OBJECTIVES: Heart Failure (HF) represents the most costly condition for the Medicare population and one of the most common reasons for admission to US Hospitals. This study sought to quantify the actual hospital costs for these admissions looking at different diagnoses and varying severities. METHODS: Using the Premier hospital database, admissions from year 2010 were included if they met the following criteria: (a) one or more inpatient admission(s) with an International Classification of Diseases, Ninth Revision (ICD-9) primary diagnosis code of HF (both chronic and acute HF) and (b) Diagnosis-Related Group (DRG) Codes 291-Complications and Comorbidities, 292-Comorbidities or 293-Without any Complications and Comorbidities. Patients with an implantable cardiac device (e.g. ICD, CRT-D) were excluded. HF admissions were analyzed by DRG. Summary statistics were generated for the cost to the hospital overall and for each DRG code. RESULTS: A total of 592,279 inpatient admissions with a HF Diagnosis code were initially identified; 483,297 were excluded due to evidence of a device and/or a lack of HF-related DRG, leaving 108,982 admissions. Of the admissions that met the criteria, 44% were classified as DRG 291, 36% DRG 292, and 20% DRG 293. Mean costs were $8184 (SD $8,015; median $6140; first quartile (Q1) $3989, third quartile (Q3) $9691). Total costs of an admission were 51% fixed and 49% variable. Mean Length-of-Stay for admissions was 4.92 days (SD 4.74; median 4.00; Q1 2.00, Q3 6.00). Looking at DRGs separately, DRG 291 had the highest mean cost $10,558 (SD $10,033.6), followed by 292 $7,017 (SD $5,728) and 293 $5,067 (SD $4,091). CONCLUSIONS: The cost of a HF hospitalization typically exceeded the average reimbursement provided by Medicare which in 2010 was $8245, $5947, and $3917 for DRGs 291, 292, and 293, respectively.  Heart Failure is a highly prevalent and costly condition that imposes a significant burden on US hospitals.