Scripps Memorial Hospital La Jolla Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Scripps Memorial Hospital La Jolla, La Jolla, CA in 2024, from traditional Medicare claims. Back to the Scripps Memorial Hospital La Jolla profile, with quality ratings, finances and negotiated rates.
6,291
Medicare inpatient discharges
In 164 published DRGs
2.37
Case mix index
IPPS FY 2027
34%
Surgical stays
66%
Stays with complications
In DRGs with a CC or MCC
5,495
Medicare outpatient services
In 44 service groups
Inpatient stays by major diagnostic category
Circulatory system2,125 discharges in 39 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 365 | $226,830 | $28,605 | $37,881 | 3.24 |
| Heart failure and shock with MCCMS-DRG 291, medical | 338 | $82,114 | $11,181 | $13,713 | 1.28 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 208 | $380,051 | $44,009 | $63,468 | 4.88 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 102 | $554,315 | $64,473 | $92,571 | 6.25 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 82 | $133,474 | $14,301 | $22,290 | 1.82 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 72 | $117,577 | $13,936 | $19,635 | 1.59 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 67 | $691,069 | $72,508 | $115,409 | 7.71 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 64 | $210,847 | $20,458 | $35,211 | 2.16 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 62 | $240,816 | $27,209 | $40,216 | 2.87 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 59 | $93,103 | $8,761 | $15,548 | 1.08 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 51 | $48,484 | $5,872 | $8,097 | 0.74 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 49 | $131,222 | $18,629 | $21,914 | 2.09 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 47 | $179,721 | $19,862 | $30,013 | 2.28 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 37 | $64,841 | $9,543 | $10,828 | 1.20 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 31 | $284,483 | $35,914 | $47,509 | 3.90 |
| Syncope and collapseMS-DRG 312, medical | 30 | $45,350 | $6,672 | $7,573 | 0.86 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 29 | $243,262 | $29,205 | $40,625 | 3.18 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 28 | $76,638 | $7,362 | $12,799 | 0.91 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 26 | $580,170 | $47,797 | $96,888 | 5.24 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 25 | $615,557 | $46,916 | $102,798 | 5.88 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 25 | $276,245 | $33,925 | $46,133 | 3.46 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 25 | $230,116 | $27,579 | $38,429 | 2.97 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 24 | $40,585 | $4,056 | $6,778 | 0.55 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 23 | $70,700 | $8,271 | $11,807 | 0.97 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 21 | $140,705 | $16,130 | $23,498 | 1.83 |
| Hypertension without MCCMS-DRG 305, medical | 21 | $53,305 | $6,111 | $8,902 | 0.75 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 21 | $267,087 | $38,318 | $44,604 | 4.14 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 20 | $549,991 | $37,953 | $91,849 | 4.04 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 20 | $51,858 | $9,179 | $8,660 | 1.07 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 19 | $425,608 | $46,760 | $71,077 | 5.06 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 18 | $345,267 | $45,724 | $57,660 | 5.04 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 17 | $88,991 | $12,919 | $14,861 | 1.58 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 16 | $355,424 | $29,564 | $59,356 | 3.35 |
| Cardiac defibrillator implant without MCCMS-DRG 277, surgical | 16 | $252,464 | $38,321 | $42,162 | 4.78 |
| Heart failure and shock with CCMS-DRG 292, medical | 15 | $47,284 | $7,493 | $7,897 | 0.86 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 14 | $767,250 | $94,973 | $128,131 | 9.71 |
| Percutaneous cardiovascular procedures without intraluminal device with MCCMS-DRG 250, surgical | 14 | $175,818 | $18,728 | $29,362 | 2.35 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 13 | $53,999 | $5,791 | $9,018 | 0.72 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 11 | $684,875 | $48,777 | $114,374 | 7.80 |
Infectious and parasitic diseases803 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 | 558 | $118,276 | $17,433 | $19,752 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 100 | $59,916 | $8,576 | $10,006 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 73 | $388,801 | $50,485 | $64,930 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 24 | $198,404 | $19,043 | $33,133 | 2.04 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 24 | $544,513 | $68,277 | $90,934 | 6.96 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $383,462 | $44,538 | $64,038 | 4.43 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 12 | $110,449 | $15,011 | $18,445 | 1.84 |
Musculoskeletal system and connective tissue695 discharges in 25 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 | 81 | $163,517 | $18,238 | $27,307 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 77 | $73,705 | $8,145 | $12,309 | 0.97 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 63 | $160,384 | $16,258 | $26,784 | 1.88 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 56 | $66,209 | $8,933 | $11,057 | 1.09 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 48 | $196,269 | $26,240 | $32,777 | 2.95 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 36 | $163,890 | $17,598 | $27,370 | 2.11 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 31 | $182,608 | $20,991 | $30,496 | 2.40 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 28 | $58,440 | $6,018 | $9,760 | 0.79 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 27 | $90,216 | $14,667 | $15,066 | 1.82 |
| Medical back problems with MCCMS-DRG 551, medical | 27 | $124,269 | $13,885 | $20,753 | 1.70 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 25 | $52,487 | $7,245 | $8,765 | 0.90 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 19 | $197,262 | $26,051 | $32,943 | 2.99 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 17 | $580,315 | $59,888 | $96,913 | 6.12 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 17 | $109,898 | $13,560 | $18,353 | 1.59 |
| Pathological fractures and musculoskeletal and connective tissue malignancy without cc/mMS-DRG 544, medical | 17 | $50,638 | $5,974 | $8,457 | 0.77 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 15 | $251,115 | $26,582 | $41,936 | 2.96 |
| Lower extremity and humerus procedures except hip, foot and femur without cc/mccMS-DRG 494, surgical | 14 | $146,942 | $16,375 | $24,539 | 1.87 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 13 | $448,368 | $42,634 | $74,877 | 4.61 |
| Lower extremity and humerus procedures except hip, foot and femur with MCCMS-DRG 492, surgical | 13 | $346,318 | $35,556 | $57,835 | 3.46 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 13 | $174,925 | $16,379 | $29,212 | 2.04 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 12 | $322,122 | $32,521 | $53,794 | 3.66 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 12 | $251,094 | $32,029 | $41,933 | 3.49 |
| Back and neck procedures except spinal fusion without cc/mccMS-DRG 520, surgical | 12 | $131,603 | $12,326 | $21,978 | 1.43 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 11 | $132,938 | $11,796 | $22,201 | 1.49 |
| Back and neck procedures except spinal fusion with MCC or disc device or neurostimulatorMS-DRG 518, surgical | 11 | $220,245 | $28,601 | $36,781 | 3.65 |
Digestive system609 discharges in 19 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 | 91 | $47,875 | $5,951 | $7,995 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 75 | $65,375 | $7,994 | $10,918 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 69 | $118,597 | $16,155 | $19,806 | 1.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 56 | $44,322 | $6,422 | $7,402 | 0.80 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 35 | $235,576 | $20,736 | $39,341 | 2.37 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 35 | $61,401 | $7,570 | $10,254 | 0.94 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 33 | $337,185 | $40,189 | $56,310 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 33 | $82,851 | $10,857 | $13,836 | 1.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 24 | $69,853 | $8,599 | $11,665 | 1.04 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 21 | $191,601 | $14,506 | $31,997 | 1.67 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 20 | $92,034 | $13,996 | $15,370 | 1.62 |
| Digestive malignancy with MCCMS-DRG 374, medical | 18 | $121,946 | $16,204 | $20,365 | 2.10 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 15 | $368,929 | $46,200 | $61,611 | 5.08 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 15 | $358,218 | $38,960 | $59,822 | 4.28 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 15 | $81,541 | $12,439 | $13,617 | 1.45 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 15 | $33,783 | $4,172 | $5,642 | 0.56 |
| Digestive malignancy with CCMS-DRG 375, medical | 14 | $77,357 | $8,937 | $12,919 | 1.20 |
| Inflammatory bowel disease with CCMS-DRG 386, medical | 14 | $62,660 | $8,316 | $10,464 | 0.97 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 11 | $145,870 | $17,216 | $24,360 | 2.11 |
Nervous system593 discharges in 19 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 78 | $151,777 | $17,489 | $25,347 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 72 | $89,343 | $8,221 | $14,920 | 1.02 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 49 | $62,399 | $11,297 | $10,421 | 1.36 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 38 | $93,801 | $14,798 | $15,665 | 1.79 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 35 | $61,421 | $8,866 | $10,257 | 1.06 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 35 | $165,930 | $11,177 | $27,710 | 1.32 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 34 | $87,769 | $19,285 | $14,657 | 2.39 |
| Seizures without MCCMS-DRG 101, medical | 29 | $53,409 | $6,981 | $8,919 | 0.91 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 27 | $111,828 | $11,548 | $18,675 | 1.36 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 27 | $96,800 | $10,038 | $16,166 | 1.03 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 24 | $63,274 | $5,180 | $10,567 | 0.69 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 24 | $168,022 | $21,411 | $28,060 | 2.28 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 20 | $191,001 | $21,728 | $31,897 | 2.27 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 19 | $607,975 | $59,576 | $101,532 | 4.42 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 19 | $57,713 | $6,036 | $9,638 | 0.80 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 18 | $102,322 | $15,641 | $17,088 | 1.79 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 17 | $459,378 | $49,702 | $76,716 | 5.67 |
| Seizures with MCCMS-DRG 100, medical | 15 | $110,683 | $17,784 | $18,484 | 1.98 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 13 | $78,738 | $12,882 | $13,149 | 1.47 |
Respiratory system561 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 139 | $95,961 | $14,955 | $16,025 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 81 | $67,854 | $11,310 | $11,332 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 59 | $80,766 | $10,830 | $13,488 | 1.23 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 39 | $53,983 | $7,664 | $9,015 | 0.99 |
| Major chest trauma with CCMS-DRG 184, medical | 31 | $120,104 | $8,594 | $20,057 | 1.05 |
| Major chest trauma with MCCMS-DRG 183, medical | 30 | $134,261 | $13,866 | $22,422 | 1.57 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 30 | $48,814 | $6,105 | $8,152 | 0.82 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 25 | $78,428 | $11,906 | $13,097 | 1.40 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 19 | $61,902 | $6,557 | $10,338 | 0.82 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 17 | $93,838 | $14,538 | $15,671 | 1.74 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 17 | $54,268 | $8,952 | $9,063 | 1.10 |
| Major chest procedures with CCMS-DRG 164, surgical | 15 | $282,269 | $23,065 | $47,139 | 2.55 |
| Pneumothorax with MCCMS-DRG 199, medical | 13 | $230,898 | $15,115 | $38,560 | 1.77 |
| Pneumothorax with CCMS-DRG 200, medical | 12 | $111,377 | $9,155 | $18,600 | 1.08 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 12 | $266,896 | $27,120 | $44,572 | 2.70 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 11 | $113,099 | $17,001 | $18,888 | 1.90 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 11 | $121,100 | $16,063 | $20,224 | 1.81 |
Kidney and urinary tract269 discharges in 7 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 | 59 | $97,304 | $14,875 | $16,250 | 1.65 |
| Renal failure with CCMS-DRG 683, medical | 53 | $58,010 | $7,386 | $9,688 | 0.90 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 52 | $44,543 | $6,525 | $7,439 | 0.81 |
| Renal failure with MCCMS-DRG 682, medical | 44 | $78,723 | $13,184 | $13,147 | 1.50 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 27 | $73,872 | $8,720 | $12,337 | 1.02 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 23 | $63,114 | $10,109 | $10,540 | 1.17 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 11 | $97,568 | $11,667 | $16,294 | 1.35 |
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 without MCCMS-DRG 641, medical | 50 | $46,845 | $6,228 | $7,823 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 32 | $70,012 | $10,738 | $11,692 | 1.32 |
| Endocrine disorders with CCMS-DRG 644, medical | 23 | $64,289 | $9,144 | $10,736 | 1.06 |
| Endocrine disorders with MCCMS-DRG 643, medical | 20 | $122,658 | $13,662 | $20,484 | 1.65 |
| Diabetes with MCCMS-DRG 637, medical | 16 | $100,880 | $11,823 | $16,847 | 1.45 |
| Diabetes with CCMS-DRG 638, medical | 13 | $48,271 | $7,234 | $8,061 | 0.90 |
Liver, gallbladder and pancreas123 discharges in 6 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 | 33 | $185,268 | $13,619 | $30,940 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 28 | $234,125 | $19,577 | $39,099 | 2.32 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 18 | $71,366 | $8,463 | $11,918 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 16 | $143,151 | $10,508 | $23,906 | 1.31 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 15 | $89,874 | $16,059 | $15,009 | 1.76 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 13 | $93,856 | $14,732 | $15,674 | 1.83 |
Skin, subcutaneous tissue and breast94 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 57 | $44,871 | $7,152 | $7,494 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 21 | $52,406 | $7,336 | $8,752 | 0.91 |
| Cellulitis with MCCMS-DRG 602, medical | 16 | $51,967 | $12,188 | $8,678 | 1.49 |
Other61 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Concomitant left atrial appendage closure and cardiac ablationMS-DRG 317 | 34 | $344,336 | $57,297 | $57,504 | |
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 27 | $325,727 | $42,875 | $54,396 | 4.74 |
Injuries, poisonings and toxic effects of drugs45 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 20 | $142,073 | $15,619 | $23,726 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 14 | $80,159 | $9,318 | $13,387 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 11 | $115,659 | $13,972 | $19,315 | 1.60 |
Mental diseases and disorders38 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 | 25 | $57,385 | $14,075 | $9,583 | 1.76 |
| PsychosesMS-DRG 885, medical | 13 | $90,688 | $11,548 | $15,145 | 1.37 |
Alcohol and drug use27 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 with MCCMS-DRG 896, medical | 16 | $97,570 | $14,713 | $16,294 | 1.78 |
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 11 | $68,535 | $7,229 | $11,445 | 0.86 |
Blood and immune system26 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 | 13 | $52,207 | $7,265 | $8,719 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 13 | $90,052 | $13,565 | $15,039 | 1.56 |
Female reproductive system25 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Uterine and adnexa procedures for non-malignancy without cc/mccMS-DRG 743, surgical | 14 | $153,635 | $9,035 | $25,657 | 1.16 |
| Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without cc/mccMS-DRG 741, surgical | 11 | $214,580 | $11,210 | $35,835 | 1.30 |
Transplants, ECMO and tracheostomy (pre-MDC)19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and necMS-DRG 003, surgical | 19 | $1,501,010 | $240,844 | $250,669 | 21.32 |
Factors influencing health status13 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 | 13 | $38,796 | $6,526 | $6,479 | 0.80 |
Multiple significant trauma11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other multiple significant trauma with CCMS-DRG 964, medical | 11 | $165,076 | $12,897 | $27,568 | 1.50 |
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 | 788 | 747 | $34,779 | $2,674 | $2,090 |
| Level 1 Endovascular ProceduresAPC 5191 | 660 | 660 | $48,189 | $2,871 | $2,208 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 528 | 508 | $203,871 | $27,383 | $21,117 |
| Level 3 Endovascular ProceduresAPC 5193 | 421 | 395 | $118,665 | $11,842 | $8,874 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 301 | 285 | $17,087 | $1,587 | $1,220 |
| Level 2 Intraocular ProceduresAPC 5492 | 292 | 268 | $56,665 | $3,983 | $3,116 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 199 | 199 | $43,354 | $8,796 | $6,514 |
| Level 1 Intraocular ProceduresAPC 5491 | 193 | 145 | $46,071 | $2,281 | $1,752 |
| Level 4 Endovascular ProceduresAPC 5194 | 186 | 176 | $155,517 | $19,762 | $14,606 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 168 | 168 | $85,036 | $11,407 | $8,569 |
| Level 2 Endovascular ProceduresAPC 5192 | 161 | 160 | $76,051 | $5,564 | $4,338 |
| Level 2 Upper GI ProceduresAPC 5302 | 127 | 117 | $17,237 | $1,843 | $1,445 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 121 | 115 | $156,838 | $14,394 | $10,772 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 115 | 115 | $98,375 | $5,646 | $4,358 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 98 | 97 | $138,253 | $22,038 | $17,052 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 95 | 95 | $195,776 | $38,681 | $29,375 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 94 | 93 | $204,075 | $10,888 | $8,164 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 93 | 91 | $53,070 | $6,388 | $4,982 |
| Level 4 Gynecologic ProceduresAPC 5414 | 79 | 78 | $24,030 | $3,024 | $2,389 |
| Level 3 Vascular ProceduresAPC 5183 | 74 | 70 | $46,441 | $3,080 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 67 | 66 | $98,032 | $6,732 | $5,339 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 58 | 57 | $30,973 | $2,783 | $2,141 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 57 | 49 | $27,267 | $3,667 | $2,930 |
| Level 3 Lower GI ProceduresAPC 5313 | 47 | 44 | $22,964 | $2,794 | $2,176 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 41 | 38 | $21,383 | $3,093 | $2,373 |
| Level 5 Gynecologic ProceduresAPC 5415 | 40 | 40 | $61,080 | $4,868 | $3,792 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 33 | 33 | $21,117 | $1,574 | $1,196 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 29 | 29 | $134,017 | $9,943 | $7,546 |
| Complex GI ProceduresAPC 5331 | 29 | 26 | $53,891 | $5,246 | $4,263 |
| Level 3 Upper GI ProceduresAPC 5303 | 27 | 27 | $35,912 | $3,760 | $2,888 |
| Level 4 Urology and Related ServicesAPC 5374 | 26 | 22 | $40,048 | $3,415 | $2,629 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 24 | 21 | $65,352 | $3,389 | $2,636 |
| Level 3 Urology and Related ServicesAPC 5373 | 24 | 16 | $39,796 | $1,993 | $1,516 |
| Level 3 Intraocular ProceduresAPC 5493 | 24 | 23 | $85,697 | $4,913 | $4,004 |
| Level 2 Vascular ProceduresAPC 5182 | 23 | 23 | $25,030 | $1,561 | $1,204 |
| Level 6 Gynecologic ProceduresAPC 5416 | 23 | 23 | $99,265 | $7,653 | $5,836 |
| Level 4 Breast/Lymphatic Surgery and Related ProceduresAPC 5094 | 22 | 17 | $198,575 | $19,978 | $15,549 |
| Level 5 ENT ProceduresAPC 5165 | 20 | 20 | $86,178 | $5,732 | $4,436 |
| Level 4 Vascular ProceduresAPC 5184 | 20 | 19 | $62,425 | $5,374 | $3,946 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 18 | 18 | $127,604 | $27,263 | $21,011 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 14 | 14 | $252,999 | $21,219 | $15,763 |
| Level 4 Airway EndoscopyAPC 5154 | 13 | 13 | $33,633 | $3,668 | $2,833 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 12 | 12 | $82,062 | $7,545 | $5,682 |
| Level 5 Urology and Related ServicesAPC 5375 | 11 | $61,241 | $5,069 | $3,918 |
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.