Unc Rex Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Unc Rex Hospital, Raleigh, NC in 2024, from traditional Medicare claims. Back to the Unc Rex Hospital profile, with quality ratings, finances and negotiated rates.
6,565
Medicare inpatient discharges
In 171 published DRGs
2.02
Case mix index
IPPS FY 2027
33%
Surgical stays
68%
Stays with complications
In DRGs with a CC or MCC
8,660
Medicare outpatient services
In 51 service groups
Inpatient stays by major diagnostic category
Circulatory system2,163 discharges in 45 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 295 | $29,801 | $8,172 | $9,209 | 1.28 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 181 | $20,947 | $3,910 | $6,473 | 0.74 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 116 | $81,962 | $20,227 | $25,326 | 3.24 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 115 | $67,062 | $10,906 | $20,722 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 95 | $35,546 | $6,139 | $10,984 | 1.08 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 95 | $34,602 | $7,264 | $10,692 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 95 | $91,210 | $19,030 | $28,184 | 2.87 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 78 | $54,079 | $10,117 | $16,710 | 1.59 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 74 | $139,110 | $31,362 | $42,985 | 4.88 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 69 | $48,324 | $13,152 | $14,932 | 2.16 |
| Heart failure and shock with CCMS-DRG 292, medical | 63 | $28,505 | $4,846 | $8,808 | 0.86 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 58 | $65,907 | $14,427 | $20,365 | 2.28 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 56 | $168,564 | $41,599 | $52,086 | 6.25 |
| Syncope and collapseMS-DRG 312, medical | 48 | $29,964 | $4,950 | $9,259 | 0.86 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 45 | $85,617 | $23,123 | $26,456 | 3.35 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 43 | $90,534 | $20,652 | $27,975 | 3.46 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 42 | $98,088 | $23,289 | $30,309 | 4.04 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 42 | $44,958 | $13,060 | $13,892 | 2.09 |
| Other vascular procedures with CCMS-DRG 253, surgical | 41 | $67,055 | $14,902 | $20,720 | 2.55 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 38 | $34,443 | $5,424 | $10,643 | 0.91 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 35 | $115,935 | $26,062 | $35,824 | 4.16 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 32 | $116,203 | $34,669 | $35,907 | 5.06 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 31 | $91,212 | $22,144 | $28,184 | 3.46 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 29 | $136,201 | $33,946 | $42,086 | 5.20 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 29 | $24,559 | $5,942 | $7,589 | 1.07 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 27 | $138,745 | $46,602 | $42,872 | 7.71 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 23 | $162,371 | $51,387 | $50,173 | 7.80 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 21 | $51,488 | $17,368 | $15,910 | 2.81 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 21 | $124,849 | $25,030 | $38,578 | 3.90 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 20 | $132,956 | $32,515 | $41,083 | 5.24 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 19 | $66,002 | $11,315 | $20,394 | 1.83 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 18 | $49,345 | $9,292 | $15,248 | 1.74 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 17 | $21,130 | $5,679 | $6,529 | 0.97 |
| Hypertension without MCCMS-DRG 305, medical | 15 | $26,044 | $3,953 | $8,048 | 0.75 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 14 | $132,896 | $30,575 | $41,065 | 5.88 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 14 | $93,513 | $30,004 | $28,896 | 4.81 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 14 | $46,453 | $9,860 | $14,354 | 1.54 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 13 | $41,105 | $9,726 | $12,702 | 1.58 |
| Percutaneous cardiovascular procedures without intraluminal device with MCCMS-DRG 250, surgical | 12 | $79,081 | $13,790 | $24,436 | 2.35 |
| Cardiac defibrillator implant without MCCMS-DRG 277, surgical | 12 | $169,985 | $32,636 | $52,525 | 4.78 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 12 | $30,877 | $3,768 | $9,541 | 0.72 |
| Chest painMS-DRG 313, medical | 12 | $24,910 | $3,855 | $7,697 | 0.72 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 12 | $101,690 | $27,809 | $31,422 | 4.14 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 11 | $264,775 | $59,671 | $81,815 | 9.71 |
| Hypertension with MCCMS-DRG 304, medical | 11 | $35,938 | $7,001 | $11,105 | 1.15 |
Respiratory system767 discharges in 19 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 144 | $42,333 | $10,219 | $13,081 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 91 | $28,781 | $8,086 | $8,893 | 1.33 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 83 | $26,289 | $5,608 | $8,123 | 0.99 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 72 | $20,512 | $4,464 | $6,338 | 0.82 |
| Major chest procedures with CCMS-DRG 164, surgical | 47 | $51,122 | $15,147 | $15,797 | 2.55 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 46 | $39,554 | $7,647 | $12,222 | 1.23 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 41 | $22,981 | $5,284 | $7,101 | 0.96 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 35 | $35,552 | $8,271 | $10,985 | 1.40 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 31 | $24,144 | $6,424 | $7,461 | 1.10 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 30 | $40,782 | $9,518 | $12,602 | 1.88 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 28 | $23,245 | $4,759 | $7,183 | 0.85 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 19 | $25,078 | $4,702 | $7,749 | 0.82 |
| Major chest procedures with MCCMS-DRG 163, surgical | 18 | $75,963 | $29,023 | $23,472 | 4.71 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 18 | $50,211 | $9,945 | $15,515 | 1.74 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 18 | $90,890 | $16,202 | $28,085 | 2.70 |
| Respiratory infections and inflammations without cc/mccMS-DRG 179, medical | 12 | $20,857 | $4,435 | $6,445 | 0.76 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 12 | $24,374 | $5,436 | $7,532 | 0.91 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 11 | $16,731 | $2,897 | $5,170 | 0.63 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 11 | $39,853 | $9,279 | $12,315 | 1.81 |
Digestive system740 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 96 | $24,807 | $5,784 | $7,665 | 0.98 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 91 | $46,388 | $14,788 | $14,334 | 2.37 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 84 | $22,396 | $4,239 | $6,920 | 0.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 64 | $109,766 | $30,012 | $33,918 | 4.52 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 51 | $44,972 | $11,795 | $13,896 | 1.79 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 47 | $33,281 | $9,125 | $10,284 | 1.67 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 44 | $21,800 | $3,919 | $6,736 | 0.80 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 39 | $35,544 | $8,060 | $10,983 | 1.28 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 37 | $19,600 | $5,683 | $6,057 | 0.94 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 30 | $24,756 | $5,641 | $7,650 | 1.04 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 27 | $37,138 | $10,182 | $11,476 | 1.62 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 19 | $47,004 | $10,608 | $14,524 | 1.75 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 16 | $121,458 | $34,014 | $37,531 | 5.08 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 16 | $19,632 | $2,474 | $6,066 | 0.56 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 15 | $81,550 | $26,856 | $25,199 | 4.28 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 14 | $34,461 | $7,701 | $10,648 | 1.45 |
| Peritoneal adhesiolysis without cc/mccMS-DRG 337, surgical | 13 | $32,762 | $9,084 | $10,124 | 1.50 |
| Digestive malignancy with MCCMS-DRG 374, medical | 13 | $34,121 | $12,811 | $10,543 | 2.10 |
| Digestive malignancy with CCMS-DRG 375, medical | 13 | $30,501 | $6,858 | $9,425 | 1.20 |
| Other digestive system diagnoses without cc/mccMS-DRG 395, medical | 11 | $17,023 | $3,215 | $5,260 | 0.65 |
Musculoskeletal system and connective tissue546 discharges in 19 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Medical back problems without MCCMS-DRG 552, medical | 60 | $22,667 | $5,159 | $7,004 | 0.97 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 52 | $54,205 | $12,386 | $16,749 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 48 | $66,906 | $12,803 | $20,674 | 2.11 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 47 | $94,049 | $21,385 | $29,061 | 3.66 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 41 | $73,623 | $11,471 | $22,750 | 1.88 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 31 | $109,591 | $28,894 | $33,863 | 4.61 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 31 | $97,449 | $16,729 | $30,112 | 2.67 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 27 | $20,787 | $4,976 | $6,423 | 0.90 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 26 | $120,363 | $23,330 | $37,192 | 3.49 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 26 | $44,736 | $8,437 | $13,823 | 1.59 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 24 | $25,385 | $6,005 | $7,844 | 1.09 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 23 | $64,991 | $18,379 | $20,082 | 2.95 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 23 | $46,663 | $12,658 | $14,419 | 2.04 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 16 | $125,500 | $37,696 | $38,779 | 6.12 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 16 | $90,912 | $17,583 | $28,092 | 2.96 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 16 | $19,776 | $4,387 | $6,111 | 0.79 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 14 | $24,495 | $4,690 | $7,569 | 0.82 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 13 | $111,255 | $14,452 | $34,378 | 2.48 |
| Medical back problems with MCCMS-DRG 551, medical | 12 | $37,926 | $10,619 | $11,719 | 1.70 |
Infectious and parasitic diseases501 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 | 316 | $52,272 | $11,791 | $16,152 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 63 | $130,384 | $30,330 | $40,289 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 56 | $30,660 | $5,997 | $9,474 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 23 | $154,044 | $38,787 | $47,600 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 18 | $38,454 | $9,153 | $11,882 | 1.84 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 13 | $58,855 | $11,009 | $18,186 | 2.04 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 12 | $38,581 | $11,996 | $11,922 | 2.14 |
Kidney and urinary tract496 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 131 | $21,139 | $4,551 | $6,532 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 102 | $24,345 | $6,761 | $7,523 | 1.17 |
| Renal failure with CCMS-DRG 683, medical | 69 | $22,791 | $5,292 | $7,042 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 58 | $38,783 | $10,592 | $11,984 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 49 | $17,997 | $5,977 | $5,561 | 1.02 |
| Renal failure with MCCMS-DRG 682, medical | 48 | $28,086 | $9,084 | $8,679 | 1.50 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 27 | $38,968 | $7,608 | $12,041 | 1.35 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 12 | $36,457 | $7,309 | $11,265 | 1.48 |
Nervous system420 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 | 70 | $33,968 | $5,570 | $10,496 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 66 | $47,223 | $11,167 | $14,592 | 2.00 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 43 | $31,307 | $7,554 | $9,674 | 1.36 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 35 | $29,222 | $5,806 | $9,030 | 1.14 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 28 | $24,653 | $3,229 | $7,618 | 0.69 |
| Seizures with MCCMS-DRG 100, medical | 21 | $54,001 | $11,124 | $16,686 | 1.98 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 20 | $94,064 | $28,828 | $29,066 | 4.42 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 19 | $39,527 | $9,090 | $12,214 | 1.47 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 18 | $25,778 | $5,467 | $7,965 | 1.03 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 16 | $41,329 | $11,887 | $12,771 | 1.79 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 15 | $44,087 | $11,317 | $13,623 | 1.81 |
| Extracranial procedures with CCMS-DRG 038, surgical | 15 | $32,131 | $9,281 | $9,928 | 1.60 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 15 | $41,540 | $12,425 | $12,836 | 2.39 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 14 | $26,232 | $4,391 | $8,106 | 0.80 |
| Seizures without MCCMS-DRG 101, medical | 14 | $31,112 | $5,278 | $9,614 | 0.91 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 11 | $25,915 | $5,839 | $8,008 | 1.03 |
Endocrine, nutritional and metabolic282 discharges in 7 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 | 91 | $21,003 | $4,328 | $6,490 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 86 | $28,250 | $7,305 | $8,729 | 1.32 |
| Diabetes with CCMS-DRG 638, medical | 27 | $21,436 | $5,286 | $6,624 | 0.90 |
| Endocrine disorders with MCCMS-DRG 643, medical | 23 | $36,992 | $9,460 | $11,431 | 1.65 |
| Diabetes with MCCMS-DRG 637, medical | 21 | $37,226 | $9,920 | $11,503 | 1.45 |
| O.r. procedures for obesity without cc/mccMS-DRG 621, surgical | 20 | $36,809 | $7,661 | $11,374 | 1.52 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 14 | $53,402 | $9,415 | $16,501 | 1.98 |
Liver, gallbladder and pancreas225 discharges in 12 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 37 | $48,889 | $9,714 | $15,107 | 1.63 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 29 | $49,733 | $11,350 | $15,367 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 27 | $40,990 | $10,384 | $12,666 | 1.76 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 21 | $21,586 | $5,067 | $6,670 | 0.86 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 17 | $34,436 | $5,652 | $10,641 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 16 | $47,907 | $13,868 | $14,803 | 2.32 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 16 | $24,261 | $4,565 | $7,497 | 0.95 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 14 | $41,284 | $6,491 | $12,757 | 1.31 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 14 | $40,904 | $9,702 | $12,639 | 1.83 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 12 | $31,056 | $6,316 | $9,596 | 1.03 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 11 | $71,234 | $18,625 | $22,011 | 2.89 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 11 | $37,905 | $12,621 | $11,713 | 1.92 |
Blood and immune system118 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 43 | $32,978 | $8,939 | $10,190 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 42 | $24,171 | $5,035 | $7,469 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 21 | $35,489 | $9,736 | $10,966 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 12 | $34,988 | $12,240 | $10,811 | 2.19 |
Skin, subcutaneous tissue and breast102 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 62 | $17,746 | $4,944 | $5,484 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 29 | $24,133 | $8,912 | $7,457 | 1.49 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 11 | $42,360 | $9,431 | $13,089 | 1.75 |
Other59 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 | 25 | $98,200 | $24,428 | $30,344 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 19 | $60,979 | $14,179 | $18,843 | 2.49 |
| Single level spinal fusion except cervical without MCCMS-DRG 451 | 15 | $87,904 | $19,361 | $27,162 |
Mental diseases and disorders51 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 | 40 | $28,372 | $10,061 | $8,767 | 1.76 |
| PsychosesMS-DRG 885, medical | 11 | $33,492 | $6,716 | $10,349 | 1.37 |
Injuries, poisonings and toxic effects of drugs47 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 | 18 | $45,247 | $10,912 | $13,981 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 17 | $20,690 | $6,489 | $6,393 | 1.03 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 12 | $83,476 | $20,154 | $25,794 | 3.72 |
Factors influencing health status37 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 | 26 | $19,138 | $4,448 | $5,914 | 0.80 |
| Other factors influencing health statusMS-DRG 951, medical | 11 | $13,259 | $3,404 | $4,097 | 0.59 |
Ear, nose, mouth and throat11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 11 | $27,790 | $3,868 | $8,587 | 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 |
|---|---|---|---|---|---|
| Level 1 Intraocular ProceduresAPC 5491 | 1,219 | 791 | $10,156 | $1,640 | $1,752 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 1,077 | 1,033 | $55,586 | $10,109 | $10,772 |
| Comprehensive Observation ServicesAPC 8011 | 724 | 698 | $14,986 | $1,920 | $2,090 |
| Level 1 Endovascular ProceduresAPC 5191 | 683 | 679 | $15,165 | $2,072 | $2,208 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 344 | 341 | $121,388 | $19,295 | $21,117 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 314 | 312 | $20,371 | $4,058 | $4,358 |
| Level 3 Endovascular ProceduresAPC 5193 | 303 | 288 | $45,172 | $8,048 | $8,874 |
| Level 2 Intraocular ProceduresAPC 5492 | 302 | 281 | $14,733 | $2,857 | $3,116 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 273 | 253 | $5,701 | $1,125 | $1,220 |
| Level 4 Urology and Related ServicesAPC 5374 | 227 | 189 | $15,710 | $2,452 | $2,629 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 210 | 208 | $22,896 | $4,985 | $5,339 |
| Level 3 Vascular ProceduresAPC 5183 | 206 | 201 | $12,169 | $2,264 | $2,405 |
| Level 2 Upper GI ProceduresAPC 5302 | 193 | 172 | $7,317 | $1,340 | $1,445 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 183 | 183 | $40,413 | $7,853 | $8,569 |
| Level 5 Urology and Related ServicesAPC 5375 | 175 | 161 | $16,753 | $3,688 | $3,918 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 152 | 152 | $27,897 | $7,352 | $8,164 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 149 | 136 | $11,836 | $2,716 | $2,930 |
| Level 2 Endovascular ProceduresAPC 5192 | 136 | 133 | $24,939 | $4,036 | $4,338 |
| Level 3 Urology and Related ServicesAPC 5373 | 130 | 113 | $9,090 | $1,433 | $1,516 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 125 | 124 | $20,457 | $4,601 | $4,982 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 111 | 109 | $87,393 | $14,974 | $15,763 |
| Level 4 Endovascular ProceduresAPC 5194 | 93 | 87 | $66,783 | $13,382 | $14,606 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 91 | 91 | $27,632 | $5,927 | $6,514 |
| Level 4 Airway EndoscopyAPC 5154 | 85 | 85 | $21,525 | $2,623 | $2,833 |
| Level 5 Airway EndoscopyAPC 5155 | 84 | 83 | $22,796 | $4,793 | $5,183 |
| Level 4 Vascular ProceduresAPC 5184 | 84 | 77 | $16,826 | $3,895 | $3,946 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 79 | 79 | $103,662 | $27,546 | $29,375 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 79 | 77 | $11,718 | $1,673 | $1,780 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 73 | 71 | $17,339 | $2,344 | $2,636 |
| Level 1 Nerve ProceduresAPC 5431 | 67 | 58 | $11,744 | $1,322 | $1,407 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 59 | 59 | $65,763 | $15,610 | $17,052 |
| Level 4 Gynecologic ProceduresAPC 5414 | 57 | 57 | $12,300 | $2,241 | $2,389 |
| Level 5 ENT ProceduresAPC 5165 | 53 | 53 | $18,905 | $4,042 | $4,436 |
| Level 5 Gynecologic ProceduresAPC 5415 | 51 | 51 | $21,238 | $3,563 | $3,792 |
| Level 3 Lower GI ProceduresAPC 5313 | 45 | 40 | $13,295 | $2,026 | $2,176 |
| Level 2 Vascular ProceduresAPC 5182 | 41 | 41 | $8,052 | $1,065 | $1,204 |
| Level 3 Intraocular ProceduresAPC 5493 | 38 | 33 | $18,692 | $3,645 | $4,004 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 36 | 36 | $15,184 | $2,257 | $2,373 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 35 | 34 | $7,916 | $1,153 | $1,196 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 34 | 34 | $12,236 | $1,978 | $2,141 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 34 | 32 | $57,466 | $16,956 | $18,465 |
| Level 3 Upper GI ProceduresAPC 5303 | 31 | 31 | $20,044 | $2,659 | $2,888 |
| Level 6 Gynecologic ProceduresAPC 5416 | 31 | 31 | $23,770 | $5,420 | $5,836 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 28 | 28 | $43,393 | $5,357 | $5,682 |
| Level 6 Urology and Related ServicesAPC 5376 | 21 | 21 | $22,427 | $6,661 | $7,291 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 18 | 18 | $46,662 | $19,536 | $21,011 |
| Complex GI ProceduresAPC 5331 | 17 | 15 | $23,439 | $4,088 | $4,263 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 17 | 16 | $78,657 | $23,156 | $26,719 |
| Level 3 Airway EndoscopyAPC 5153 | 15 | 15 | $8,461 | $1,217 | $1,264 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 15 | 15 | $32,655 | $4,893 | $4,524 |
| Level 8 Urology and Related ServicesAPC 5378 | 13 | 13 | $65,303 | $16,488 | $17,428 |
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.