Florida / HCA Florida Lake Monroe Hospital
CMS certification 100161 · Sanford, FL · 3 entries in CMS's price-transparency list
HCA Florida Lake Monroe Hospital: charges and Medicare payments
HCA Florida Lake Monroe Hospital reported 911 Medicare inpatient stays across 40 DRGs in 2024. Across them it charged 8.45 times what it was paid — mid-range in Florida, number 59 of 159 hospitals with at least 100 stays (state median 7.04×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 128 stays at an average charge of $121,316, 34% above the national average. It also billed 409 outpatient services, charging 15.08 times what Medicare paid.
- 1Medicare inpatient stays 911
- 2Charge ÷ paid, inpatient 8.45×
- 3Rank in FL (highest ratio = 1) 59 of 159
- 4CMS price-transparency actions 3
Inpatient stays
For the 40 DRGs that can be compared with the national average, HCA Florida Lake Monroe Hospital charged more than the national average in 38 (95%). 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 | 128 | $121,316 | +34% | $16,170 |
| 274 Percutaneous and Other Intracardiac Procedures without MCC | 46 | $208,782 | +33% | $24,124 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 44 | $117,586 | +55% | $14,511 |
| 291 Heart Failure and Shock with MCC | 42 | $77,703 | +38% | $11,844 |
| 193 Simple Pneumonia and Pleurisy with MCC | 34 | $77,434 | +30% | $11,506 |
| 312 Syncope and Collapse | 31 | $84,154 | +85% | $8,081 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 30 | $165,297 | +66% | $14,761 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 30 | $73,740 | +84% | $7,306 |
| 682 Renal Failure with MCC | 28 | $99,505 | +51% | $12,010 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 24 | $75,734 | +26% | $10,659 |
| 177 Respiratory Infections and Inflammations with MCC | 23 | $91,822 | +30% | $13,192 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 21 | $118,003 | +134% | $8,225 |
| 481 Hip and Femur Procedures except Major Joint with CC | 21 | $224,915 | +123% | $18,507 |
| 310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC | 19 | $41,005 | +43% | $5,703 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 19 | $176,859 | +54% | $16,613 |
| 552 Medical Back Problems without MCC | 19 | $99,803 | +104% | $8,942 |
| 091 Other Disorders of Nervous System with MCC | 18 | $132,211 | +60% | $13,763 |
| 189 Pulmonary Edema and Respiratory Failure | 18 | $81,853 | +42% | $11,720 |
| 305 Hypertension without MCC | 18 | $72,035 | +80% | $7,470 |
| 313 Chest Pain | 18 | $52,806 | +32% | $7,746 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 18 | $66,334 | +79% | $7,410 |
| 683 Renal Failure with CC | 18 | $68,506 | +68% | $9,655 |
| 377 Gastrointestinal Hemorrhage with MCC | 17 | $160,586 | +88% | $14,194 |
| 690 Kidney and Urinary Tract Infections without MCC | 17 | $53,542 | +42% | $7,363 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 17 | $90,292 | +23% | $12,348 |
| 884 Organic Disturbances and Intellectual Disability | 16 | $73,176 | +17% | $13,055 |
| 069 Transient Ischemia without Thrombolytic | 15 | $96,299 | +91% | $7,436 |
| 870 Septicemia or Severe Sepsis with MV >96 Hours | 15 | $321,060 | -1% | $43,012 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 14 | $133,656 | +140% | $8,879 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 13 | $147,697 | +9% | $25,560 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 13 | $47,531 | +32% | $8,021 |
| 321 Percutaneous Cardiovascular Procedures with Intraluminal... | 13 | $198,932 | +22% | $21,762 |
| 689 Kidney and Urinary Tract Infections with MCC | 13 | $97,482 | +90% | $9,963 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 12 | $110,703 | +73% | $9,583 |
| 314 Other Circulatory System Diagnoses with MCC | 12 | $92,098 | -3% | $15,506 |
| 811 Red Blood Cell Disorders with MCC | 12 | $82,078 | +20% | $11,729 |
| 812 Red Blood Cell Disorders without MCC | 12 | $72,804 | +64% | $8,157 |
| 394 Other Digestive System Diagnoses with CC | 11 | $66,885 | +42% | $8,380 |
| 638 Diabetes with CC | 11 | $46,502 | +12% | $9,778 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 11 | $94,982 | +94% | $8,970 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 76 | $175,077 | $11,906 |
| Comprehensive Observation Services | 73 | $44,974 | $2,452 |
| Level 2 Upper GI Procedures | 49 | $36,259 | $1,668 |
| Level 3 Electrophysiologic Procedures | 36 | $222,741 | $21,459 |
| Level 1 Endovascular Procedures | 30 | $58,882 | $2,957 |
| Level 3 Urology and Related Services | 30 | $57,430 | $1,813 |
| Level 3 Vascular Procedures | 19 | $27,811 | $2,766 |
| Level 5 Neurostimulator and Related Procedures | 17 | $170,912 | $28,046 |
| Level 4 Musculoskeletal Procedures | 15 | $108,966 | $6,136 |
| Level 4 Urology and Related Services | 15 | $82,025 | $3,158 |
| Level 2 Musculoskeletal Procedures | 13 | $57,190 | $1,456 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 12 | $16,677 | $1,469 |
| Level 4 Pacemaker and Similar Procedures | 12 | $146,540 | $17,611 |
| Level 5 Urology and Related Services | 12 | $121,030 | $4,687 |
Against the Florida average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), HCA Florida Lake Monroe Hospital charged $121,316 on average, 8% more than the Florida average of $112,838, and was paid $16,170 against a state average of $15,663. For Percutaneous and Other Intracardiac Procedures without MCC (DRG 274), HCA Florida Lake Monroe Hospital charged $208,782 on average, 13% more than the Florida average of $185,126, and was paid $24,124 against a state average of $24,802. For Acute Myocardial Infarction, Discharged Alive with MCC (DRG 280), HCA Florida Lake Monroe Hospital charged $117,586 on average, 26% more than the Florida average of $93,403, and was paid $14,511 against a state average of $12,779. For Heart Failure and Shock with MCC (DRG 291), HCA Florida Lake Monroe Hospital charged $77,703 on average, 15% more than the Florida average of $67,659, and was paid $11,844 against a state average of $10,715. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $175,077 was 64% above the state average of $106,979. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $44,974 was 58% above the state average of $28,431. For Level 2 Upper GI Procedures (outpatient APC 5302), its average charge of $36,259 was 92% above the state average of $18,929. For Level 3 Electrophysiologic Procedures (outpatient APC 5213), its average charge of $222,741 was 14% above the state average of $195,231.
Price-transparency record
CMS's enforcement list records these actions for a hospital named HCA Florida Lake Monroe Hospital in Sanford, FL, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2023-07-11 (CMS case 335)
- Closure Notice — 2023-11-02 (CMS case 335)
- Met Requirements — 2025-05-02 (CMS case 4278)
A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.
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.