APR-DRG Description Ave Charge
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1 Abdominal Pain 16, , Acute & Subacute Endocarditis 15, , Acute Myocardial Infarction 17, , Alcohol Abuse & Dependence 19, , Alcoholic Liver Disease 21, , Allergic Reactions 6, , Amputation of Lower Limb Except Toes 30, , Anal Procedures 15, , Angina Pectoris & Coronary Atherosclerosis 8, , Appendectomy 31, , Asthma 13, , Bacterial & Tuberculous Infections of Nervous System 6, , Cardiac Arrest 16, , Cardiac Arrhythmia & Conduction Disorders 15, , Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease 38, , Cardiac Pacemaker & Defibrillator Device Replacement 21, , Cellulitis & Other Bacterial Skin Infections 13, , Cesarean Delivery 13, , Chest Pain 6, , Chronic Obstructive Pulmonary Disease 16, , Coagulation & Platelet Disorders 30, , Connective Tissue Disorders 13, , Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue 3, , CVA & Precerebral Occulusion w/ Infarct 24, , D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses 16, , Degenerative Nervous System Disorders Exc Mult Sclerosis 26, , Dental & Oral Diseases & Injuries 8, , Depression Except Major Depressive Disorder 13, , Diabetes 13, , Digestive Malignancy 14, , Disorders of Pancreas Except Malignancy 13, , Disorders of the Gallbladder & Biliary Tract 11, , Diverticulitis & Diverticulosis 13, , Page: 1 of 5
2 Drug & Alcohol Abuse or Dependence, Left Against Medical Advice 6, , Electrolyte Disorders Except Hypovolemia Related 10, , False Labor 2, , Fever 18, , Foot & Toe Procedures 24, , Fracture of Pelvis or Dislocation of Hip 6, , Fracture or Dislocation Except Femur, Pelvis & Back 7, , Fractures of Femur 7, , Gastrointestinal Vascular Insufficiency 13, , Heart Failure 16, , Hepatic Coma & Other Major Acute Liver Disorders 15, , Hernia Procedures Except Inguinal, Femoral & Umbilical 28, , Hip & Femur Procedures for Non-Trauma Except Joint Replacement 22, , Hip & Femur Procedures for Trauma Except Joint Replacement 24, , Hip Joint Replacement 46, , Hypertension 16, , Hypovolemia & Related Electrolyte Disorders 11, , Infections Of The Upper Respiratory Tract 12, , Infectious & Parasitic Diseases Including HIV W O.R. Procedure 40, , Inflammatory Bowel Disease 11, , Inguinal, Femoral & Umbilical Hernia Procedures 17, , Interstitial Lung Disease 11, , Intestinal Obstruction 10, , Kidney & Urinary Tract Infections 13, , Kidney & Urinary Tract Procedures for Nonmalignancy 28, , Knee & Lower Leg Procedures Except Foot 27, , Knee Joint Replacement 40, , Laparoscopic Cholecystectomy 32, , Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior 22, , Major Bladder Procedures 43, , Major Chest & Respiratory Trauma 13, , Major Esophageal Disorders 23, , Major Gastrointestinal & Peritoneal Infections 20, , Page: 2 of 5
3 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul 13, , Major Pancreas, Liver & Shunt Procedures 26, , Major Respiratory & Chest Procedures 25, , Major Respiratory Infections & Inflammations 22, , Major Small & Large Bowel Procedures 42, , Male Reproductive System Diagnoses Except Malignancy 11, , Malfunction, Reaction & Comp of Orthopedic Device or Procedure 20, , Malfunction, Reaction & Complic of Genitourinary Device Or Proc 16, , Malfunction, Reaction & Complication Of G.I. Device Or Procedure 18, , Malignancy of Hepatobiliary System & Pancreas 13, , Malnutrition, Failure To Thrive & Other Nutritional Disorders 13, , Mastectomy Procedures 24, , Menstrual & Other Female Reproductive System Disorders 26, , Minor Small & Large Bowel Procedures 23, , Moderately Extensive Procedure Unrelated To Principal Diagnosis 30, , Neonate, Birthwt > 2499g W Other Significant Condition 3, , Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond 4, , Neonate, Birthwt > 2499g w/ Major Anomaly 3, , Neonate, Birthwt G W OR W/O Other Significant Condition 11, , Neonate, Birthwt G W OR W/O Other Significant Condition 3, , Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem 2, , Neonate, BWT G W Major Anomaly 3, , Neonate, BWT G, Normal Newborn Or Neonate W Other Problem 2, , Neonate, Transferred <5 Days Old, Born Here 2, , Nervous System Malignancy 15, , Non-Bacterial Gastroenteritis, Nausea & Vomiting 15, , Nonextensive Procedure Unrelated To Principal Diagnosis 14, , Nontraumatic Stupor & Coma 19, , O.R. Procedure For Other Complications Of Treatment 66, , Opioid Abuse & Dependence 16, , Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections 19, , Other & Unspecified Gastrointestinal Hemorrhage 16, , Other Aftercare & Convalescence 1, , Page: 3 of 5
4 Other Anemia & Disorders Of Blood & Blood Forming Organs 19, , Other Antepartum Diagnoses 7, , Other Back & Neck Disorders, Fractures & Injuries 15, , Other Bladder Procedures 18, , Other Circulatory System Diagnoses 30, , Other Complications of Treatment 13, , Other Digestive System & Abdominal Procedures 14, , Other Digestive System Diagnoses 17, , Other Disorders of Nervous System 19, , Other Disorders Of The Liver 28, , Other Ear, Nose, Mouth & Throat Procedures 69, , Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses 5, , Other Endocrine Disorders 20, , Other Esophageal Disorders 8, , Other Female Reproductive System & Related Procedures 22, , Other Hepatobiliary, Pancreas & Abdominal Procedures 36, , Other Infectious & Parasitic Diseases 11, , Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms 14, , Other Kidney, Urinary Tract & Related Procedures 29, , Other Musculoskeletal System & Connective Tissue Diagnoses 13, , Other Nervous System & Related Procedures 14, , Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses 39, , Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms 21, , Other Pneumonia 16, , Other Respiratory & Chest Procedures 50, , Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses 22, , Other Skin, Subcutaneous Tissue & Breast Disorders 13, , Other Skin, Subcutaneous Tissue & Related Procedures 19, , Other Vascular Procedures 19, , Peptic Ulcer & Gastritis 20, , Peripheral & Other Vascular Disorders 8, , Peripheral, Cranial & Autonomic Nerve Disorders 29, , Peritoneal Adhesiolysis 28, , Page: 4 of 5
5 Poisoning Of Medicinal Agents 18, , Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure 32, , Post-Operative, Post-Traumatic, Other Device Infections 20, , Postpartum & Post Abortion Diagnoses w/o Procedure 15, , Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 19, , Pulmonary Edema & Respiratory Failure 22, , Pulmonary Embolism 17, , Renal Failure 13, , Respiratory Malignancy 25, , Respiratory System Diagnosis w/ Ventilator Support 96+ Hours 63, , Respiratory System Signs, Symptoms & Other Diagnoses 15, , Seizure 24, , Septicemia & Disseminated Infections 21, , Shoulder, Upper Arm & Forearm Procedures 45, , Sickle Cell Anemia Crisis 5, , Signs, Symptoms & Other Factors Influencing Health Status 11, , Skin Ulcers 14, , Syncope & Collapse 17, , Threatened Abortion 2, , Tonsill & Adenoid Procedures 17, , Toxic Effects Of Non-Medicinal Substances 20, , Urethral & Transurethral Procedures 19, , Urinary Stones & Acquired Upper Urinary Tract Obstruction 8, , Uterine & Adnexa Procedures For Leiomyoma 17, , Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma 39, , Vaginal Delivery 6, , Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C 8, , Vaginal Delivery w/ Sterilization &/or D&C 11, , Vertigo & Other Labyrinth Disorders 18, , Page: 5 of 5
All Medicaid (APR) DRG 2015
All Medicaid (APR) DRG 2015 DRG DRG Description Avg. Charge 251 Abdominal Pain $9,517.49 564 Abortion w/o D&C, Aspiration Curettage or Hysterotomy $8,133.15 193 Acute & Subacute Endocarditis $13,780.84
DRG Code DRG Description FY18 Average Charge
DRG Code DRG Description FY18 Average Charge 3 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O $ 665,511 4 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $ 422,497 37 EXTRACRANIAL
Randolph Health Average Inpatient DRG Charge
004 Trach W Mv >96 Hrs Or Pdx Exc Face, Mouth & Neck W/O Maj O.R. 244,470 040 Periph/Cranial Nerve & Other Nerv Syst Proc W Mcc 61,412 041 Periph/Cranial Nerve & Other Nerv Syst Proc W Cc Or Periph Neurostim
SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 84, ,037.80
Inpatient Visits by DRG Inpatient Discharges between 10/01/17 and 09/30/18 DRG DRG Description Average Charge Self-Pay Price VAGINAL DELIVERY W/O COMPLICATING 775 DIAGNOSES 14,680.67 5,578.66 795 NORMAL
State of Florida: Patients Admitted with APR DRG 194 Heart Failure Reasons for Readmission
Patients Readmitted within 15 days pril 2007 - arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of Heart Failure 2,778 42.1% 2,201 392 185 401 31.2% 650 42.5% 1,459 45.5%
Average Gross Charges ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC ,254 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC - 280
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC - 281 15,254 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC - 280 24,827 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC - 282 11,575 AFTERCARE,
Maine Workers' Compensation Board Medical Fee Schedule
001 SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 29.1 26.4106 $243,431.25 $257,869.40 002 SURG SYSTEM W/O MCC 15.1 13.4227 $123,719.44 $131,057.36 003 SURG MOUTH & NECK W MAJ O.R. 23.4
State of Florida: Patients Admitted with APR DRG 139 Other Pneumonia. Reasons for Readmission
Patients Readmitted within 15 days pril 2007 - arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of Other Pneumonia 589 18.5% 507 66 16 88 12.0% 81 15.0% 333 21.1% 87 26.8%
004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27,845.
DRG Number DRG Name DRG Average Charge 004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134,495.54 011 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27,845.14 012 TRACHEOSTOMY FOR
APC/DRG Code APC/DRG Name # of Discharges Average of Charges 5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9, ACUTE ADJUSTMENT
5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9,950 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION MS 3 $8,161 62 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC MS 10 $30,145
DRG DRG DESCRIPTION AVE CHARGE AVE DAYS 4 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $176, TRACHEOSTOMY FOR
DRG DRG DESCRIPTION AVE CHARGE AVE DAYS 4 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $176,341.00 13.0 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $82,442.00 11.0 25 CRANIOTOMY
Orange Regional Medical Center Average Charge Per Inpatient Case - based on MS DRG
Per Inpatient Case - based on MS DRG 003 ECMO or trach w MV 96+ hrs or pdx exc face, mouth & neck w maj O.R. 737,213 004 Trach w MV 96+ hrs or pdx exc face, mouth & neck w/o maj O.R. 298,769 011 Tracheostomy
National Average Payment (Ver 30.0) Average Length of Stay (in days) Average Charge Per Stay. Average Charge Per Day.
Per 2013 1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 221 11,675 $223,519,640 1 $139,225.55 $1,011,401 $19,145 52.8 2013 2 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 54 1,440
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ALL Other (MS) DRG 2015
ALL Other (MS) DRG 2015 DRG DRG Description Avg. Charge 770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $8,072.48 779 ABORTION W/O D&C $9,405.76 289 ACUTE & SUBACUTE ENDOCARDITIS W CC $20,196.02
DRG ECPS/MMIS Data Table Version 27 Grouper, Claims Data from hospitals' fiscal year 2009
001 Craniotomy Age >17 W CC 83 2 30,245 23,882 28,389 16,451 20 Yes 3.5716 002 Craniotomy Age >17 W/O CC 109 1 18,050 10,118 17,513 8,683 14 Yes 2.2033 006 Carpal Tunnel Release 2-5,480 761 5,480 761 999
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Average DRG Description
Leesburg Regional Medical Center Inpatient Data Average Charge per DRG 12 Months Ending Quarter 1 of 2018 Average DRG Description Charge 3 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ
Raw Average Raw Cost. Cost
Average StDev Claims with s Capped at old 1.0463 Average Stable Weight 001 Craniotomy Age >17 W CC 23 2 27,256 13,023 26,840 12,010 12 3.4255 3.4210 NJ_MK 3.4210 3.5794 26 52,782 002 Craniotomy Age >17
770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $27, ABORTION W/O D&C $17, ACUTE & SUBACUTE ENDOCARDITIS W CC $34,537.
DRG Code DRG Definition Average Charges 770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $27,846.73 779 ABORTION W/O D&C $17,218.06 289 ACUTE & SUBACUTE ENDOCARDITIS W CC $34,537.58 880 ACUTE ADJUSTMENT
Average DRG DRG Description
s by DRG 3 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. $466,547 4 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $513,102 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES
1 640 Normal Newborn, Birthweight 2500g+ $3,741 $2,245 $ Vaginal Delivery $9,133 $5,480 $2,192
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1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC $762,065.15 2 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC $552,519.55 3 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK
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1 640 Normal Newborn, Birthweight 2500g+ $2,718 $1,658 $ Vaginal Delivery $6,410 $3,910 $2,244
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1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 0 $0 2 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 0 0 3 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 0
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1 640 Normal Newborn, Birthweight 2500g+ $3,032 $1,850 $1, Vaginal Delivery $6,350 $3,874 $2,223
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