The HCUP Cost-to-Charge Ratio (CCR) for Emergency Department (ED) Files are hospital-level files designed to supplement the data elements in the State Emergency Department Databases (SEDD) and Nationwide Emergency Department Sample (NEDS), beginning with data year 2012. HCUP Cost-to-Charge Ratio (CCR) for Inpatient Files are also available. The CCR Files are part of a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. HCUP databases, tools, and software inform decision making at the national, State, and community levels.

Contents:

• Overview of the CCR for ED Files
• Description of the CCR for ED Files
• File Information for the CCR Files for the NEDS
• File Information for the CCR Files for the SEDD
• Hardware and Software Requirements
• User Documentation
• How Can Users Obtain the CCR for ED Files?

The HCUP Emergency Department databases contain data on total charges for each hospital emergency department (ED) visit in the databases. The charge information for ED visits represents the amount that hospitals billed for services, but does not reflect how much hospital services cost or the specific amounts that hospitals received in payment. For some analyses, users may be interested in estimating how hospital charges translate into actual costs.

The HCUP CCR for ED Files enable this conversion. Each file contains hospital-specific cost-to-charge ratios based on all-payer ED costs for nearly every hospital in the corresponding SEDD and NEDS. Cost information was obtained from the hospital accounting reports collected by the Centers for Medicare & Medicaid Services. Some imputations for missing values were necessary.

Users can merge the data elements on the appropriate file to the corresponding SEDD or NEDS by the HCUP hospital identification number (HOSPID for the SEDD and HOSP_NEDS for the NEDS). Using the merged data elements from the cost-to-charge ratio files and the total charges reported in the SEDD or NEDS, users may convert the hospital total charge data to cost estimates by multiplying the HCUP total charges element (TOTCHG) by the appropriate cost-to-charge ratio.

HCUP CCR for ED Files are designed to be used exclusively with the HCUP SEDD or NEDS. The CCR Files are unique by year and database.

The HCUP CCR for ED Files are used to estimate the cost of resource use for ED visits based on the reported total charge and the cost-to-charge ratios provided in the supplemental files. Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. Hospital charges reflect the amount the hospital billed for the entire ED visit and do not include professional (physician) fees.

The CCR for ED Files allow researchers to estimate costs using hospital-specific ratios, where provided, or by weighted average ratios for hospitals in peer groups defined by hospital characteristics and State.

There is one CCR File per data year for the NEDS. Users can merge the data elements from the appropriate CCR File onto the corresponding NEDS, using the included NEDS hospital identification number (HOSP_ED). The filenames for the CCR Files for the NEDS are listed in the separate Appendix to the User Guide (in Excel format).

The following table provides links to the Summary Statistics for the CCR Files for the NEDS starting in 2018.

Data Year	Summary Statistics for the CCR Files for the NEDS
2023	X
2022	X
2021	X
2020	X
2019	X
2018	X

In February 2026, the structure of the CCR Files for the SEDD was revised. Previously, there was one combined multi-state CCR File for the SEDD per data year (2012-2023) that included information for all States with available data. The previously combined multi-state CCR Files for the SEDD have been split into State-specific files. There is one CCR File per SEDD for each data year. The unit of observation within the CCR Files for the SEDD remains hospitals in the SEDD, identified by the HCUP hospital identification number (HOSPID). The availability of data elements within the CCR Files for the SEDD continues to depend on HCUP Partner permission for data release.

The CCR Files for the SEDD are in ASCII comma separated value (CSV) format (the files do not require a password). Any CCR File for the SEDD obtained starting in March 2026 will be State-specific and have the filename of CCR_SEDD_<YYYY>_<SS>, where <YYYY> is the data year and <SS> is the 2-character State abbreviation. The filenames for the combined multi-state CCR Files for the SEDD obtained prior to March 2026 are listed in the separate Appendix to the User Guide (in Excel format).

The following table provides links to the Summary Statistics for the previously combined multi-state CCR Files for the SEDD released through the HCUP Central Distributor (CD) starting in 2018.

Data Year	Previously Combined Multi-state CCR Files for the SEDD	Summary Statistics
2023	CD-SEDD	X
2022	CD-SEDD	X
2021	CD-SEDD	X
2020	CD-SEDD	X
2019	CD-SEDD	X
2018	CD-SEDD	X

The HCUP CCR for ED Files are available in ASCII comma-separated values (CSV) format. Any analyses using the SEDD and NEDS require a statistical software package such as SAS, SPSS, or Stata.

User documentation for the HCUP CCR for ED Files includes a user guide and a methodologies document.

The user guide contains:

• A more detailed description of the files' purpose, usage, and format
• Instructions for linking the files to the SEDD or NEDS
• Descriptions of key data elements
• A summary of HCUP Partner participation

The methodologies document contains:

• An overview of the CCR method
• A detailed description of the development process for the CCR Files
• A summary of the CCR imputation model
• Guidance for using the CCRs with HCUP databases

User Documentation for CCR for ED Files

• User Guide: Cost-to-Charge Ratio for Emergency Department Files (PDF file, 321 KB)
  • User Guide Appendix (Excel file, x.x KB)
• HCUP Cost-to-Charge Ratio Methodologies (HCUP Methods Series Report) (PDF file, 679 KB)

HCUP CCR for ED Files are provided as separate files available with the HCUP Central Distributor. These supplemental files are available free of charge from the HCUP Central Distributor.

The CCR for the NEDS are provided as complimentary files that are automatically included with download orders for the NEDS. The CCR Files for the SEDD can be added to an order for the accompanying SEDD - they are not automatically included with the order.