Falmouth Hospital: charges and Medicare payments

Falmouth Hospital reported 2,570 Medicare inpatient stays across 64 DRGs in 2024. Across them it charged 2.39 times what it was paid — among the higher ratios in Massachusetts, number 12 of 52 hospitals with at least 100 stays (state median 2×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 509 stays at an average charge of $31,143, 66% below the national average. It also billed 1,694 outpatient services, charging 4.43 times what Medicare paid.

1Medicare inpatient stays 2,570
2Charge ÷ paid, inpatient 2.39×
3Rank in MA (highest ratio = 1) 12 of 52
4CMS price-transparency actions 0

Average charge per stay at Falmouth Hospital, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 64 DRGs that can be compared with the national average, Falmouth Hospital charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.

DRG	Stays	Avg charge	vs US	Avg paid
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	509	$31,143	-66%	$15,230
291 Heart Failure and Shock with MCC	169	$23,637	-58%	$10,425
177 Respiratory Infections and Inflammations with MCC	119	$27,243	-61%	$12,744
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	106	$20,589	-58%	$8,444
689 Kidney and Urinary Tract Infections with MCC	103	$20,092	-61%	$9,082
193 Simple Pneumonia and Pleurisy with MCC	100	$22,478	-62%	$10,294
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	76	$19,696	-51%	$6,611
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	63	$33,580	-66%	$14,665
698 Other Kidney and Urinary Tract Diagnoses with MCC	59	$27,845	-62%	$12,912
189 Pulmonary Edema and Respiratory Failure	57	$25,764	-55%	$9,987
280 Acute Myocardial Infarction, Discharged Alive with MCC	55	$32,807	-57%	$12,583
690 Kidney and Urinary Tract Infections without MCC	53	$19,225	-49%	$6,502
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	51	$26,333	-53%	$7,947
378 Gastrointestinal Hemorrhage with CC	50	$27,101	-44%	$8,137
190 Chronic Obstructive Pulmonary Disease with MCC	42	$17,448	-66%	$9,421
603 Cellulitis without MCC	40	$17,062	-54%	$7,187
682 Renal Failure with MCC	40	$28,526	-57%	$11,722
853 Infectious and Parasitic Diseases with O.R. Procedures with...	40	$78,724	-66%	$37,169
194 Simple Pneumonia and Pleurisy with CC	37	$18,762	-51%	$7,025
312 Syncope and Collapse	35	$27,854	-39%	$7,367
470 Major Hip and Knee Joint Replacement or Reattachment of...	35	$42,242	-55%	$15,138
552 Medical Back Problems without MCC	34	$20,850	-57%	$7,717
178 Respiratory Infections and Inflammations with CC	32	$20,618	-54%	$7,853
683 Renal Failure with CC	32	$17,921	-56%	$7,274
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	28	$26,442	-59%	$10,504
281 Acute Myocardial Infarction, Discharged Alive with CC	28	$19,829	-61%	$6,985
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	25	$28,844	-53%	$10,378
069 Transient Ischemia without Thrombolytic	24	$23,705	-53%	$6,544
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	24	$17,449	-53%	$6,314
602 Cellulitis with MCC	23	$26,066	-57%	$11,070
282 Acute Myocardial Infarction, Discharged Alive without CC/MCC	20	$17,803	-59%	$5,878
308 Cardiac Arrhythmia and Conduction Disorders with MCC	20	$25,668	-55%	$9,737
377 Gastrointestinal Hemorrhage with MCC	20	$39,168	-54%	$13,664
390 Gastrointestinal Obstruction without CC/MCC	17	$16,821	-40%	$4,539
481 Hip and Femur Procedures except Major Joint with CC	17	$44,345	-56%	$16,506
536 Fractures of Hip and Pelvis without MCC	17	$18,173	-52%	$6,392
551 Medical Back Problems with MCC	17	$28,009	-64%	$14,652
854 Infectious and Parasitic Diseases with O.R. Procedures with...	17	$42,488	-57%	$16,100
309 Cardiac Arrhythmia and Conduction Disorders with CC	16	$23,704	-34%	$6,079
388 Gastrointestinal Obstruction with MCC	16	$26,436	-61%	$11,801
305 Hypertension without MCC	15	$23,133	-42%	$6,127
483 Major Joint or Limb Reattachment Procedures of Upper...	15	$65,418	-48%	$20,212
521 Hip Replacement with Principal Diagnosis of Hip Fracture...	15	$54,721	-60%	$21,894
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	15	$19,040	-55%	$7,296
813 Coagulation Disorders	15	$23,261	-71%	$12,611
310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC	14	$17,927	-38%	$4,576
870 Septicemia or Severe Sepsis with MV >96 Hours	14	$125,464	-61%	$56,531
329 Major Small and Large Bowel Procedures with MCC	13	$89,912	-58%	$35,267
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	13	$53,242	-48%	$16,654
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	13	$26,343	-56%	$10,686
812 Red Blood Cell Disorders without MCC	13	$25,907	-42%	$7,391
896 Alcohol, Drug Abuse or Dependence without Rehabilitation...	13	$28,842	-63%	$14,367
202 Bronchitis and Asthma with CC/MCC	12	$19,670	-57%	$7,811
389 Gastrointestinal Obstruction with CC	12	$16,991	-56%	$6,496
393 Other Digestive System Diagnoses with MCC	12	$31,990	-58%	$12,595
638 Diabetes with CC	12	$17,560	-58%	$7,216
066 Intracranial Hemorrhage or Cerebral Infarction without...	11	$25,266	-40%	$7,142
100 Seizures with MCC	11	$37,832	-60%	$14,853
184 Major Chest Trauma with CC	11	$25,279	-54%	$8,928
195 Simple Pneumonia and Pleurisy without CC/MCC	11	$14,346	-52%	$5,129

Showing the 60 most frequent of 64 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	471	$18,977	$2,894
Level 2 Excision/ Biopsy/ Incision and Drainage	172	$6,875	$1,725
Level 5 Musculoskeletal Procedures	152	$29,860	$14,028
Level 4 Musculoskeletal Procedures	124	$21,588	$7,683
Level 3 Musculoskeletal Procedures	99	$9,920	$3,476
Level 1 Nerve Procedures	97	$10,914	$2,074
Level 2 Upper GI Procedures	66	$9,258	$2,043
Level 1 Laparoscopy and Related Services	60	$22,538	$6,115
Level 5 Urology and Related Services	57	$12,802	$5,557
Level 3 Vascular Procedures	51	$14,875	$3,423
Level 4 Urology and Related Services	51	$11,692	$3,744
Level 2 Musculoskeletal Procedures	46	$6,527	$1,726
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	45	$16,663	$3,716
Level 4 Gynecologic Procedures	44	$9,965	$3,298
Level 1 Breast/Lymphatic Surgery and Related Procedures	31	$18,972	$4,094
Level 3 Excision/ Biopsy/ Incision and Drainage	23	$10,616	$3,052
Level 6 Musculoskeletal Procedures	22	$44,504	$19,132
Level 3 Urology and Related Services	20	$9,077	$2,188
Level 3 Pacemaker and Similar Procedures	18	$41,270	$11,454
Level 2 Vascular Procedures	17	$7,214	$1,720
Level 2 Breast/Lymphatic Surgery and Related Procedures	16	$37,428	$7,003
Level 2 Urology and Related Services	12	$41,092	$734

Against the Massachusetts average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Falmouth Hospital charged $31,143 on average, 31% less than the Massachusetts average of $45,229, and was paid $15,230 against a state average of $19,536. For Heart Failure and Shock with MCC (DRG 291), Falmouth Hospital charged $23,637 on average, 22% less than the Massachusetts average of $30,373, and was paid $10,425 against a state average of $12,996. For Respiratory Infections and Inflammations with MCC (DRG 177), Falmouth Hospital charged $27,243 on average, 27% less than the Massachusetts average of $37,072, and was paid $12,744 against a state average of $15,861. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Falmouth Hospital charged $20,589 on average, 16% less than the Massachusetts average of $24,420, and was paid $8,444 against a state average of $10,272. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $18,977 was 35% above the state average of $14,010. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $6,875 was 4% above the state average of $6,596. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $29,860 was 16% below the state average of $35,549. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $21,588 was 14% below the state average of $25,145.

Price-transparency record

No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.

Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.

Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.