New York / Highland Hospital

CMS certification 330164 · Rochester, NY · 1 entry in CMS's price-transparency list

Highland Hospital: charges and Medicare payments

Highland Hospital reported 1,723 Medicare inpatient stays across 56 DRGs in 2024. Across them it charged 2.14 times what it was paid — among the lower ratios in New York, number 90 of 123 hospitals with at least 100 stays (state median 2.74×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 233 stays at an average charge of $37,747, 58% below the national average. It also billed 1,442 outpatient services, charging 3.77 times what Medicare paid.

1Medicare inpatient stays 1,723
2Charge ÷ paid, inpatient 2.14×
3Rank in NY (highest ratio = 1) 90 of 123
4CMS price-transparency actions 1

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

Inpatient stays

For the 56 DRGs that can be compared with the national average, Highland 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	233	$37,747	-58%	$20,112
291 Heart Failure and Shock with MCC	144	$25,239	-55%	$12,754
193 Simple Pneumonia and Pleurisy with MCC	59	$29,725	-50%	$15,164
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	56	$17,933	-55%	$8,416
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	55	$23,281	-53%	$11,419
470 Major Hip and Knee Joint Replacement or Reattachment of...	51	$45,610	-51%	$19,759
698 Other Kidney and Urinary Tract Diagnoses with MCC	51	$27,693	-62%	$15,954
177 Respiratory Infections and Inflammations with MCC	49	$30,417	-57%	$16,728
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	44	$16,957	-54%	$8,510
683 Renal Failure with CC	39	$19,050	-53%	$9,418
481 Hip and Femur Procedures except Major Joint with CC	37	$54,868	-46%	$19,531
603 Cellulitis without MCC	37	$16,076	-57%	$9,003
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	35	$23,230	-61%	$12,886
682 Renal Failure with MCC	35	$28,792	-56%	$14,755
690 Kidney and Urinary Tract Infections without MCC	33	$20,526	-46%	$9,051
853 Infectious and Parasitic Diseases with O.R. Procedures with...	33	$94,183	-59%	$48,750
178 Respiratory Infections and Inflammations with CC	32	$28,488	-37%	$9,961
812 Red Blood Cell Disorders without MCC	32	$32,323	-27%	$9,357
189 Pulmonary Edema and Respiratory Failure	29	$26,007	-55%	$12,629
378 Gastrointestinal Hemorrhage with CC	29	$24,436	-50%	$10,144
057 Degenerative Nervous System Disorders without MCC	24	$29,248	-48%	$14,601
389 Gastrointestinal Obstruction with CC	24	$17,900	-54%	$8,161
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	24	$48,505	-53%	$20,584
190 Chronic Obstructive Pulmonary Disease with MCC	23	$43,945	-13%	$14,664
699 Other Kidney and Urinary Tract Diagnoses with CC	23	$17,812	-62%	$11,515
314 Other Circulatory System Diagnoses with MCC	22	$52,176	-45%	$20,916
552 Medical Back Problems without MCC	22	$21,997	-55%	$9,785
637 Diabetes with MCC	22	$42,054	-37%	$15,655
312 Syncope and Collapse	21	$20,316	-55%	$8,864
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	20	$38,501	-37%	$17,322
394 Other Digestive System Diagnoses with CC	20	$17,670	-62%	$9,340
638 Diabetes with CC	20	$19,294	-54%	$9,919
951 Other Factors Influencing Health Status	20	$13,454	-47%	$6,735
194 Simple Pneumonia and Pleurisy with CC	19	$16,662	-57%	$8,898
377 Gastrointestinal Hemorrhage with MCC	19	$46,019	-46%	$17,679
689 Kidney and Urinary Tract Infections with MCC	19	$41,699	-19%	$11,422
884 Organic Disturbances and Intellectual Disability	19	$47,923	-23%	$19,724
388 Gastrointestinal Obstruction with MCC	17	$31,737	-54%	$16,628
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	16	$16,756	-61%	$8,991
948 Signs and Symptoms without MCC	16	$15,537	-59%	$8,188
543 Pathological Fractures and Musculoskeletal and Connective...	15	$17,240	-65%	$10,687
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	14	$26,193	-53%	$11,031
092 Other Disorders of Nervous System with CC	14	$25,031	-51%	$10,565
309 Cardiac Arrhythmia and Conduction Disorders with CC	14	$15,109	-58%	$8,153
439 Disorders of Pancreas except Malignancy with CC	13	$14,881	-66%	$8,682
521 Hip Replacement with Principal Diagnosis of Hip Fracture...	13	$62,194	-54%	$26,022
643 Endocrine Disorders with MCC	13	$41,688	-44%	$16,516
870 Septicemia or Severe Sepsis with MV >96 Hours	13	$139,938	-57%	$62,142
467 Revision of Hip or Knee Replacement with CC	12	$76,053	-52%	$27,917
602 Cellulitis with MCC	12	$29,378	-51%	$21,123
854 Infectious and Parasitic Diseases with O.R. Procedures with...	12	$51,680	-47%	$22,202
252 Other Vascular Procedures with MCC	11	$140,542	-18%	$47,294
308 Cardiac Arrhythmia and Conduction Disorders with MCC	11	$33,221	-41%	$11,340
390 Gastrointestinal Obstruction without CC/MCC	11	$17,425	-38%	$6,507
445 Disorders of The Biliary Tract with CC	11	$25,182	-57%	$12,043
454 Combined Anterior and Posterior Spinal Fusion with CC	11	$107,495	-62%	$51,036

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	280	$12,471	$2,869
Level 5 Musculoskeletal Procedures	211	$31,729	$13,523
Level 2 Excision/ Biopsy/ Incision and Drainage	102	$6,977	$1,719
Level 5 Urology and Related Services	77	$21,400	$5,429
Level 1 Laparoscopy and Related Services	72	$20,985	$6,050
Level 3 Urology and Related Services	71	$11,004	$2,160
Level 4 Gynecologic Procedures	64	$12,371	$3,315
Level 4 Urology and Related Services	60	$14,599	$3,647
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	56	$14,852	$3,564
Level 2 Breast/Lymphatic Surgery and Related Procedures	50	$28,188	$6,914
Level 2 Laparoscopy and Related Services	49	$36,572	$10,902
Level 1 Breast/Lymphatic Surgery and Related Procedures	38	$18,325	$4,041
Level 6 Musculoskeletal Procedures	37	$41,014	$19,711
Level 4 Musculoskeletal Procedures	34	$23,901	$7,585
Level 5 ENT Procedures	34	$22,240	$5,918
Level 3 Airway Endoscopy	31	$9,547	$1,800
Level 3 Vascular Procedures	31	$17,770	$3,379
Level 2 Upper GI Procedures	28	$8,186	$2,017
Level 4 Airway Endoscopy	23	$16,023	$3,970
Level 5 Neurostimulator and Related Procedures	17	$74,744	$32,821
Level 2 Musculoskeletal Procedures	16	$10,426	$1,704
Level 4 Vascular Procedures	14	$22,742	$5,827
Level 3 Musculoskeletal Procedures	13	$16,777	$3,432
Level 3 Lower GI Procedures	12	$11,754	$2,779
Level 6 Urology and Related Services	11	$25,510	$9,760

Against the New York average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Highland Hospital charged $37,747 on average, 68% less than the New York average of $116,930, and was paid $20,112 against a state average of $24,426. For Heart Failure and Shock with MCC (DRG 291), Highland Hospital charged $25,239 on average, 69% less than the New York average of $81,161, and was paid $12,754 against a state average of $16,034. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Highland Hospital charged $29,725 on average, 61% less than the New York average of $77,177, and was paid $15,164 against a state average of $15,976. For Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders without MCC (DRG 392), Highland Hospital charged $17,933 on average, 64% less than the New York average of $50,017, and was paid $8,416 against a state average of $9,945. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $12,471 was 53% below the state average of $26,675. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $31,729 was 53% below the state average of $67,926. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $6,977 was 46% below the state average of $12,815. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $21,400 was 24% below the state average of $28,292.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Highland Hospital in Rochester, NY, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

Met Requirements — 2026-02-13 (CMS case 7035)

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.