This study conducted a descriptive analysis of the number of cases, average length of stay, average per-case cost, average daily cost, and cost composition based on the front-page medical record of 4,653 special cases from a provincial tertiary hospital in Hefei in 2024. Univariate analysis revealed that age, gender, length of stay, medical insurance type, presence of complications, DRG category and department category all significantly influenced hospitalization costs for special cases. Structural equation modeling analysis indicated that special cases constituted 12.64% of total cases, yet accounted for 22.71% and 29.81% of total length of stay and hospitalization costs, respectively, indicating significant resource consumption. Costs for high-cost cases were primarily composed of material fees, while low-cost cases were dominated by laboratory test fees. Both cost structures exhibited a pattern of heavy reliance on material consumption and low labor costs. The study suggests that hospitals should adjust the medical cost structure, shorten the average length of stay and refine medical insurance payment policies through the DRG payment tool. These measures help achieve the goals of cost control, quality improvement and efficiency enhancement, thereby promoting a win-win situation for healthcare providers, medical insurers and patients.