 | $9,231 | $16,999 | 0.95 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 14 | $59,873 | $9,254 | $13,771 | 1.03 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 14 | $107,266 | $18,710 | $24,671 | 1.83 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 13 | $84,705 | $11,513 | $19,482 | 1.09 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 11 | $167,940 | $28,487 | $38,626 | 2.89 |
Endocrine, nutritional and metabolic154 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 | 42 | $73,639 | $12,732 | $16,937 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 42 | $40,906 | $7,129 | $9,408 | 0.78 |
| Endocrine disorders with CCMS-DRG 644, medical | 21 | $51,407 | $9,740 | $11,824 | 1.06 |
| Diabetes with CCMS-DRG 638, medical | 18 | $51,241 | $8,313 | $11,785 | 0.90 |
| Endocrine disorders with MCCMS-DRG 643, medical | 16 | $88,699 | $16,112 | $20,401 | 1.65 |
| Diabetes with MCCMS-DRG 637, medical | 15 | $72,715 | $14,080 | $16,724 | 1.45 |
Mental diseases and disorders133 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 110 | $44,816 | $13,094 | $10,308 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 23 | $57,521 | $16,624 | $13,230 | 1.76 |
Alcohol and drug use104 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 | 90 | $38,565 | $7,687 | $8,870 | 0.86 |
| Alcohol, drug abuse or dependence without rehabilitation therapy with MCCMS-DRG 896, medical | 14 | $63,505 | $16,859 | $14,606 | 1.78 |
Skin, subcutaneous tissue and breast79 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 45 | $50,238 | $8,219 | $11,555 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 34 | $48,170 | $8,256 | $11,079 | 0.91 |
Blood cancers and poorly differentiated neoplasms73 discharges in 3 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 | 49 | $85,454 | $12,213 | $19,654 | 1.21 |
| Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy aMS-DRG 837, medical | 13 | $221,114 | $45,126 | $50,856 | 4.84 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 11 | $146,725 | $18,603 | $33,747 | 1.57 |
Injuries, poisonings and toxic effects of drugs54 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 17 | $116,575 | $18,373 | $26,812 | 1.82 |
| Poisoning and toxic effects of drugs without MCCMS-DRG 918, medical | 13 | $57,315 | $7,509 | $13,182 | 0.86 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 12 | $116,414 | $15,508 | $26,775 | 1.60 |
| Complications of treatment with CCMS-DRG 920, medical | 12 | $46,349 | $9,701 | $10,660 | 1.03 |
Other51 discharges in 2 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 | 30 | $280,607 | $54,562 | $64,540 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 21 | $169,256 | $24,660 | $38,929 | 2.49 |
Factors influencing health status34 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 | 34 | $50,262 | $7,459 | $11,560 | 0.80 |
Blood and immune system33 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 17 | $48,176 | $7,168 | $11,080 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 16 | $50,607 | $14,865 | $11,640 | 1.56 |
Ear, nose, mouth and throat12 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 12 | $35,645 | $6,560 | $8,198 | 0.74 |
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 | 366 | 346 | $21,664 | $2,848 | $2,090 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 315 | 302 | $122,253 | $29,499 | $21,117 |
| Level 1 Endovascular ProceduresAPC 5191 | 264 | 263 | $31,300 | $3,073 | $2,208 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 242 | 232 | $82,713 | $15,465 | $10,772 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 203 | 199 | $44,550 | $5,991 | $4,358 |
| Level 2 Intraocular ProceduresAPC 5492 | 203 | 183 | $32,757 | $4,221 | $3,116 |
| Level 3 Vascular ProceduresAPC 5183 | 186 | 177 | $18,300 | $3,344 | $2,405 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 183 | 177 | $16,657 | $1,654 | $1,220 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 176 | 168 | $47,877 | $7,782 | $5,339 |
| Level 2 Upper GI ProceduresAPC 5302 | 174 | 152 | $15,862 | $1,984 | $1,445 |
| Level 4 Vascular ProceduresAPC 5184 | 166 | 158 | $25,189 | $5,755 | $3,946 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 141 | 134 | $31,274 | $2,980 | $2,141 |
| Level 5 Urology and Related ServicesAPC 5375 | 129 | 125 | $41,555 | $5,427 | $3,918 |
| Level 2 Vascular ProceduresAPC 5182 | 122 | 110 | $5,444 | $1,666 | $1,204 |
| Level 4 Urology and Related ServicesAPC 5374 | 116 | 95 | $32,370 | $3,657 | $2,629 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 115 | 115 | $71,354 | $11,899 | $8,164 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 107 | 106 | $60,783 | $12,403 | $8,569 |
| Level 3 Endovascular ProceduresAPC 5193 | 79 | 72 | $84,213 | $12,827 | $8,874 |
| Level 3 Urology and Related ServicesAPC 5373 | 75 | 57 | $15,068 | $2,136 | $1,516 |
| Level 5 Airway EndoscopyAPC 5155 | 74 | 73 | $34,197 | $7,376 | $5,183 |
| Level 4 Airway EndoscopyAPC 5154 | 70 | 65 | $27,689 | $3,901 | $2,833 |
| Level 5 ENT ProceduresAPC 5165 | 60 | 60 | $37,999 | $6,141 | $4,436 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 60 | 59 | $36,541 | $3,625 | $2,636 |
| Level 4 Endovascular ProceduresAPC 5194 | 58 | 56 | $99,237 | $21,023 | $14,606 |
| Level 3 Airway EndoscopyAPC 5153 | 52 | 49 | $14,708 | $1,781 | $1,264 |
| Level 4 Gynecologic ProceduresAPC 5414 | 50 | 49 | $25,386 | $3,214 | $2,389 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 41 | 41 | $135,635 | $41,538 | $29,375 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 39 | 39 | $39,658 | $9,538 | $6,514 |
| Level 3 Intraocular ProceduresAPC 5493 | 36 | 35 | $39,581 | $5,331 | $4,004 |
| Level 4 ENT ProceduresAPC 5164 | 34 | 34 | $18,714 | $3,371 | $2,217 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 30 | 29 | $53,461 | $6,952 | $4,982 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 30 | 30 | $11,895 | $1,686 | $1,196 |
| Level 3 Upper GI ProceduresAPC 5303 | 29 | 27 | $28,732 | $3,741 | $2,888 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 27 | 26 | $28,649 | $3,999 | $2,930 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 25 | 25 | $87,091 | $23,953 | $17,052 |
| Complex GI ProceduresAPC 5331 | 19 | 13 | $36,178 | $5,035 | $4,263 |
| Level 6 Urology and Related ServicesAPC 5376 | 17 | 17 | $55,660 | $10,481 | $7,291 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 16 | 16 | $20,623 | $3,372 | $2,373 |
| Level 2 Endovascular ProceduresAPC 5192 | 16 | 16 | $41,755 | $5,996 | $4,338 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 11 | 11 | $117,077 | $22,840 | $15,763 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 11 | $19,545 | $2,452 | $1,780 |
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.