New Jersey / Saint Michael's Medical Center
CMS certification 310096 · Newark, NJ · 1 entry in CMS's price-transparency list
Saint Michael's Medical Center: charges and Medicare payments
Saint Michael's Medical Center reported 313 Medicare inpatient stays across 13 DRGs in 2024. Across them it charged 4.05 times what it was paid — among the lower ratios in New Jersey, number 57 of 60 hospitals with at least 100 stays (state median 6.25×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 76 stays at an average charge of $124,243, 38% above the national average. It also billed 147 outpatient services, charging 13.29 times what Medicare paid.
- 1Medicare inpatient stays 313
- 2Charge ÷ paid, inpatient 4.05×
- 3Rank in NJ (highest ratio = 1) 57 of 60
- 4CMS price-transparency actions 1
Inpatient stays
For the 13 DRGs that can be compared with the national average, Saint Michael's Medical Center charged more than the national average in 9 (69%). 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 | 76 | $124,243 | +38% | $25,480 |
| 291 Heart Failure and Shock with MCC | 48 | $66,812 | +19% | $16,892 |
| 885 Psychoses | 42 | $51,237 | +16% | $19,456 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 26 | $55,773 | -7% | $16,692 |
| 193 Simple Pneumonia and Pleurisy with MCC | 17 | $74,747 | +25% | $17,660 |
| 177 Respiratory Infections and Inflammations with MCC | 16 | $89,097 | +26% | $21,473 |
| 377 Gastrointestinal Hemorrhage with MCC | 15 | $130,091 | +52% | $25,346 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 14 | $36,554 | -9% | $11,115 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 13 | $41,778 | +16% | $9,275 |
| 682 Renal Failure with MCC | 13 | $59,683 | -9% | $18,738 |
| 313 Chest Pain | 11 | $36,448 | -9% | $11,046 |
| 603 Cellulitis without MCC | 11 | $43,612 | +17% | $12,606 |
| 690 Kidney and Urinary Tract Infections without MCC | 11 | $38,808 | +3% | $11,748 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Endovascular Procedures | 63 | $26,908 | $3,466 |
| Level 1 Intraocular Procedures | 56 | $36,328 | $2,503 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 17 | $37,510 | $3,716 |
| Level 3 Vascular Procedures | 11 | $22,627 | $3,424 |
Against the New Jersey average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Saint Michael's Medical Center charged $124,243 on average, 6% less than the New Jersey average of $131,698, and was paid $25,480 against a state average of $19,296. For Heart Failure and Shock with MCC (DRG 291), Saint Michael's Medical Center charged $66,812 on average, 31% less than the New Jersey average of $97,469, and was paid $16,892 against a state average of $12,811. For Psychoses (DRG 885), Saint Michael's Medical Center charged $51,237 on average, 44% less than the New Jersey average of $91,986, and was paid $19,456 against a state average of $15,005. For Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC (DRG 640), Saint Michael's Medical Center charged $55,773 on average, 43% less than the New Jersey average of $97,749, and was paid $16,692 against a state average of $13,386. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $26,908 was 9% below the state average of $29,645. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $36,328 was 81% above the state average of $20,104. For Level 1 Abdominal/Peritoneal/Biliary and Related Procedures (outpatient APC 5341), its average charge of $37,510 was 49% above the state average of $25,232. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $22,627 was 5% above the state average of $21,558.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Saint Michael's Medical Center in Newark, NJ, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-04-16 (CMS case 3865)
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.