Mississippi / Merit Health Madison
CMS certification 250038 · Canton, MS
Merit Health Madison: charges and Medicare payments
Merit Health Madison reported 71 Medicare inpatient stays across 4 DRGs in 2024. Across them it charged 6.97 times what it was paid. Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 28 stays at an average charge of $93,403, 3% above the national average. It also billed 236 outpatient services, charging 22.93 times what Medicare paid.
- 1Medicare inpatient stays 71
- 2Charge ÷ paid, inpatient 6.97×
- 3Rank in MS (highest ratio = 1) –
- 4CMS price-transparency actions 0
Inpatient stays
For the 4 DRGs that can be compared with the national average, Merit Health Madison charged more than the national average in 4 (100%). 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 | 28 | $93,403 | +3% | $15,486 |
| 193 Simple Pneumonia and Pleurisy with MCC | 16 | $98,806 | +65% | $11,513 |
| 291 Heart Failure and Shock with MCC | 16 | $70,979 | +26% | $10,455 |
| 189 Pulmonary Edema and Respiratory Failure | 11 | $94,391 | +64% | $11,744 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 44 | $37,470 | $2,292 |
| Level 3 Vascular Procedures | 35 | $57,533 | $2,486 |
| Level 4 Urology and Related Services | 23 | $51,762 | $2,817 |
| Level 4 Vascular Procedures | 22 | $103,873 | $4,601 |
| Level 3 Urology and Related Services | 19 | $39,726 | $1,634 |
| Level 5 Urology and Related Services | 19 | $73,302 | $4,332 |
| Level 5 Musculoskeletal Procedures | 16 | $136,352 | $11,006 |
| Level 3 Lower GI Procedures | 15 | $45,660 | $2,351 |
| Level 1 Laparoscopy and Related Services | 15 | $81,362 | $4,654 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 14 | $44,077 | $1,357 |
| Level 2 Breast/Lymphatic Surgery and Related Procedures | 14 | $111,400 | $5,459 |
Against the Mississippi average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Merit Health Madison charged $93,403 on average, 45% more than the Mississippi average of $64,437, and was paid $15,486 against a state average of $14,187. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Merit Health Madison charged $98,806 on average, 107% more than the Mississippi average of $47,785, and was paid $11,513 against a state average of $9,796. For Heart Failure and Shock with MCC (DRG 291), Merit Health Madison charged $70,979 on average, 63% more than the Mississippi average of $43,650, and was paid $10,455 against a state average of $9,475. For Pulmonary Edema and Respiratory Failure (DRG 189), Merit Health Madison charged $94,391 on average, 95% more than the Mississippi average of $48,358, and was paid $11,744 against a state average of $9,556. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $37,470 was 133% above the state average of $16,069. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $57,533 was 212% above the state average of $18,445. For Level 4 Urology and Related Services (outpatient APC 5374), its average charge of $51,762 was 117% above the state average of $23,835. For Level 4 Vascular Procedures (outpatient APC 5184), its average charge of $103,873 was 261% above the state average of $28,789.
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.