Non-extensive operating room procedures unrelated to principal diagnosis with major complications in Pennsylvania
What 8 hospitals in Pennsylvania charged and were paid for a Medicare hospital stay for non-extensive operating room procedures unrelated to principal diagnosis with major complications (DRG 987), from 2024 Medicare claims.
Average charge
$250,965
Hospital list price billed
Average payment
$40,175
Medicare + patient + other payers
Medicare paid
$31,387
Average per stay
State rank
#8 of 16
1 = lowest average payment
Hospitals in Pennsylvania billed an average of $250,965 for non-extensive operating room procedures unrelated to principal diagnosis with major complications, about 6.2 times the average total payment of $40,175. That payment is 2% below the U.S. average of $41,021.
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 $40,175Billed $250,965
About 16¢ was paid for every $1 hospitals in Pennsylvania billed for this stay.
Medicare prices this stay in 2 versions, by how sick the patient was. Compare them in Pennsylvania:
Pennsylvania hospitals: non-extensive operating room procedures unrelated to principal diagnosis with major complications
Every Pennsylvania hospital that billed Medicare for this stay at least 11 times. Click a column to sort.
| Hospital | Stays | Avg charge | Avg payment | Medicare paid |
|---|---|---|---|---|
| Lehigh Valley HospitalAllentown | 20 | $179,764 | $27,620 | $25,303 |
| Thomas Jefferson University HospitalPhiladelphia | 15 | $239,864 | $48,795 | $39,768 |
| UPMC Presbyterian ShadysidePittsburgh | 14 | $422,212 | $38,638 | $26,996 |
| Reading Hospital and Med CtrWest Reading | 13 | $103,288 | $27,494 | $25,422 |
| Lancaster General HospitalLancaster | 13 | $83,716 | $36,411 | $19,097 |
| Temple University HospitalPhiladelphia | 11 | $404,935 | $46,539 | $32,792 |
| Allegheny General HospitalPittsburgh | 11 | $164,874 | $40,663 | $35,476 |
| Hospital of the Univ of PaPhiladelphia | 11 | $481,911 | $65,782 | $52,687 |
Lowest and highest payments in Pennsylvania
Among hospitals with at least 11 Medicare hospital stays. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Reading Hospital and Med CtrWest Reading, PA | $27,494 |
|---|---|
| Lehigh Valley HospitalAllentown, PA | $27,620 |
| Lancaster General HospitalLancaster, PA | $36,411 |
| UPMC Presbyterian ShadysidePittsburgh, PA | $38,638 |
| Allegheny General HospitalPittsburgh, PA | $40,663 |
Highest
| Hospital of the Univ of PaPhiladelphia, PA | $65,782 |
|---|---|
| Thomas Jefferson University HospitalPhiladelphia, PA | $48,795 |
| Temple University HospitalPhiladelphia, PA | $46,539 |
| Allegheny General HospitalPittsburgh, PA | $40,663 |
| UPMC Presbyterian ShadysidePittsburgh, PA | $38,638 |
Non-extensive operating room procedures unrelated to principal diagnosis with major complications in other states
Questions
How much does non-extensive operating room procedures unrelated to principal diagnosis with major complications cost in Pennsylvania?
In 2024 Medicare data, a hospital stay for non-extensive operating room procedures unrelated to principal diagnosis with major complications (DRG 987) at 8 hospitals in Pennsylvania was billed at $250,965 on average, while the average total payment was $40,175, of which Medicare paid $31,387. Your own cost depends on your insurance, deductible and the hospital.
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 Pennsylvania, average charges were 6.2 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.