Simple pneumonia and pleurisy with complications
What 1,522 hospitals in the U.S. charged and were paid for a Medicare hospital stay for simple pneumonia and pleurisy with complications (DRG 194), from 2024 Medicare claims.
Average charge
$38,636
Hospital list price billed
Average payment
$7,941
Medicare + patient + other payers
Medicare paid
$5,880
Average per stay
Volume
41,948
Medicare hospital stays
Hospitals in the U.S. billed an average of $38,636 for simple pneumonia and pleurisy with complications, about 4.9 times the average total payment of $7,941.
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 $7,941Billed $38,636
About 21¢ was paid for every $1 hospitals in the U.S. billed for this stay.
Medicare prices this stay in 3 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
| Pelham Medical CenterGreer, SC | $4,973 |
|---|---|
| Palm Beach Gardens Medical CenterPalm Beach Gardens, FL | $5,205 |
| Williamson Medical CenterFranklin, TN | $5,273 |
| Roper HospitalCharleston, SC | $5,280 |
| Marietta Memorial HospitalMarietta, OH | $5,322 |
| Villages Regional Hospital theLady Lake, FL | $5,356 |
| Baxter Regional Medical CenterMountain Home, AR | $5,358 |
| Crestwood Medical CenterHuntsville, AL | $5,365 |
| Slidell Memorial HospitalSlidell, LA | $5,391 |
| Delray Medical CenterDelray Beach, FL | $5,403 |
Highest
| University of MD Charles Regional Medical CenterLa Plata, MD | $16,591 |
|---|---|
| Stanford HospitalPalo Alto, CA | $16,396 |
| Sinai Hospital of BaltimoreBaltimore, MD | $15,929 |
| Jackson Health SystemMiami, FL | $15,797 |
| Hospital of the Univ of PaPhiladelphia, PA | $15,688 |
| South Brooklyn HealthBrooklyn, NY | $15,452 |
| The Johns Hopkins HospitalBaltimore, MD | $15,167 |
| St John's Episcopal Hospital at South ShoreFar Rockaway, NY | $15,051 |
| Santa Clara Valley Medical CenterSan Jose, CA | $14,903 |
| The Queens Medical CenterHonolulu, HI | $14,723 |
Simple pneumonia and pleurisy with 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 |
|---|---|---|---|---|
| Alabama | 37 | $27,733 | $6,857 | $5,365 – $11,272 |
| Alaska | 3 | $35,747 | $15,006 | $13,013 – $17,409 |
| Arizona | 26 | $38,812 | $7,732 | $5,995 – $13,127 |
| Arkansas | 25 | $26,784 | $6,317 | $5,358 – $8,620 |
| California | 109 | $73,263 | $9,767 | $6,330 – $22,612 |
| Colorado | 9 | $54,759 | $7,068 | $5,886 – $9,879 |
| Connecticut | 18 | $32,377 | $9,165 | $7,035 – $13,418 |
| Delaware | 5 | $27,979 | $7,762 | $6,820 – $8,379 |
| Florida | 121 | $51,324 | $7,459 | $5,205 – $15,797 |
| Georgia | 45 | $36,487 | $8,231 | $5,696 – $15,284 |
| Hawaii | 3 | $44,158 | $12,743 | $8,552 – $14,723 |
| Idaho | 1 | $23,232 | $6,405 | – |
| Illinois | 67 | $32,938 | $7,659 | $5,686 – $15,245 |
| Indiana | 49 | $29,898 | $6,815 | $5,761 – $10,150 |
| Iowa | 15 | $24,033 | $6,219 | $5,563 – $8,855 |
| Kansas | 14 | $36,839 | $6,480 | $5,019 – $8,970 |
| Kentucky | 27 | $30,006 | $6,348 | $5,461 – $10,493 |
| Louisiana | 32 | $30,773 | $6,404 | $4,885 – $8,154 |
| Maine | 8 | $23,946 | $7,620 | $6,534 – $8,693 |
| Maryland | 37 | $12,233 | $11,047 | $7,137 – $25,002 |
| Massachusetts | 46 | $19,459 | $8,160 | $6,374 – $16,846 |
| Michigan | 42 | $24,207 | $7,597 | $5,244 – $11,226 |
| Minnesota | 26 | $23,678 | $7,938 | $5,829 – $13,285 |
| Mississippi | 25 | $34,067 | $6,567 | $5,472 – $10,802 |
| Missouri | 37 | $31,164 | $6,943 | $5,146 – $10,531 |
| Montana | 2 | $19,468 | $6,660 | $6,391 – $6,974 |
| Nebraska | 7 | $27,161 | $7,022 | $5,821 – $8,972 |
| Nevada | 11 | $77,821 | $8,520 | $7,312 – $11,642 |
| New Hampshire | 9 | $26,189 | $7,380 | $6,180 – $10,268 |
| New Jersey | 49 | $65,965 | $8,236 | $6,201 – $12,997 |
| New Mexico | 4 | $31,101 | $7,729 | $5,997 – $10,425 |
| New York | 93 | $49,171 | $10,004 | $6,880 – $40,893 |
| North Carolina | 48 | $29,362 | $7,967 | $5,552 – $14,360 |
| North Dakota | 4 | $20,210 | $7,473 | $6,720 – $7,908 |
| Ohio | 71 | $28,712 | $6,879 | $5,089 – $10,861 |
| Oklahoma | 30 | $36,729 | $7,064 | $5,896 – $10,896 |
| Oregon | 8 | $27,584 | $8,637 | $6,997 – $11,045 |
| Pennsylvania | 80 | $40,799 | $7,325 | $5,401 – $15,688 |
| Rhode Island | 7 | $24,322 | $7,836 | $6,314 – $9,934 |
| South Carolina | 33 | $34,432 | $7,497 | $4,973 – $11,400 |
| South Dakota | 4 | $32,898 | $7,084 | $5,718 – $7,952 |
| Tennessee | 33 | $33,301 | $7,299 | $5,273 – $12,511 |
| Texas | 94 | $46,278 | $8,089 | $5,437 – $44,834 |
| Utah | 2 | $25,956 | $7,411 | $6,626 – $8,841 |
| Vermont | 3 | $25,525 | $7,280 | $5,347 – $9,422 |
| Virginia | 42 | $29,522 | $7,362 | $5,381 – $13,977 |
| Washington | 14 | $35,451 | $8,121 | $6,882 – $10,169 |
| West Virginia | 17 | $27,799 | $6,552 | $5,468 – $8,575 |
| Wisconsin | 23 | $28,163 | $7,255 | $5,454 – $10,485 |
| Wyoming | 5 | $24,707 | $9,410 | $7,637 – $12,140 |
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg charge | Avg payment |
|---|---|---|---|
| Anne Arundel Medical CenterAnnapolis, MD | 192 | $10,206 | $9,416 |
| Christiana Care Health Services, INC.Newark, DE | 173 | $28,387 | $8,379 |
| New York-Presbyterian HospitalNew York, NY | 172 | $74,386 | $12,038 |
| Evanston HospitalEvanston, IL | 149 | $28,151 | $7,744 |
| Southcoast Hospital Group, INCFall River, MA | 147 | $19,761 | $7,197 |
| Sarasota Memorial HospitalSarasota, FL | 144 | $36,056 | $6,531 |
| NYU Hospitals CenterNew York, NY | 143 | $86,943 | $12,450 |
| Martin Memorial Health SystemsStuart, FL | 141 | $30,252 | $5,584 |
| Adventhealth OrlandoOrlando, FL | 140 | $53,788 | $7,975 |
| South Shore HospitalSouth Weymouth, MA | 129 | $13,445 | $6,966 |
| Virtua West Jersey HospitalVoorhees, NJ | 123 | $76,851 | $7,021 |
| Morristown Memorial HospitalMorristown, NJ | 118 | $63,304 | $8,597 |
| Lehigh Valley HospitalAllentown, PA | 118 | $47,429 | $7,645 |
| St Francis Hospital, RoslynRoslyn, NY | 117 | $49,887 | $7,932 |
| Naples Community HospitalNaples, FL | 111 | $38,939 | $6,563 |
Questions
How much does simple pneumonia and pleurisy with complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for simple pneumonia and pleurisy with complications (DRG 194) at 1,522 hospitals in the U.S. was billed at $38,636 on average, while the average total payment was $7,941, of which Medicare paid $5,880. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for simple pneumonia and pleurisy with complications?
Among states with at least three hospitals reporting, the average total payment was highest in Alaska ($15,006), Hawaii ($12,743), Maryland ($11,047) and lowest in Iowa ($6,219), Arkansas ($6,317), Kentucky ($6,348).
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 4.9 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.