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Range of Medicare Payments (Low-25th Percentile/High-75th Percentile) for Top Five Elective Inpatient Hospital Procedures, FY2006

Bar Graph Table Map Map & Table
  Rank by: 
Rank Order:



 Hip/Knee Replacement LowHip/Knee Replacement HighGallbladder Removal By Laparoscope With Complications or Preexisting Conditions LowGallbladder Removal By Laparoscope With Complications or Preexisting Conditions HighInsertion of Heart Defibrillator LowInsertion of Heart Defibrillator HighBack & Neck Operations Except Back or Neck Fusion LowBack & Neck Operations Except Back or Neck Fusion HighRepair of Previous Hip or Knee Replacement LowRepair of Previous Hip or Knee Replacement High
 
United States$10,085$12,257$9,474$11,378$29,410$37,779$7,258$9,010$12,763$16,228
 
Alabama$9,448$10,487$8,896$9,889$26,788$30,855$6,695$7,475$11,785$13,244
Alaska$14,150$16,600$13,798$15,565$41,548NA$9,963$14,237$18,060$20,981
Arizona$10,265$11,826$9,835$11,158$28,901$37,210$7,395$10,473$12,822$14,793
Arkansas$9,509$10,554$9,070$9,844$26,993$30,041$6,780$7,678$12,228$13,783
California$12,029$15,071$11,717$14,367$35,284$45,237$8,933$11,087$15,156$20,067
Colorado$10,450$11,448$9,902$10,817$29,973$33,010$7,473$8,490$13,084$15,240
Connecticut$12,062$14,020$11,262$13,246$39,450$43,395$9,250$9,994$15,265$17,607
Delaware$10,607$12,392$9,906$11,708$34,912$35,256$7,953$8,833$13,213$15,701
District of Columbia$10,913$14,583$10,189$13,977$38,954$43,124$9,760$10,533$13,798$18,907
Florida$9,796$10,653$9,243$10,238$27,977$31,776$6,967$7,664$12,307$13,916
Georgia$10,019$11,565$9,801$10,794$28,788$35,705$7,101$8,946$12,663$15,081
Hawaii$12,259$14,832$11,505$13,553$33,821$42,624$8,473$10,443$15,210$18,746
Idaho$10,107$10,956$9,603$10,339$30,212$30,346$7,116$7,714$12,712$13,647
Illinois$10,574$12,106$9,944$11,424$30,102$36,761$7,542$9,210$13,373$16,532
Indiana$10,089$10,853$9,539$10,193$28,355$32,108$7,108$7,783$12,520$14,184
Iowa$9,761$10,662$9,168$9,900$28,091$30,517$6,916$7,847$12,052$13,724
Kansas$9,593$10,637$9,108$10,055$26,961$30,278$6,755$7,565$11,982$13,617
Kentucky$9,824$11,178$9,282$10,678$29,875$32,496$7,258$8,096$12,237$13,879
Louisiana$9,750$10,866$9,100$10,267$27,419$30,916$7,051$7,867$12,331$14,121
Maine$10,756$12,590$10,100$11,285$29,416$35,819$8,026$8,974$13,677$15,914
Maryland$13,579$19,575$7,633$14,964$29,649$49,184$5,653$11,892$13,519$28,002
Massachusetts$11,664$15,144$10,886$12,618$37,828$46,109$8,213$10,719$14,742$19,558
Michigan$10,589$12,579$9,996$11,885$32,141$37,315$7,801$9,029$13,352$16,095
Minnesota$10,896$11,667$10,199$10,889$31,860$37,310$7,967$9,399$13,819$16,756
Mississippi$10,230$11,230$9,189$10,584$27,675$31,871$7,226$7,940$12,959$14,353
Missouri$9,749$10,780$9,165$10,149$27,597$33,642$6,919$7,721$12,005$14,147
Montana$9,820$10,508$9,185$10,033$27,659$28,328$6,978$7,425$12,439$13,372
Nebraska$10,035$11,130$9,555$10,419$28,203$33,431$7,066$7,933$12,939$16,420
Nevada$10,707$11,810$10,359$11,206$33,745$36,213$7,966$9,073$13,275$15,033
New Hampshire$11,226$12,037$10,484$10,895$31,571$44,948$7,899$8,475$14,178$20,214
New Jersey$11,658$13,726$10,983$12,956$36,420$41,761$8,324$9,928$14,630$17,717
New Mexico$10,279$11,954$10,007$11,545$28,658$35,884$7,373$8,991$13,552$15,908
New York$10,443$15,245$10,070$15,467$35,036$50,933$7,607$11,712$14,172$20,946
North Carolina$10,269$11,489$9,708$10,825$30,882$38,668$7,535$8,763$12,774$14,672
North Dakota$9,540$10,563$8,891$9,858$28,294$31,345$6,708$7,153$12,282$13,373
Ohio$9,737$11,050$9,198$10,291$29,622$34,652$7,352$8,641$12,447$15,200
OklahomaNANANANANANANANANANA
Oregon$11,109$12,220$10,610$11,545$31,518$34,766$8,102$8,803$13,971$16,074
Pennsylvania$9,946$11,618$9,289$10,715$30,157$35,426$7,330$8,756$12,765$15,932
Rhode Island$11,279$15,327$10,328$12,169$43,607$44,646$8,412$11,186$13,987$18,963
South Carolina$10,142$11,412$9,500$10,596$28,504$36,623$7,242$8,671$12,819$15,619
South Dakota$9,718$10,856$9,767$10,229$27,743$30,509$7,497$7,644$12,937$13,722
Tennessee$9,829$11,445$9,174$10,561$29,040$33,327$7,269$8,003$12,323$14,303
Texas$10,106$11,826$9,610$11,173$29,006$34,598$7,216$8,429$12,932$15,302
Utah$9,923$11,347$9,483$10,648$30,631$39,481$7,275$8,249$12,330$16,611
Vermont$11,145$15,373$9,856$10,624$43,204NA$7,847$10,824$14,355$19,430
Virginia$9,601$10,822$9,076$10,154$29,213$34,703$7,045$8,244$12,135$14,878
Washington$11,719$13,112$11,010$12,120$35,291$37,638$8,412$9,330$14,812$16,630
West Virginia$9,497$10,964$8,997$10,232$27,448$30,925$6,926$7,748$11,951$13,860
Wisconsin$10,116$11,412$9,482$10,447$29,711$33,605$7,092$8,040$12,731$14,492
Wyoming$10,357$11,466$10,187$10,701$30,786$31,590$7,292$7,716$13,079$13,848
 
GuamNANANANANANANANANANA
Puerto Rico$6,167$6,571$5,988$6,482$17,546NA$4,396$4,997$7,891$8,395
Virgin IslandsNANANANANANANANANANA
 


Notes:

Each payment is the sum of Medicare payments for the DRG including DRG, Teaching, Disproportionate Share, Capital, and Outlier payments for all cases. Also included in Medicare Payments are co-payments and deductibles paid by patients.

The range of payments between the 25th percentile and the 75th percentile excludes the lowest 25 percent of payments and the highest 25 percent of payments. It is the range of payments for the most typical cases treated in the geographic area for the DRG. It excludes unusually low payments for cases such as those where a patient is transferred to another facility before receiving a full course of treatment. It also excludes unusually high payments for cases that are more complex and costly to treat than is typical for most cases in the DRG.

Replacement of hip, knee, or ankle or reattachment of thigh, foot or ankle (DRG 544) consists of the following procedures: replacement of total knee joint, replacement of total hip joint, replacement of knee joint, replacement of ankle, foot attachment, lower leg/ankle reattachment or thigh reattachment. In 2006, there were 442,933 cases reported. The national average payment for hip or knee replacements was $11,916 and the national average charge was $38,447.

Gallbladder removal by laparoscope with complications or preexisting conditions (DRG 493) is comprised of the removal of the gallbladder by laparoscope or the removal of part of the gallbladder by laparoscope. In 2006, 60,164 cases of gallbladder removal by laparoscope were reported. The national average payment was $11,151 while the national average charge was $36,349.

Insertion of heart defibrillator (DRG 515) includes the following procedures: insertion of conventional heart defibrillator, two heart chamber pacing with internal heart defibrillator, total system, insertion of defibrillator motor, and the insertion of defibrillator lead into left heart chamber.  57,618 cases of insertion of heart defibrillator procedures were reported in 2006.  The national average payment was $35,369 and the national average charge was $103,425.

Back and neck operations except back or neck fusion (DRG 500) consist of the following procedures: exploration and removing pressure from spine, removal of disc from back and neck, insertion of nerve stimulator lead into back, and removal of abnormal tissue from back. In 2006, 44,733 cases of back and neck operations were reported. The national average payment was $5,708 and the national average charge was $19,615.

Repair of previous hip, or  knee replacement (DRG 545) consists of the following procedures: revision of hip replacement or revision of knee replacement.  In 2006, there were 40,516 cases reported. The national average payment for repair of previous hip or knee replacements was $15,552 and the national average charge was $49.830.


Sources: The Centers for Medicare and Medicaid Services (CMS) Health Care Consumer Initiatives, Top 31 Elective Inpatient Hospital DRGs, Fiscal Year 2006, from the Medicare Provider Analysis and Review File (MedPAR), Centers for Medicare and Medicaid Services, Office of Information Services, the Medicare Decision Support Access Facility. Available at: http://www.cms.hhs.gov/HealthCareConInit/02_Hospital.asp#TopOfPage; accessed November 2007.
Definitions: DRGs: Diagnosis Related Groups.
National Average Payments: The sum of the total payments of all hospitals in the nation divided by the number of cases in the nation for the DRG.
National Average Charges: The sum of the covered charges of all hospitals in the nation divided by the number of cases in the nation for the DRG.
NA: Data excluded because payments were unusually low.


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