OBJECTIVES: The Italian National Health Service (Servizio Sanitario Nazionale-SSN) is structured on two levels: the national and regional level. The national government defines the benefits package (essential levels of care, livelli essenziali di assistenza-LEA) to which citizens are constitutionally entitled and which each Regional Health Service (Servizio Sanitario Regionale-SSR) is responsible for. Since 1997 the regions have been fully autonomous in organizing and managing their SSR, including the definition of DRG tariffs for hospital admissions. The aim of this study is compare the regional differences among tariffs for the main surgical DRGs of each Major Diagnostic Category (MDC). METHODS: In order to identify the surgical DRGs with the highest volumes for each MDC, we used the dataset of admissions registered in 2010 by all hospitals (DRG version 24 ICD9-CM), published by the Italian Department of Health (Ministero della Salute), and we analyzed the variability among tariffs by calculating their average and standard deviations (the extra-reimbursement has not been considered). RESULTS: Average tariffs were calculated starting from the standard regional tariff for each DRG. Comparing the first 10 DRGs, we identified a variation in the average tariff which rose from -1.8% to +22.6% and a standard deviation with a minimum of 425€ and a maximum of 1443€. Further complexity is given by the intra-regional variation by type of hospital, where we observed a variation inside the same region of 82% for the same DRG. CONCLUSIONS: The SSN is characterized by a high variability of regional DRG tariffs, also inside the regions. Moreover in Italy there is not a defined procedure to update the classification of DRGs and the related tariffs. Therefore there is a need to establish a systematic periodical review, which should involve all the different stakeholders of SSN, and to share data updated with them about the volume of admissions.