Illinois / Mt Sinai Hospital Medical Center
CMS certification 140018 · Chicago, IL · 1 entry in CMS's price-transparency list
Mt Sinai Hospital Medical Center: charges and Medicare payments
Mt Sinai Hospital Medical Center reported 215 Medicare inpatient stays across 11 DRGs in 2024. Across them it charged 3.06 times what it was paid — among the lower ratios in Illinois, number 84 of 106 hospitals with at least 100 stays (state median 4.06×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 59 stays at an average charge of $70,759, 22% below the national average. It also billed 297 outpatient services, charging 9.24 times what Medicare paid.
- 1Medicare inpatient stays 215
- 2Charge ÷ paid, inpatient 3.06×
- 3Rank in IL (highest ratio = 1) 84 of 106
- 4CMS price-transparency actions 1
Inpatient stays
For the 11 DRGs that can be compared with the national average, Mt Sinai Hospital Medical Center charged more than the national average in 3 (27%). 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 | 59 | $70,759 | -22% | $25,050 |
| 291 Heart Failure and Shock with MCC | 34 | $44,871 | -20% | $17,750 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 21 | $185,037 | -19% | $55,321 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 15 | $72,959 | -1% | $25,704 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 14 | $62,513 | +12% | $16,134 |
| 193 Simple Pneumonia and Pleurisy with MCC | 13 | $45,859 | -23% | $17,843 |
| 189 Pulmonary Edema and Respiratory Failure | 12 | $44,043 | -23% | $16,425 |
| 312 Syncope and Collapse | 12 | $31,168 | -32% | $14,352 |
| 683 Renal Failure with CC | 12 | $51,087 | +26% | $15,452 |
| 870 Septicemia or Severe Sepsis with MV >96 Hours | 12 | $237,228 | -27% | $73,750 |
| 377 Gastrointestinal Hemorrhage with MCC | 11 | $104,575 | +22% | $22,502 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 158 | $19,794 | $2,573 |
| Level 1 Intraocular Procedures | 53 | $17,986 | $2,183 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 36 | $7,805 | $1,539 |
| Level 3 Urology and Related Services | 21 | $11,987 | $1,934 |
| Level 3 Vascular Procedures | 17 | $21,217 | $3,026 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 12 | $14,396 | $2,698 |
Against the Illinois average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Mt Sinai Hospital Medical Center charged $70,759 on average, 4% less than the Illinois average of $73,987, and was paid $25,050 against a state average of $17,651. For Heart Failure and Shock with MCC (DRG 291), Mt Sinai Hospital Medical Center charged $44,871 on average, 3% less than the Illinois average of $46,293, and was paid $17,750 against a state average of $11,813. For Infectious and Parasitic Diseases with O.R. Procedures with MCC (DRG 853), Mt Sinai Hospital Medical Center charged $185,037 on average, 1% more than the Illinois average of $183,276, and was paid $55,321 against a state average of $45,582. For Other Kidney and Urinary Tract Diagnoses with MCC (DRG 698), Mt Sinai Hospital Medical Center charged $72,959 on average, 29% more than the Illinois average of $56,671, and was paid $25,704 against a state average of $14,839. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $19,794 was 8% below the state average of $21,498. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $17,986 was 21% above the state average of $14,917. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $7,805 was 34% below the state average of $11,818. For Level 3 Urology and Related Services (outpatient APC 5373), its average charge of $11,987 was 12% below the state average of $13,661.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Mt Sinai Hospital Medical Center in Chicago, IL, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-04-29 (CMS case 4197)
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.