{ "study": { "slug": "hospital-charges-by-drg", "title": "What Hospitals Charge for the Same Procedure (2024)", "url": "https://fonteum.com/research/hospital-charges-by-drg", "methodology_version": "hospital-charges-by-drg/v1" }, "data_as_of": "2026-06-12", "temporal_coverage": "2024", "sources": [ { "name": "CMS Medicare Inpatient Hospitals — by Provider and Service, data year 2024", "publisher": "U.S. Centers for Medicare & Medicaid Services", "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-inpatient-hospitals", "release_date": "2026-06-11", "retrieved_at": "2026-06-12", "license": "U.S. Government Works (17 U.S.C. §105)" } ], "headline": { "data_year": 2024, "hospital_by_drg_rows": 145879, "hospitals": 2906, "ms_drgs": 540, "discharges": 4952481, "mean_covered_charge_usd": 92408, "mean_total_payment_usd": 18360, "mean_medicare_payment_usd": 15166, "charge_to_payment_ratio": 5.03, "showcase_drg": "470" }, "sections": [ { "id": "by_drg", "label": "Featured MS-DRGs — charge distribution across hospitals", "columns": [ "ms_drg", "label", "cms_description", "hospitals", "discharges", "min_charge_usd", "p10_charge_usd", "median_charge_usd", "p90_charge_usd", "max_charge_usd", "mean_charge_usd", "mean_payment_usd", "max_min_ratio", "p90_p10_ratio", "highest_state", "highest_state_mean_charge_usd", "lowest_state", "lowest_state_mean_charge_usd", "state_ratio" ], "rows": [ { "ms_drg": "871", "label": "Sepsis (severe, with MCC)", "cms_description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "hospitals": 2661, "discharges": 577119, "min_charge_usd": 10088, "p10_charge_usd": 32161, "median_charge_usd": 65249, "p90_charge_usd": 140999, "max_charge_usd": 591962, "mean_charge_usd": 90381, "mean_payment_usd": 18230, "max_min_ratio": 58.7, "p90_p10_ratio": 4.4, "highest_state": "NV", "highest_state_mean_charge_usd": 185672, "lowest_state": "MD", "lowest_state_mean_charge_usd": 26919, "state_ratio": 6.9 }, { "ms_drg": "291", "label": "Heart failure & shock (with MCC)", "cms_description": "HEART FAILURE AND SHOCK WITH MCC", "hospitals": 2587, "discharges": 304694, "min_charge_usd": 8827, "p10_charge_usd": 22190, "median_charge_usd": 43409, "p90_charge_usd": 96115, "max_charge_usd": 437712, "mean_charge_usd": 56495, "mean_payment_usd": 12050, "max_min_ratio": 49.6, "p90_p10_ratio": 4.3, "highest_state": "NV", "highest_state_mean_charge_usd": 102739, "lowest_state": "MD", "lowest_state_mean_charge_usd": 18459, "state_ratio": 5.6 }, { "ms_drg": "193", "label": "Pneumonia & pleurisy (with MCC)", "cms_description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "hospitals": 2442, "discharges": 136649, "min_charge_usd": 9396, "p10_charge_usd": 24559, "median_charge_usd": 46587, "p90_charge_usd": 101466, "max_charge_usd": 375925, "mean_charge_usd": 60101, "mean_payment_usd": 12020, "max_min_ratio": 40, "p90_p10_ratio": 4.1, "highest_state": "NV", "highest_state_mean_charge_usd": 110500, "lowest_state": "MD", "lowest_state_mean_charge_usd": 17060, "state_ratio": 6.5 }, { "ms_drg": "280", "label": "Heart attack — survived (with MCC)", "cms_description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "hospitals": 1825, "discharges": 83841, "min_charge_usd": 11208, "p10_charge_usd": 32825, "median_charge_usd": 61366, "p90_charge_usd": 128249, "max_charge_usd": 448234, "mean_charge_usd": 76887, "mean_payment_usd": 14805, "max_min_ratio": 40, "p90_p10_ratio": 3.9, "highest_state": "NV", "highest_state_mean_charge_usd": 135319, "lowest_state": "MD", "lowest_state_mean_charge_usd": 24009, "state_ratio": 5.6 }, { "ms_drg": "689", "label": "Kidney / urinary-tract infection (with MCC)", "cms_description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "hospitals": 1945, "discharges": 79740, "min_charge_usd": 8670, "p10_charge_usd": 22594, "median_charge_usd": 40751, "p90_charge_usd": 89143, "max_charge_usd": 380378, "mean_charge_usd": 52052, "mean_payment_usd": 10698, "max_min_ratio": 43.9, "p90_p10_ratio": 3.9, "highest_state": "NV", "highest_state_mean_charge_usd": 103464, "lowest_state": "MD", "lowest_state_mean_charge_usd": 16746, "state_ratio": 6.2 }, { "ms_drg": "065", "label": "Stroke (incl. clot-buster tPA)", "cms_description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "hospitals": 1727, "discharges": 68157, "min_charge_usd": 10682, "p10_charge_usd": 25540, "median_charge_usd": 45544, "p90_charge_usd": 100197, "max_charge_usd": 363815, "mean_charge_usd": 56315, "mean_payment_usd": 9911, "max_min_ratio": 34.1, "p90_p10_ratio": 3.9, "highest_state": "NV", "highest_state_mean_charge_usd": 98453, "lowest_state": "MD", "lowest_state_mean_charge_usd": 15480, "state_ratio": 6.4 }, { "ms_drg": "470", "label": "Major hip / knee joint replacement", "cms_description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "hospitals": 1212, "discharges": 59121, "min_charge_usd": 19194, "p10_charge_usd": 42710, "median_charge_usd": 79947, "p90_charge_usd": 167283, "max_charge_usd": 383606, "mean_charge_usd": 92976, "mean_payment_usd": 17318, "max_min_ratio": 20, "p90_p10_ratio": 3.9, "highest_state": "NV", "highest_state_mean_charge_usd": 187520, "lowest_state": "MD", "lowest_state_mean_charge_usd": 27939, "state_ratio": 6.7 }, { "ms_drg": "190", "label": "COPD (with MCC)", "cms_description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "hospitals": 1595, "discharges": 49661, "min_charge_usd": 11158, "p10_charge_usd": 22754, "median_charge_usd": 41850, "p90_charge_usd": 86174, "max_charge_usd": 314888, "mean_charge_usd": 50958, "mean_payment_usd": 10575, "max_min_ratio": 28.2, "p90_p10_ratio": 3.8, "highest_state": "CA", "highest_state_mean_charge_usd": 94847, "lowest_state": "MD", "lowest_state_mean_charge_usd": 16718, "state_ratio": 5.7 } ] }, { "id": "showcase_by_state", "label": "Mean covered charge by state for MS-DRG 470 (states with 5+ reporting hospitals)", "columns": [ "state", "hospitals", "mean_charge_usd" ], "rows": [ { "state": "NV", "hospitals": 9, "mean_charge_usd": 187520 }, { "state": "NM", "hospitals": 6, "mean_charge_usd": 162040 }, { "state": "CO", "hospitals": 17, "mean_charge_usd": 151836 }, { "state": "FL", "hospitals": 88, "mean_charge_usd": 141350 }, { "state": "CA", "hospitals": 119, "mean_charge_usd": 139092 }, { "state": "TX", "hospitals": 77, "mean_charge_usd": 112676 }, { "state": "AZ", "hospitals": 29, "mean_charge_usd": 111317 }, { "state": "NY", "hospitals": 56, "mean_charge_usd": 109029 }, { "state": "VA", "hospitals": 34, "mean_charge_usd": 108341 }, { "state": "AL", "hospitals": 24, "mean_charge_usd": 103212 }, { "state": "GA", "hospitals": 27, "mean_charge_usd": 96366 }, { "state": "LA", "hospitals": 10, "mean_charge_usd": 95335 }, { "state": "KY", "hospitals": 14, "mean_charge_usd": 94698 }, { "state": "MS", "hospitals": 14, "mean_charge_usd": 94224 }, { "state": "SC", "hospitals": 19, "mean_charge_usd": 92947 }, { "state": "WA", "hospitals": 26, "mean_charge_usd": 91317 }, { "state": "NJ", "hospitals": 26, "mean_charge_usd": 91075 }, { "state": "IN", "hospitals": 34, "mean_charge_usd": 86276 }, { "state": "TN", "hospitals": 29, "mean_charge_usd": 81997 }, { "state": "IL", "hospitals": 45, "mean_charge_usd": 77882 }, { "state": "ID", "hospitals": 7, "mean_charge_usd": 77034 }, { "state": "PA", "hospitals": 64, "mean_charge_usd": 76683 }, { "state": "OK", "hospitals": 26, "mean_charge_usd": 73994 }, { "state": "NH", "hospitals": 8, "mean_charge_usd": 71785 }, { "state": "NC", "hospitals": 40, "mean_charge_usd": 70787 }, { "state": "OH", "hospitals": 42, "mean_charge_usd": 70129 }, { "state": "WI", "hospitals": 20, "mean_charge_usd": 68802 }, { "state": "UT", "hospitals": 14, "mean_charge_usd": 68166 }, { "state": "OR", "hospitals": 13, "mean_charge_usd": 66864 }, { "state": "WV", "hospitals": 10, "mean_charge_usd": 65462 }, { "state": "WY", "hospitals": 5, "mean_charge_usd": 65123 }, { "state": "MO", "hospitals": 32, "mean_charge_usd": 64921 }, { "state": "NE", "hospitals": 11, "mean_charge_usd": 64039 }, { "state": "CT", "hospitals": 12, "mean_charge_usd": 63224 }, { "state": "MI", "hospitals": 37, "mean_charge_usd": 62892 }, { "state": "AR", "hospitals": 10, "mean_charge_usd": 60567 }, { "state": "KS", "hospitals": 21, "mean_charge_usd": 58017 }, { "state": "IA", "hospitals": 15, "mean_charge_usd": 57837 }, { "state": "MT", "hospitals": 6, "mean_charge_usd": 56937 }, { "state": "MN", "hospitals": 20, "mean_charge_usd": 54556 }, { "state": "SD", "hospitals": 9, "mean_charge_usd": 52111 }, { "state": "MA", "hospitals": 39, "mean_charge_usd": 43430 }, { "state": "MD", "hospitals": 25, "mean_charge_usd": 27939 } ] }, { "id": "showcase_hospital_examples", "label": "Highest- and lowest-charging named hospitals for MS-DRG 470", "columns": [ "band", "hospital", "city", "state", "discharges", "avg_covered_charge_usd", "avg_total_payment_usd" ], "rows": [ { "band": "highest", "hospital": "MEDICAL CITY PLANO", "city": "PLANO", "state": "TX", "discharges": 67, "avg_covered_charge_usd": 341612, "avg_total_payment_usd": 16916 }, { "band": "highest", "hospital": "GOOD SAMARITAN HOSPITAL", "city": "SAN JOSE", "state": "CA", "discharges": 52, "avg_covered_charge_usd": 327882, "avg_total_payment_usd": 20833 }, { "band": "highest", "hospital": "MEDICAL CITY MCKINNEY", "city": "MCKINNEY", "state": "TX", "discharges": 78, "avg_covered_charge_usd": 314538, "avg_total_payment_usd": 16842 }, { "band": "highest", "hospital": "CJW MEDICAL CENTER", "city": "RICHMOND", "state": "VA", "discharges": 108, "avg_covered_charge_usd": 312023, "avg_total_payment_usd": 13531 }, { "band": "highest", "hospital": "CARONDELET ST. JOSEPH HOSPITAL", "city": "TUCSON", "state": "AZ", "discharges": 34, "avg_covered_charge_usd": 308825, "avg_total_payment_usd": 14912 }, { "band": "lowest", "hospital": "ST. JOSEPH MEDICAL CENTER", "city": "TOWSON", "state": "MD", "discharges": 113, "avg_covered_charge_usd": 20699, "avg_total_payment_usd": 18420 }, { "band": "lowest", "hospital": "ANNE ARUNDEL MEDICAL CENTER INC.", "city": "ANNAPOLIS", "state": "MD", "discharges": 140, "avg_covered_charge_usd": 21430, "avg_total_payment_usd": 19777 }, { "band": "lowest", "hospital": "BEVERLY HOSPITAL", "city": "BEVERLY", "state": "MA", "discharges": 195, "avg_covered_charge_usd": 22194, "avg_total_payment_usd": 16152 }, { "band": "lowest", "hospital": "SUBURBAN HOSPITAL", "city": "BETHESDA", "state": "MD", "discharges": 65, "avg_covered_charge_usd": 22938, "avg_total_payment_usd": 20521 }, { "band": "lowest", "hospital": "ANNA JAQUES HOSPITAL", "city": "NEWBURYPORT", "state": "MA", "discharges": 80, "avg_covered_charge_usd": 24248, "avg_total_payment_usd": 15691 } ] } ], "limitations": [ "Charges are not prices. A covered charge is a hospital's list price, not what Medicare, an insurer, or a patient pays; Medicare reimburses a fixed DRG rate.", "Correlational, not causal. The study describes how charges differ across hospitals and states; it does not explain why, and charge levels are not a measure of care quality, efficiency, or patient outcomes.", "Medicare fee-for-service only, one year. The file covers traditional Medicare Part A inpatient stays for 2024 and excludes Medicare Advantage, Medicaid, and commercial payers.", "Hospital-level averages, with suppression. CMS publishes a per-hospital average per DRG, not individual bills, and suppresses hospital-DRG cells with fewer than 11 discharges, so very low-volume combinations are absent and within-hospital variation is hidden.", "A DRG is a category, not a single operation. Case mix within a DRG differs across hospitals, which explains part — but far from all — of the charge variation.", "State coverage. Hospitals join to a state via CCN; a handful of facilities without a directory match are excluded from the state-level tables only." ], "reproducible_sql": "-- Headline: charges vs payments, discharge-weighted across the whole file\nSELECT\n count(*) AS rows,\n count(distinct ccn) AS hospitals,\n count(distinct ms_drg_code) AS drgs,\n sum(total_discharges) AS discharges,\n round(sum(avg_covered_charges * total_discharges)\n / sum(total_discharges)) AS mean_covered_charge,\n round(sum(avg_total_payments * total_discharges)\n / sum(total_discharges)) AS mean_total_payment,\n round((sum(avg_covered_charges * total_discharges)\n / sum(total_discharges))\n / (sum(avg_total_payments * total_discharges)\n / sum(total_discharges)), 2) AS charge_to_payment_ratio\nFROM inpatient_utilization_summary;\n\n-- Cross-hospital charge distribution for one DRG (here a joint replacement)\nSELECT\n min(avg_covered_charges) AS min_charge,\n percentile_cont(0.10) WITHIN GROUP (ORDER BY avg_covered_charges) AS p10,\n percentile_cont(0.50) WITHIN GROUP (ORDER BY avg_covered_charges) AS median,\n percentile_cont(0.90) WITHIN GROUP (ORDER BY avg_covered_charges) AS p90,\n max(avg_covered_charges) AS max_charge\nFROM inpatient_utilization_summary\nWHERE ms_drg_code = '470';\n\n-- Charge by state for one DRG (states with >= 5 reporting hospitals)\nSELECT d.state,\n count(*) AS hospitals,\n round(sum(i.avg_covered_charges * i.total_discharges)\n / sum(i.total_discharges)) AS mean_charge\nFROM inpatient_utilization_summary i\nJOIN hospital_directory d ON d.ccn = i.ccn\nWHERE i.ms_drg_code = '470'\nGROUP BY d.state\nHAVING count(*) >= 5\nORDER BY mean_charge DESC;", "license": "U.S. Government Works (17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the as-of date above. Re-derive by running the published query against the named source file; no per-person records are included." }