Tennessee / Highpoint Health-Sumner With Ascension Saint Thoma
CMS certification 440003 · Gallatin, TN
Highpoint Health-Sumner With Ascension Saint Thoma: charges and Medicare payments
Highpoint Health-Sumner With Ascension Saint Thoma reported 1,207 Medicare inpatient stays across 42 DRGs in 2024. Across them it charged 7 times what it was paid — among the higher ratios in Tennessee, number 11 of 65 hospitals with at least 100 stays (state median 4.42×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 231 stays at an average charge of $95,376, 6% above the national average. It also billed 542 outpatient services, charging 12.62 times what Medicare paid.
- 1Medicare inpatient stays 1,207
- 2Charge ÷ paid, inpatient 7×
- 3Rank in TN (highest ratio = 1) 11 of 65
- 4CMS price-transparency actions 0
Inpatient stays
For the 42 DRGs that can be compared with the national average, Highpoint Health-Sumner With Ascension Saint Thoma charged more than the national average in 26 (62%). 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 | 231 | $95,376 | +6% | $13,391 |
| 291 Heart Failure and Shock with MCC | 88 | $73,602 | +31% | $9,704 |
| 689 Kidney and Urinary Tract Infections with MCC | 51 | $52,929 | +3% | $8,171 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 48 | $50,626 | +3% | $7,402 |
| 193 Simple Pneumonia and Pleurisy with MCC | 45 | $67,557 | +13% | $9,822 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 44 | $78,101 | +54% | $8,544 |
| 690 Kidney and Urinary Tract Infections without MCC | 44 | $40,992 | +8% | $6,013 |
| 312 Syncope and Collapse | 38 | $46,201 | +1% | $6,536 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 33 | $38,528 | -4% | $6,170 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 32 | $87,510 | +15% | $10,841 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 32 | $40,251 | +9% | $5,856 |
| 378 Gastrointestinal Hemorrhage with CC | 26 | $53,550 | +10% | $7,279 |
| 552 Medical Back Problems without MCC | 25 | $48,033 | -2% | $6,907 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 25 | $52,110 | -14% | $9,337 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 23 | $39,324 | +9% | $5,589 |
| 313 Chest Pain | 23 | $37,957 | -5% | $5,536 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 23 | $192,525 | -16% | $33,872 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 22 | $75,792 | +3% | $10,282 |
| 305 Hypertension without MCC | 21 | $33,725 | -16% | $5,874 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 19 | $94,995 | -5% | $13,083 |
| 177 Respiratory Infections and Inflammations with MCC | 19 | $80,790 | +14% | $11,510 |
| 377 Gastrointestinal Hemorrhage with MCC | 19 | $84,550 | -1% | $12,087 |
| 682 Renal Failure with MCC | 19 | $77,413 | +17% | $10,224 |
| 948 Signs and Symptoms without MCC | 19 | $40,751 | +7% | $5,874 |
| 481 Hip and Femur Procedures except Major Joint with CC | 16 | $93,602 | -7% | $13,671 |
| 563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,... | 16 | $36,290 | -15% | $6,612 |
| 189 Pulmonary Edema and Respiratory Failure | 15 | $60,915 | +6% | $9,243 |
| 603 Cellulitis without MCC | 15 | $40,604 | +9% | $6,600 |
| 637 Diabetes with MCC | 15 | $48,202 | -28% | $10,062 |
| 638 Diabetes with CC | 14 | $47,573 | +14% | $6,697 |
| 683 Renal Failure with CC | 14 | $38,981 | -4% | $6,608 |
| 191 Chronic Obstructive Pulmonary Disease with CC | 13 | $49,514 | +25% | $6,461 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 13 | $46,087 | -9% | $7,113 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 13 | $61,707 | -3% | $10,621 |
| 854 Infectious and Parasitic Diseases with O.R. Procedures with... | 13 | $125,060 | +27% | $21,417 |
| 286 Circulatory Disorders except AMI, with Cardiac... | 12 | $120,534 | +7% | $14,324 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 12 | $131,027 | +14% | $19,797 |
| 391 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 12 | $64,313 | +5% | $9,052 |
| 812 Red Blood Cell Disorders without MCC | 12 | $36,012 | -19% | $6,620 |
| 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale | 11 | $115,473 | +77% | $9,394 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 11 | $130,773 | +28% | $14,191 |
| 536 Fractures of Hip and Pelvis without MCC | 11 | $35,166 | -7% | $5,732 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 98 | $29,719 | $2,339 |
| Level 5 Urology and Related Services | 78 | $29,614 | $4,372 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 59 | $13,987 | $1,397 |
| Level 3 Vascular Procedures | 48 | $28,708 | $2,658 |
| Level 4 Urology and Related Services | 44 | $23,841 | $2,949 |
| Level 1 Endovascular Procedures | 38 | $32,505 | $2,812 |
| Level 2 Upper GI Procedures | 38 | $12,100 | $1,598 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 24 | $37,541 | $2,437 |
| Level 4 Musculoskeletal Procedures | 19 | $69,257 | $5,905 |
| Level 2 Vascular Procedures | 18 | $10,345 | $1,380 |
| Level 1 Laparoscopy and Related Services | 16 | $56,475 | $4,971 |
| Level 3 Urology and Related Services | 15 | $18,952 | $1,755 |
| Level 3 Musculoskeletal Procedures | 13 | $24,189 | $2,789 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 12 | $34,774 | $2,981 |
| Level 2 Musculoskeletal Procedures | 11 | $13,040 | $1,385 |
| Level 3 Endovascular Procedures | 11 | $94,488 | $9,472 |
Against the Tennessee average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Highpoint Health-Sumner With Ascension Saint Thoma charged $95,376 on average, 36% more than the Tennessee average of $70,379, and was paid $13,391 against a state average of $15,065. For Heart Failure and Shock with MCC (DRG 291), Highpoint Health-Sumner With Ascension Saint Thoma charged $73,602 on average, 60% more than the Tennessee average of $46,128, and was paid $9,704 against a state average of $10,346. For Kidney and Urinary Tract Infections with MCC (DRG 689), Highpoint Health-Sumner With Ascension Saint Thoma charged $52,929 on average, 24% more than the Tennessee average of $42,654, and was paid $8,171 against a state average of $9,423. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Highpoint Health-Sumner With Ascension Saint Thoma charged $50,626 on average, 24% more than the Tennessee average of $40,769, and was paid $7,402 against a state average of $8,809. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $29,719 was 49% above the state average of $19,917. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $29,614 was 13% above the state average of $26,306. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $13,987 was 36% above the state average of $10,318. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $28,708 was 50% above the state average of $19,196.
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.