New York / Lenox Hill Hospital

CMS certification 330119 · New York, NY · 4 entries in CMS's price-transparency list

Lenox Hill Hospital: charges and Medicare payments

Lenox Hill Hospital reported 4,039 Medicare inpatient stays across 132 DRGs in 2024. Across them it charged 5.09 times what it was paid — among the higher ratios in New York, number 32 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: 576 stays at an average charge of $133,038, 47% above the national average. It also billed 5,690 outpatient services, charging 6.87 times what Medicare paid.

1Medicare inpatient stays 4,039
2Charge ÷ paid, inpatient 5.09×
3Rank in NY (highest ratio = 1) 32 of 123
4CMS price-transparency actions 4

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

Inpatient stays

For the 132 DRGs that can be compared with the national average, Lenox Hill Hospital charged more than the national average in 118 (89%). 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	576	$133,038	+47%	$25,809
291 Heart Failure and Shock with MCC	171	$148,632	+164%	$19,778
470 Major Hip and Knee Joint Replacement or Reattachment of...	136	$99,541	+7%	$26,238
267 Endovascular Cardiac Valve Replacement and Supplement...	108	$260,906	+18%	$52,704
274 Percutaneous and Other Intracardiac Procedures without MCC	84	$165,337	+5%	$40,659
177 Respiratory Infections and Inflammations with MCC	67	$102,787	+46%	$19,198
853 Infectious and Parasitic Diseases with O.R. Procedures with...	63	$337,051	+47%	$64,419
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	60	$70,531	+44%	$13,767
330 Major Small and Large Bowel Procedures with CC	51	$149,990	+26%	$29,152
378 Gastrointestinal Hemorrhage with CC	50	$77,959	+61%	$12,808
312 Syncope and Collapse	49	$76,415	+68%	$11,568
689 Kidney and Urinary Tract Infections with MCC	49	$108,854	+112%	$17,493
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	48	$94,863	+57%	$19,280
025 Craniotomy and Endovascular Intracranial Procedures with MCC	46	$307,556	+33%	$65,069
322 Percutaneous Cardiovascular Procedures with Intraluminal...	46	$109,324	-5%	$35,318
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	46	$68,674	+71%	$11,970
682 Renal Failure with MCC	46	$85,028	+29%	$19,024
377 Gastrointestinal Hemorrhage with MCC	45	$165,690	+94%	$28,989
454 Combined Anterior and Posterior Spinal Fusion with CC	45	$205,885	-26%	$68,217
603 Cellulitis without MCC	45	$59,571	+60%	$12,317
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	44	$220,657	+121%	$30,917
481 Hip and Femur Procedures except Major Joint with CC	41	$147,192	+46%	$25,405
280 Acute Myocardial Infarction, Discharged Alive with MCC	40	$167,999	+122%	$23,602
309 Cardiac Arrhythmia and Conduction Disorders with CC	40	$88,678	+146%	$10,018
552 Medical Back Problems without MCC	39	$64,596	+32%	$13,423
698 Other Kidney and Urinary Tract Diagnoses with MCC	39	$102,027	+39%	$20,477
329 Major Small and Large Bowel Procedures with MCC	38	$317,133	+48%	$65,389
951 Other Factors Influencing Health Status	38	$52,697	+106%	$8,450
266 Endovascular Cardiac Valve Replacement and Supplement...	36	$396,522	+39%	$82,951
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	35	$97,463	+60%	$17,472
252 Other Vascular Procedures with MCC	34	$272,885	+60%	$52,802
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	34	$64,624	+74%	$10,807
314 Other Circulatory System Diagnoses with MCC	32	$181,876	+92%	$29,426
690 Kidney and Urinary Tract Infections without MCC	32	$60,729	+61%	$12,018
216 Cardiac Valve and Other Major Cardiothoracic Procedures with...	31	$494,875	0%	$107,074
683 Renal Failure with CC	30	$64,631	+59%	$12,215
812 Red Blood Cell Disorders without MCC	30	$65,447	+47%	$12,752
069 Transient Ischemia without Thrombolytic	29	$87,982	+74%	$11,344
164 Major Chest Procedures with CC	29	$132,652	+4%	$31,240
091 Other Disorders of Nervous System with MCC	27	$91,069	+10%	$20,858
092 Other Disorders of Nervous System with CC	27	$70,330	+36%	$13,388
236 Coronary Bypass without Cardiac Catheterization without MCC	27	$200,289	-5%	$40,878
193 Simple Pneumonia and Pleurisy with MCC	26	$126,331	+111%	$21,457
270 Other Major Cardiovascular Procedures with MCC	26	$310,389	+20%	$69,201
300 Peripheral Vascular Disorders with CC	26	$112,470	+128%	$17,328
321 Percutaneous Cardiovascular Procedures with Intraluminal...	26	$230,090	+41%	$43,719
189 Pulmonary Edema and Respiratory Failure	25	$82,546	+43%	$16,847
235 Coronary Bypass without Cardiac Catheterization with MCC	25	$278,965	-5%	$73,771
519 Back and Neck Procedures except Spinal Fusion with CC	25	$106,964	+2%	$24,251
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	25	$62,676	+47%	$12,844
811 Red Blood Cell Disorders with MCC	25	$81,307	+19%	$17,527
884 Organic Disturbances and Intellectual Disability	25	$90,909	+46%	$22,937
057 Degenerative Nervous System Disorders without MCC	24	$100,203	+77%	$17,579
219 Cardiac Valve and Other Major Cardiothoracic Procedures...	24	$498,713	+25%	$93,631
331 Major Small and Large Bowel Procedures without CC/MCC	24	$95,299	+11%	$25,396
287 Circulatory Disorders except AMI, with Cardiac...	23	$109,546	+71%	$17,155
460 Spinal Fusion except Cervical without MCC	23	$208,936	+23%	$47,531
870 Septicemia or Severe Sepsis with MV >96 Hours	22	$492,969	+52%	$99,465
190 Chronic Obstructive Pulmonary Disease with MCC	21	$103,614	+105%	$13,687
299 Peripheral Vascular Disorders with MCC	21	$154,573	+106%	$21,152

Showing the 60 most frequent of 132 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 1 Intraocular Procedures	1,999	$18,247	$2,592
Level 2 Intraocular Procedures	413	$24,074	$4,510
Level 4 Urology and Related Services	292	$21,732	$3,848
Level 2 Musculoskeletal Procedures	228	$16,459	$1,795
Level 5 Urology and Related Services	215	$42,838	$5,675
Level 2 Excision/ Biopsy/ Incision and Drainage	172	$16,794	$1,782
Level 1 Endovascular Procedures	165	$35,341	$3,642
Level 4 Musculoskeletal Procedures	163	$34,191	$8,003
Level 1 Laparoscopy and Related Services	153	$41,211	$6,479
Level 3 Musculoskeletal Procedures	142	$20,749	$3,569
Level 3 Endovascular Procedures	130	$60,467	$12,210
Level 3 Urology and Related Services	103	$18,019	$2,278
Level 2 Upper GI Procedures	87	$13,047	$2,143
Level 8 Urology and Related Services	86	$88,310	$21,588
Level 3 Vascular Procedures	81	$21,558	$3,522
Level 4 Gynecologic Procedures	79	$20,857	$3,488
Level 5 Airway Endoscopy	73	$36,170	$7,457
Level 3 Excision/ Biopsy/ Incision and Drainage	72	$20,798	$3,165
Level 3 Electrophysiologic Procedures	66	$101,207	$25,006
Level 5 Musculoskeletal Procedures	61	$53,843	$14,530
Level 2 Endovascular Procedures	61	$32,304	$6,438
Level 1 Breast/Lymphatic Surgery and Related Procedures	52	$28,328	$4,228
Level 5 ENT Procedures	52	$30,956	$6,394
Level 2 Vascular Procedures	52	$8,129	$1,749
Level 4 Vascular Procedures	52	$38,791	$5,962

Against the New York average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Lenox Hill Hospital charged $133,038 on average, 14% more than the New York average of $116,930, and was paid $25,809 against a state average of $24,426. For Heart Failure and Shock with MCC (DRG 291), Lenox Hill Hospital charged $148,632 on average, 83% more than the New York average of $81,161, and was paid $19,778 against a state average of $16,034. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Lenox Hill Hospital charged $99,541 on average, 7% less than the New York average of $107,202, and was paid $26,238 against a state average of $23,235. For Endovascular Cardiac Valve Replacement and Supplement Procedures without MCC (DRG 267), Lenox Hill Hospital charged $260,906 on average, 16% more than the New York average of $225,176, and was paid $52,704 against a state average of $54,006. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $18,247 was 13% above the state average of $16,178. For Level 2 Intraocular Procedures (outpatient APC 5492), its average charge of $24,074 was 12% below the state average of $27,383. For Level 4 Urology and Related Services (outpatient APC 5374), its average charge of $21,732 was 7% above the state average of $20,339. For Level 2 Musculoskeletal Procedures (outpatient APC 5112), its average charge of $16,459 was 26% above the state average of $13,038.

Price-transparency record

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

Warning Notice — 2021-07-20 (CMS case 401)
CAP Request — 2022-01-12 (CMS case 401)
Closure Notice — 2023-05-23 (CMS case 401)
Met Requirements — 2025-03-28 (CMS case 3484)

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.