St. Francis Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for St. Francis Hospital, Roslyn, NY in 2024, from traditional Medicare claims. Back to the St. Francis Hospital profile, with quality ratings, finances and negotiated rates.
10,053
Medicare inpatient discharges
In 200 published DRGs
2.25
Case mix index
IPPS FY 2027
37%
Surgical stays
59%
Stays with complications
In DRGs with a CC or MCC
8,943
Medicare outpatient services
In 44 service groups
Inpatient stays by major diagnostic category
Circulatory system3,970 discharges in 50 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 644 | $74,872 | $9,759 | $14,001 | 1.28 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 368 | $189,957 | $25,726 | $35,522 | 3.24 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 367 | $313,509 | $40,118 | $58,626 | 4.88 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 183 | $67,813 | $7,702 | $12,681 | 1.08 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 178 | $130,309 | $13,766 | $24,368 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 170 | $116,843 | $17,258 | $21,850 | 2.16 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 140 | $423,030 | $52,427 | $79,107 | 6.25 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 121 | $49,378 | $5,009 | $9,234 | 0.74 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 117 | $180,127 | $23,302 | $33,684 | 2.87 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 97 | $136,698 | $17,803 | $25,562 | 2.28 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 93 | $88,384 | $8,681 | $16,528 | 1.20 |
| Syncope and collapseMS-DRG 312, medical | 91 | $60,935 | $6,183 | $11,395 | 0.86 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 80 | $248,362 | $38,857 | $46,444 | 5.20 |
| Other vascular procedures with CCMS-DRG 253, surgical | 76 | $150,652 | $20,908 | $28,172 | 2.55 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 76 | $225,935 | $30,784 | $42,250 | 3.90 |
| Cardiac defibrillator implant without MCCMS-DRG 277, surgical | 61 | $274,619 | $36,781 | $51,354 | 4.78 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 61 | $89,128 | $12,612 | $16,667 | 1.59 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 58 | $58,025 | $7,733 | $10,851 | 1.07 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 56 | $297,607 | $48,973 | $55,653 | 7.80 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 55 | $37,603 | $3,017 | $7,032 | 0.55 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 50 | $160,670 | $27,685 | $30,045 | 3.35 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 46 | $182,226 | $26,719 | $34,076 | 3.46 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 45 | $217,940 | $28,796 | $40,755 | 4.04 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 45 | $106,652 | $15,299 | $19,944 | 2.09 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 44 | $210,389 | $26,516 | $39,343 | 3.18 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 40 | $475,238 | $81,746 | $88,869 | 9.71 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 40 | $74,523 | $12,551 | $13,936 | 1.58 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 37 | $104,945 | $13,451 | $19,625 | 1.83 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 37 | $239,005 | $42,848 | $44,694 | 5.06 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 36 | $213,524 | $32,378 | $39,929 | 4.16 |
| Cardiac defibrillator implant with MCC or carotid sinus neurostimulatorMS-DRG 276, surgical | 34 | $373,945 | $53,471 | $69,928 | 6.21 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 34 | $71,935 | $7,438 | $13,452 | 0.97 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 33 | $189,070 | $28,882 | $35,356 | 3.46 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 33 | $55,451 | $6,081 | $10,369 | 0.91 |
| Chest painMS-DRG 313, medical | 32 | $42,131 | $5,047 | $7,879 | 0.72 |
| Cardiac defibrillator implant with cardiac catheterization and MCCMS-DRG 275, surgical | 31 | $443,979 | $63,456 | $83,024 | 7.04 |
| Hypertension without MCCMS-DRG 305, medical | 31 | $52,484 | $4,861 | $9,814 | 0.75 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 29 | $422,405 | $62,328 | $78,990 | 7.71 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 22 | $323,226 | $50,035 | $60,443 | 5.88 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 21 | $288,518 | $43,188 | $53,953 | 5.24 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 20 | $135,880 | $24,025 | $25,410 | 3.27 |
| Heart failure and shock with CCMS-DRG 292, medical | 20 | $44,712 | $6,321 | $8,361 | 0.86 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 20 | $181,019 | $22,266 | $33,851 | 2.97 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 18 | $290,600 | $42,175 | $54,342 | 5.04 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 16 | $83,951 | $11,546 | $15,699 | 1.54 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 15 | $148,612 | $19,859 | $27,790 | 2.81 |
| Atherosclerosis without MCCMS-DRG 303, medical | 15 | $41,589 | $4,737 | $7,777 | 0.66 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 12 | $106,277 | $13,331 | $19,874 | 1.74 |
| Other heart assist system implantMS-DRG 215, surgical | 11 | $604,552 | $90,753 | $113,051 | 10.21 |
| Peripheral vascular disorders without cc/mccMS-DRG 301, medical | 11 | $45,186 | $4,934 | $8,450 | 0.71 |
Respiratory system1,076 discharges in 25 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 187 | $85,025 | $12,651 | $15,900 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 157 | $79,110 | $10,089 | $14,794 | 1.33 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 117 | $49,887 | $5,367 | $9,329 | 0.82 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 101 | $58,674 | $6,888 | $10,972 | 0.99 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 88 | $51,597 | $6,619 | $9,649 | 0.96 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 69 | $76,581 | $8,713 | $14,321 | 1.10 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 40 | $52,634 | $5,732 | $9,842 | 0.85 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 35 | $49,020 | $5,322 | $9,167 | 0.82 |
| Major chest procedures with CCMS-DRG 164, surgical | 29 | $126,144 | $18,760 | $23,589 | 2.55 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 25 | $118,796 | $15,518 | $22,215 | 1.90 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 22 | $36,714 | $3,840 | $6,866 | 0.63 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 21 | $175,009 | $20,028 | $32,727 | 2.70 |
| Respiratory infections and inflammations without cc/mccMS-DRG 179, medical | 20 | $48,514 | $5,033 | $9,072 | 0.76 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 20 | $71,297 | $9,190 | $13,333 | 1.23 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 18 | $75,971 | $10,204 | $14,207 | 1.40 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 14 | $106,863 | $13,346 | $19,983 | 1.88 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 14 | $107,163 | $14,026 | $20,040 | 1.74 |
| Pneumothorax with CCMS-DRG 200, medical | 14 | $74,198 | $8,504 | $13,875 | 1.08 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 14 | $106,707 | $14,908 | $19,954 | 1.81 |
| Respiratory neoplasms with CCMS-DRG 181, medical | 13 | $63,090 | $8,722 | $11,798 | 1.10 |
| Respiratory signs and symptomsMS-DRG 204, medical | 13 | $46,437 | $5,934 | $8,684 | 0.82 |
| Major chest procedures with MCCMS-DRG 163, surgical | 12 | $203,694 | $36,815 | $38,091 | 4.71 |
| Major chest trauma with CCMS-DRG 184, medical | 11 | $47,854 | $7,475 | $8,949 | 1.05 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 11 | $47,254 | $6,810 | $8,836 | 0.91 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 11 | $537,185 | $67,965 | $100,454 | 6.91 |
Digestive system992 discharges in 25 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 | 177 | $43,656 | $5,191 | $8,164 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 162 | $65,539 | $7,174 | $12,256 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 99 | $121,425 | $15,163 | $22,707 | 1.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 65 | $112,784 | $16,928 | $21,091 | 2.37 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 57 | $57,875 | $6,596 | $10,823 | 0.94 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 37 | $55,862 | $5,272 | $10,446 | 0.80 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 37 | $76,781 | $9,449 | $14,358 | 1.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 30 | $74,064 | $7,700 | $13,850 | 1.04 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 29 | $81,063 | $11,565 | $15,159 | 1.67 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 29 | $79,105 | $9,792 | $14,793 | 1.36 |
| Digestive malignancy with CCMS-DRG 375, medical | 28 | $82,879 | $8,969 | $15,498 | 1.20 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 26 | $94,538 | $13,600 | $17,679 | 1.62 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 25 | $227,854 | $31,100 | $42,609 | 4.52 |
| Digestive malignancy with MCCMS-DRG 374, medical | 21 | $122,749 | $16,742 | $22,954 | 2.10 |
| Inguinal and femoral hernia procedures with CCMS-DRG 351, surgical | 20 | $80,209 | $11,061 | $14,999 | 1.46 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 20 | $87,187 | $12,622 | $16,304 | 1.72 |
| Gastrointestinal hemorrhage without cc/mccMS-DRG 379, medical | 19 | $32,838 | $3,839 | $6,141 | 0.63 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 18 | $105,244 | $17,143 | $19,681 | 2.50 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 17 | $93,515 | $11,475 | $17,487 | 1.75 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 16 | $29,116 | $3,672 | $5,445 | 0.56 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 13 | $79,366 | $11,695 | $14,841 | 1.45 |
| Other digestive system diagnoses without cc/mccMS-DRG 395, medical | 13 | $37,185 | $4,303 | $6,954 | 0.65 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 12 | $106,717 | $16,761 | $19,956 | 2.11 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 11 | $229,610 | $39,479 | $42,937 | 5.08 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 11 | $77,560 | $12,416 | $14,504 | 1.60 |
Infectious and parasitic diseases961 discharges in 11 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 | 571 | $111,780 | $15,513 | $20,903 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 151 | $63,833 | $7,163 | $11,937 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 93 | $249,004 | $41,713 | $46,564 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 27 | $384,470 | $56,490 | $71,896 | 6.96 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 24 | $116,026 | $15,410 | $21,697 | 2.04 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 23 | $56,689 | $7,412 | $10,601 | 1.01 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 19 | $99,761 | $14,200 | $18,655 | 1.84 |
| Viral illness without MCCMS-DRG 866, medical | 19 | $44,970 | $5,824 | $8,409 | 0.92 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $162,737 | $32,833 | $30,432 | 4.43 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 11 | $146,481 | $17,705 | $27,392 | 2.14 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 11 | $46,949 | $5,190 | $8,780 | 0.88 |
Musculoskeletal system and connective tissue914 discharges in 23 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 | 329 | $89,229 | $13,995 | $16,686 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 115 | $54,964 | $6,824 | $10,278 | 0.97 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 53 | $104,364 | $16,344 | $19,516 | 2.07 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 40 | $323,184 | $45,853 | $60,435 | 6.12 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 37 | $137,203 | $25,374 | $25,657 | 3.49 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 37 | $176,911 | $22,547 | $33,082 | 2.96 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 33 | $40,120 | $5,862 | $7,503 | 0.82 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 29 | $114,137 | $16,162 | $21,344 | 2.11 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 28 | $60,334 | $7,343 | $11,282 | 1.09 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 26 | $52,154 | $6,650 | $9,753 | 0.90 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 22 | $218,510 | $27,276 | $40,861 | 3.66 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 19 | $55,161 | $5,647 | $10,315 | 0.82 |
| Bilateral or multiple major joint procedures of lower extremity without MCCMS-DRG 462, surgical | 17 | $122,310 | $20,002 | $22,872 | 2.85 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 16 | $135,457 | $16,161 | $25,330 | 2.04 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 16 | $53,855 | $5,440 | $10,071 | 0.79 |
| Tendonitis, myositis and bursitis without MCCMS-DRG 558, medical | 14 | $47,737 | $5,945 | $8,927 | 0.88 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 13 | $139,391 | $21,246 | $26,066 | 2.67 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 13 | $129,448 | $23,187 | $24,207 | 2.95 |
| Cervical spinal fusion without cc/mccMS-DRG 473, surgical | 12 | $141,212 | $19,648 | $26,407 | 2.46 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 12 | $176,175 | $23,784 | $32,945 | 2.49 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 11 | $186,443 | $24,516 | $34,865 | 3.33 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 11 | $115,835 | $20,089 | $21,661 | 2.48 |
| Medical back problems with MCCMS-DRG 551, medical | 11 | $88,421 | $13,221 | $16,535 | 1.70 |
Kidney and urinary tract664 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 208 | $45,436 | $5,522 | $8,497 | 0.81 |
| Renal failure with CCMS-DRG 683, medical | 103 | $54,146 | $6,410 | $10,125 | 0.90 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 77 | $69,273 | $9,061 | $12,954 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 75 | $99,943 | $11,676 | $18,689 | 1.50 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 65 | $81,283 | $13,047 | $15,200 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 38 | $45,402 | $7,279 | $8,490 | 1.02 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 28 | $66,147 | $10,128 | $12,369 | 1.35 |
| Kidney and urinary tract signs and symptoms without MCCMS-DRG 696, medical | 23 | $38,982 | $5,172 | $7,290 | 0.69 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 16 | $51,175 | $7,671 | $9,570 | 1.05 |
| Urinary stones without MCCMS-DRG 694, medical | 16 | $39,957 | $5,628 | $7,472 | 0.78 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 15 | $262,529 | $25,738 | $49,093 | 3.70 |
Nervous system411 discharges in 16 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 | 54 | $70,560 | $6,548 | $13,195 | 1.02 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 47 | $61,579 | $7,674 | $11,515 | 1.03 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 39 | $53,082 | $9,321 | $9,926 | 1.36 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 36 | $99,372 | $13,990 | $18,583 | 1.81 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 33 | $153,189 | $18,173 | $28,646 | 2.00 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 25 | $57,819 | $7,545 | $10,812 | 1.14 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 22 | $47,429 | $7,463 | $8,869 | 1.03 |
| Carotid artery stent procedures with CCMS-DRG 035, surgical | 21 | $111,828 | $17,542 | $20,912 | 2.30 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 19 | $69,082 | $13,280 | $12,918 | 1.79 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 17 | $288,298 | $36,348 | $53,912 | 4.42 |
| Extracranial procedures with CCMS-DRG 038, surgical | 17 | $103,991 | $13,519 | $19,446 | 1.60 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 17 | $110,324 | $17,492 | $20,631 | 2.39 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 17 | $61,210 | $9,059 | $11,446 | 1.32 |
| Other disorders of nervous system without cc/mccMS-DRG 093, medical | 17 | $52,667 | $4,689 | $9,849 | 0.77 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 15 | $56,217 | $4,411 | $10,513 | 0.69 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 15 | $69,546 | $4,914 | $13,005 | 0.80 |
Endocrine, nutritional and metabolic227 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 | 94 | $41,495 | $5,104 | $7,759 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 61 | $87,057 | $11,705 | $16,280 | 1.32 |
| Diabetes with CCMS-DRG 638, medical | 25 | $47,037 | $6,326 | $8,796 | 0.90 |
| Endocrine disorders with CCMS-DRG 644, medical | 19 | $51,177 | $7,703 | $9,570 | 1.06 |
| Diabetes with MCCMS-DRG 637, medical | 14 | $79,369 | $10,043 | $14,842 | 1.45 |
| Endocrine disorders with MCCMS-DRG 643, medical | 14 | $96,821 | $13,741 | $18,106 | 1.65 |
Blood and immune system205 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 | 86 | $93,893 | $11,825 | $17,558 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 55 | $67,090 | $6,626 | $12,546 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 37 | $97,009 | $11,747 | $18,141 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 14 | $200,899 | $29,326 | $37,568 | 2.19 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 13 | $77,731 | $7,535 | $14,536 | 1.20 |
Skin, subcutaneous tissue and breast167 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 97 | $45,423 | $5,979 | $8,494 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 29 | $70,916 | $11,260 | $13,261 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 18 | $53,185 | $6,255 | $9,946 | 0.91 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 12 | $95,855 | $9,581 | $17,925 | 1.75 |
| Minor skin disorders without MCCMS-DRG 607, medical | 11 | $34,091 | $6,297 | $6,375 | 0.89 |
Liver, gallbladder and pancreas132 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 | 35 | $94,831 | $12,494 | $17,733 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 32 | $69,068 | $8,084 | $12,916 | 1.09 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 20 | $154,844 | $14,812 | $28,956 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 16 | $133,519 | $13,874 | $24,968 | 1.76 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 15 | $69,597 | $7,955 | $13,015 | 1.31 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 14 | $183,500 | $17,911 | $34,314 | 2.32 |
Injuries, poisonings and toxic effects of drugs83 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with CCMS-DRG 920, medical | 34 | $51,583 | $7,834 | $9,646 | 1.03 |
| Complications of treatment with MCCMS-DRG 919, medical | 24 | $81,589 | $14,441 | $15,257 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 13 | $262,746 | $33,709 | $49,134 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 12 | $120,299 | $16,396 | $22,496 | 2.00 |
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 | 28 | $367,995 | $48,975 | $68,815 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 25 | $156,365 | $19,908 | $29,240 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 16 | $170,820 | $28,596 | $31,943 | 3.38 |
Factors influencing health status43 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Signs and symptoms without MCCMS-DRG 948, medical | 32 | $44,222 | $5,865 | $8,269 | 0.80 |
| Signs and symptoms with MCCMS-DRG 947, medical | 11 | $54,228 | $9,047 | $10,141 | 1.25 |
Ear, nose, mouth and throat35 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 24 | $47,844 | $4,680 | $8,947 | 0.74 |
| Otitis media and uri without MCCMS-DRG 153, medical | 11 | $45,004 | $4,640 | $8,416 | 0.73 |
Mental diseases and disorders30 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 | 30 | $61,238 | $13,173 | $11,452 | 1.76 |
Blood cancers and poorly differentiated neoplasms29 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 16 | $143,051 | $23,988 | $26,750 | 3.13 |
| Acute leukemia with MCCMS-DRG 834, medical | 13 | $262,310 | $45,492 | $49,052 | 5.60 |
Transplants, ECMO and tracheostomy (pre-MDC)27 discharges in 2 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 | 16 | $1,154,731 | $170,813 | $215,935 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 11 | $718,721 | $122,404 | $134,401 | 14.70 |
Male reproductive system18 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 | 18 | $65,483 | $10,858 | $12,245 | 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 |
|---|---|---|---|---|---|
| Level 1 Endovascular ProceduresAPC 5191 | 1,889 | 1,878 | $25,500 | $2,617 | $2,208 |
| Comprehensive Observation ServicesAPC 8011 | 1,743 | 1,604 | $25,230 | $2,425 | $2,090 |
| Level 3 Endovascular ProceduresAPC 5193 | 858 | 790 | $83,928 | $10,595 | $8,874 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 613 | 597 | $212,810 | $24,931 | $21,117 |
| Level 1 Intraocular ProceduresAPC 5491 | 391 | 268 | $14,928 | $2,092 | $1,752 |
| Level 2 Upper GI ProceduresAPC 5302 | 366 | 340 | $11,757 | $1,698 | $1,445 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 263 | 252 | $12,826 | $1,420 | $1,220 |
| Level 2 Endovascular ProceduresAPC 5192 | 230 | 211 | $53,494 | $4,950 | $4,338 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 206 | 205 | $33,516 | $5,155 | $4,358 |
| Level 4 Endovascular ProceduresAPC 5194 | 188 | 182 | $126,692 | $17,976 | $14,606 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 163 | 157 | $69,098 | $13,089 | $10,772 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 163 | 163 | $64,000 | $10,381 | $8,569 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 158 | 154 | $200,978 | $35,094 | $29,375 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 155 | 155 | $60,492 | $6,738 | $5,682 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 149 | 139 | $19,301 | $2,533 | $2,141 |
| Level 4 Urology and Related ServicesAPC 5374 | 133 | 124 | $20,385 | $3,129 | $2,629 |
| Level 5 Urology and Related ServicesAPC 5375 | 124 | 120 | $29,158 | $4,572 | $3,918 |
| Level 3 Vascular ProceduresAPC 5183 | 119 | 110 | $20,662 | $2,861 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 90 | 89 | $35,382 | $6,355 | $5,339 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 88 | 87 | $105,892 | $20,267 | $17,052 |
| Level 3 Urology and Related ServicesAPC 5373 | 86 | 71 | $18,966 | $1,801 | $1,516 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 81 | 81 | $53,722 | $5,854 | $4,982 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 72 | 71 | $26,571 | $3,374 | $2,930 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 67 | 67 | $102,243 | $19,314 | $15,763 |
| Level 3 Upper GI ProceduresAPC 5303 | 51 | 51 | $16,189 | $3,429 | $2,888 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 49 | 49 | $135,886 | $24,342 | $21,011 |
| Level 3 Lower GI ProceduresAPC 5313 | 48 | 47 | $16,080 | $2,537 | $2,176 |
| Level 4 Vascular ProceduresAPC 5184 | 41 | 38 | $53,075 | $4,811 | $3,946 |
| Level 3 Airway EndoscopyAPC 5153 | 37 | 36 | $19,393 | $1,524 | $1,264 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 37 | 37 | $43,848 | $9,683 | $8,164 |
| Level 4 Airway EndoscopyAPC 5154 | 31 | 30 | $30,162 | $3,252 | $2,833 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 30 | 29 | $19,481 | $2,809 | $2,373 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 29 | 29 | $23,691 | $3,106 | $2,636 |
| Implantation Wireless PA Pressure MonitorAPC 5200 | 28 | 28 | $177,710 | $31,017 | $26,955 |
| Complex GI ProceduresAPC 5331 | 28 | 21 | $27,695 | $4,934 | $4,263 |
| Level 2 Vascular ProceduresAPC 5182 | 26 | 26 | $11,609 | $1,438 | $1,204 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 20 | 20 | $13,421 | $1,443 | $1,196 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 20 | 20 | $172,325 | $31,585 | $26,719 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 15 | 15 | $89,877 | $8,979 | $7,546 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 13 | 11 | $24,341 | $6,140 | $4,524 |
| Level 1 Nerve ProceduresAPC 5431 | 12 | 12 | $19,744 | $1,733 | $1,407 |
| Level 5 Airway EndoscopyAPC 5155 | 11 | 11 | $55,067 | $6,145 | $5,183 |
| Level 5 ENT ProceduresAPC 5165 | 11 | 11 | $37,560 | $5,257 | $4,436 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 11 | 11 | $58,629 | $7,923 | $6,514 |
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.