National Payment Rates
Across commercial payers the mean rates range from $5.3K (BCBS) to $14K (Aetna), with a commercial average of $8.8K; Cigna and Anthem sit near $10K and $5.8K respectively. The widest spread between payer means is between Aetna ($14K) and BCBS ($5.3K), a gap of $8.7K. Medicare’s mean ($7.6K) falls within the commercial range.
The CMS 2024 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. It covers average submitted charges ($46K), average Medicare contribution ($7.6K), average total final payment ($9.8K), and total discharges (4.9K).
| Average Submitted Charges | Average Medicare Contribution | Average Total Final Payment | Total Discharges |
|---|---|---|---|
| $46K | $7.6K | $9.8K | 4.9K |
Patient Population
This DRG’s population is mixed but leans toward working-age and non-Medicare commercial coverage as evidenced by a notable commercial presence across payers; Medicare is a substantial but not dominant payer. Age distribution therefore spans from working-age adults to Medicare-age beneficiaries rather than being exclusively Medicare-age. Payer mix indicates meaningful volumes from private/commercial plans alongside Medicare.
State Payment Rates
State: California1 / 1
California Benchmarks
Payer rates in California range from a low mean of $9.2K with Anthem to a high mean of $18K with Aetna, reflecting a notable gap between the extremes. Several major commercial payers — Blue Cross Blue Shield, Cigna, and Aetna — cluster at or above the $12K–$18K range, while Anthem sits well below that band. Medicare’s Average Total Final Payment of $13K is similar to the commercial average, even though submitted charges are substantially higher.
Key Insights for California
- Aetna is the highest-paying commercial payer with a mean of $18K, while Anthem is the lowest-paying on average at $9.2K.
- Commercial payer means cluster around $12K–$13K (BCBS, Cigna, Commercial Average), producing a moderate spread from $9.2K to $18K across payers.
- Medicare’s Average Total Final Payment ($13K) aligns closely with the commercial average ($13K), despite much higher average submitted charges ($77K).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.