Cardiac congenital and valvular disorders with major complications
What 38 hospitals in the U.S. charged and were paid for a Medicare hospital stay for cardiac congenital and valvular disorders with major complications (DRG 306), from 2024 Medicare claims.
Average charge
$104,180
Hospital list price billed
Average payment
$19,049
Medicare + patient + other payers
Medicare paid
$14,932
Average per stay
Volume
664
Medicare hospital stays
Hospitals in the U.S. billed an average of $104,180 for cardiac congenital and valvular disorders with major complications, about 5.5 times the average total payment of $19,049.
These are averages for patients with original (fee-for-service) Medicare. Private insurance pays different, negotiated prices, and what you owe depends on your plan's deductible and coinsurance. Use these figures to compare hospitals, not as a quote.
Paid $19,049Billed $104,180
About 18¢ was paid for every $1 hospitals in the U.S. billed for this stay.
Medicare prices this stay in 2 versions, by how sick the patient was. Compare them:
Lowest and highest payments
Among hospitals with at least 20 Medicare hospital stays. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Evanston HospitalEvanston, IL | $14,592 |
|---|---|
| Main Line Hospital LankenauWynnewood, PA | $15,852 |
| Northwestern Memorial HospitalChicago, IL | $16,957 |
| Cleveland Clinic - Main CampusCleveland, OH | $17,648 |
| Cedars-Sinai Medical CenterLos Angeles, CA | $20,039 |
| NYU Hospitals CenterNew York, NY | $22,918 |
| Mount Sinai HospitalNew York, NY | $25,079 |
| New York-Presbyterian HospitalNew York, NY | $26,295 |
Highest
| New York-Presbyterian HospitalNew York, NY | $26,295 |
|---|---|
| Mount Sinai HospitalNew York, NY | $25,079 |
| NYU Hospitals CenterNew York, NY | $22,918 |
| Cedars-Sinai Medical CenterLos Angeles, CA | $20,039 |
| Cleveland Clinic - Main CampusCleveland, OH | $17,648 |
| Northwestern Memorial HospitalChicago, IL | $16,957 |
| Main Line Hospital LankenauWynnewood, PA | $15,852 |
| Evanston HospitalEvanston, IL | $14,592 |
Cardiac congenital and valvular disorders with major complications cost by state
Volume-weighted averages for each state's hospitals. Select a state to see every hospital.
| State | Hospitals | Avg charge | Avg payment | Range |
|---|---|---|---|---|
| California | 2 | $221,111 | $24,857 | $20,039 – $33,689 |
| Delaware | 1 | $61,194 | $16,434 | – |
| Florida | 3 | $86,116 | $12,213 | $11,626 – $12,472 |
| Georgia | 1 | $52,118 | $18,474 | – |
| Illinois | 2 | $58,088 | $15,240 | $14,592 – $16,957 |
| Kansas | 1 | $64,228 | $12,356 | – |
| Massachusetts | 5 | $54,736 | $18,872 | $12,760 – $21,758 |
| Minnesota | 1 | $29,888 | $14,267 | – |
| Missouri | 1 | $104,485 | $22,807 | – |
| New Jersey | 2 | $151,625 | $16,592 | $13,563 – $19,265 |
| New York | 7 | $154,758 | $24,275 | $14,395 – $37,388 |
| North Carolina | 1 | $46,453 | $10,618 | – |
| Ohio | 1 | $85,017 | $17,648 | – |
| Pennsylvania | 4 | $126,179 | $17,692 | $13,931 – $23,576 |
| Tennessee | 1 | $56,364 | $12,872 | – |
| Texas | 2 | $87,495 | $17,885 | $13,560 – $24,732 |
| Virginia | 2 | $90,471 | $24,856 | $20,291 – $28,615 |
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg charge | Avg payment |
|---|---|---|---|
| Evanston HospitalEvanston, IL | 53 | $50,679 | $14,592 |
| Mount Sinai HospitalNew York, NY | 42 | $116,124 | $25,079 |
| Cleveland Clinic - Main CampusCleveland, OH | 30 | $85,017 | $17,648 |
| Cedars-Sinai Medical CenterLos Angeles, CA | 22 | $218,580 | $20,039 |
| New York-Presbyterian HospitalNew York, NY | 21 | $187,043 | $26,295 |
| Main Line Hospital LankenauWynnewood, PA | 21 | $97,295 | $15,852 |
| Northwestern Memorial HospitalChicago, IL | 20 | $77,721 | $16,957 |
| NYU Hospitals CenterNew York, NY | 20 | $127,985 | $22,918 |
| North Shore University HospitalManhasset, NY | 19 | $159,002 | $19,977 |
| The Heart Hospital Baylor PlanoPlano, TX | 19 | $42,179 | $13,560 |
| Baystate Medical CenterSpringfield, MA | 18 | $21,367 | $16,743 |
| Beth Israel Deaconess Medical CenterBoston, MA | 18 | $39,160 | $21,531 |
| Adventhealth OrlandoOrlando, FL | 17 | $128,201 | $12,472 |
| Piedmont HospitalAtlanta, GA | 17 | $52,118 | $18,474 |
| Barnes Jewish HospitalSt Louis, MO | 17 | $104,485 | $22,807 |
Questions
How much does cardiac congenital and valvular disorders with major complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for cardiac congenital and valvular disorders with major complications (DRG 306) at 38 hospitals in the U.S. was billed at $104,180 on average, while the average total payment was $19,049, of which Medicare paid $14,932. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for cardiac congenital and valvular disorders with major complications?
Among states with at least three hospitals reporting, the average total payment was highest in New York ($24,275), Massachusetts ($18,872), Pennsylvania ($17,692) and lowest in Florida ($12,213), Pennsylvania ($17,692), Massachusetts ($18,872).
Why are hospital charges so much higher than payments?
Charges are a hospital's list prices. Medicare pays fixed rates set in advance, and private insurers negotiate their own discounts, so almost nobody pays the full charge. For this stay in the U.S., average charges were 5.5 times the average payment. Uninsured patients can ask the hospital about its financial assistance (charity care) policy and cash prices.
Source: CMS, Medicare Inpatient Hospitals by Provider and Service, 2024. Average total payment includes Medicare's payment, the patient's deductible and coinsurance, and any other payer. CMS omits hospitals with fewer than 11 hospital stays for privacy. About the data.