Simple pneumonia and pleurisy with major complications
What 2,442 hospitals in the U.S. charged and were paid for a Medicare hospital stay for simple pneumonia and pleurisy with major complications (DRG 193), from 2024 Medicare claims.
Average charge
$60,101
Hospital list price billed
Average payment
$12,020
Medicare + patient + other payers
Medicare paid
$9,868
Average per stay
Volume
136,649
Medicare hospital stays
Hospitals in the U.S. billed an average of $60,101 for simple pneumonia and pleurisy with major complications, about 5.0 times the average total payment of $12,020.
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 $12,020Billed $60,101
About 20¢ 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
| Marietta Memorial HospitalMarietta, OH | $5,659 |
|---|---|
| Central Vermont Medical CenterGraniteville-East Barre, VT | $6,627 |
| Rutland Regional Medical CenterRutland, VT | $6,921 |
| Shelby Baptist Medical CenterAlabaster, AL | $7,547 |
| Novant Health Ballantyne Medical CenterCharlotte, NC | $7,745 |
| St Mary's Jefferson Memorial HospitalJefferson City, TN | $7,833 |
| Piedmont Columbus Regional NorthsideColumbus, GA | $7,890 |
| Reynolds Memorial HospitalGlen Dale, WV | $7,896 |
| Arkansas Heart Hospital-EncoreBryant, AR | $7,898 |
| Three Crosses Regional Hospital LLCLas Cruces, NM | $7,923 |
Highest
| Parkland Health and Hospital SystemDallas, TX | $55,573 |
|---|---|
| Queens Hospital CenterJamaica, NY | $41,422 |
| Jps Health NetworkFort Worth, TX | $38,767 |
| Elmhurst Hospital CenterNew York, NY | $34,795 |
| Loyola University Medical CenterMaywood, IL | $34,165 |
| North Carolina Baptist HospitalWinston-Salem, NC | $32,122 |
| Kaiser Foundation Hospital Oakland/RichmondOakland, CA | $30,031 |
| University Health SystemSan Antonio, TX | $29,559 |
| Los Angeles General Medical CenterLos Angeles, CA | $29,319 |
| Jacobi Medical CenterBronx, NY | $29,024 |
Simple pneumonia and pleurisy 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 |
|---|---|---|---|---|
| Alabama | 45 | $51,190 | $10,084 | $7,547 – $15,658 |
| Alaska | 7 | $81,360 | $16,879 | $11,744 – $22,266 |
| Arizona | 49 | $59,733 | $11,725 | $9,381 – $17,394 |
| Arkansas | 33 | $41,508 | $9,529 | $7,898 – $14,153 |
| California | 223 | $104,377 | $15,080 | $10,483 – $60,274 |
| Colorado | 38 | $69,602 | $11,366 | $9,378 – $22,209 |
| Connecticut | 25 | $49,093 | $14,233 | $11,194 – $20,036 |
| Delaware | 6 | $38,798 | $12,102 | $10,974 – $13,022 |
| Florida | 159 | $78,333 | $10,910 | $8,202 – $21,379 |
| Georgia | 73 | $57,202 | $12,085 | $7,890 – $27,924 |
| Hawaii | 11 | $50,698 | $16,180 | $12,890 – $22,716 |
| Idaho | 10 | $44,230 | $11,075 | $9,666 – $13,737 |
| Illinois | 102 | $49,116 | $11,824 | $8,908 – $58,655 |
| Indiana | 70 | $43,706 | $10,628 | $9,017 – $17,916 |
| Iowa | 27 | $33,825 | $10,045 | $8,563 – $14,718 |
| Kansas | 29 | $56,040 | $10,596 | $7,304 – $14,135 |
| Kentucky | 55 | $43,836 | $9,950 | $8,576 – $20,297 |
| Louisiana | 37 | $49,710 | $9,767 | $7,915 – $20,224 |
| Maine | 13 | $40,972 | $11,946 | $8,988 – $14,355 |
| Maryland | 40 | $17,060 | $15,376 | $11,037 – $31,751 |
| Massachusetts | 49 | $28,103 | $12,619 | $9,720 – $25,272 |
| Michigan | 69 | $36,121 | $11,570 | $8,837 – $17,929 |
| Minnesota | 42 | $38,296 | $12,046 | $9,031 – $18,695 |
| Mississippi | 37 | $48,363 | $9,770 | $7,898 – $14,809 |
| Missouri | 56 | $48,298 | $10,786 | $8,201 – $23,932 |
| Montana | 10 | $29,327 | $10,500 | $9,136 – $12,631 |
| Nebraska | 16 | $41,518 | $11,028 | $8,808 – $15,205 |
| Nevada | 19 | $110,500 | $12,697 | $11,236 – $16,534 |
| New Hampshire | 13 | $40,443 | $11,445 | $9,700 – $16,338 |
| New Jersey | 56 | $99,889 | $13,120 | $10,110 – $26,702 |
| New Mexico | 20 | $47,872 | $12,045 | $7,923 – $21,717 |
| New York | 116 | $77,497 | $15,898 | $10,304 – $48,754 |
| North Carolina | 72 | $40,007 | $11,518 | $7,745 – $32,122 |
| North Dakota | 6 | $31,410 | $10,728 | $9,676 – $11,693 |
| Ohio | 101 | $41,640 | $10,698 | $5,659 – $16,835 |
| Oklahoma | 47 | $53,519 | $10,363 | $8,244 – $15,280 |
| Oregon | 24 | $38,184 | $13,291 | $10,773 – $16,969 |
| Pennsylvania | 109 | $59,833 | $11,339 | $8,717 – $22,598 |
| Rhode Island | 9 | $35,281 | $12,735 | $10,074 – $16,313 |
| South Carolina | 46 | $53,637 | $11,106 | $7,639 – $17,277 |
| South Dakota | 9 | $41,361 | $11,284 | $9,242 – $13,674 |
| Tennessee | 63 | $48,478 | $10,291 | $7,833 – $17,340 |
| Texas | 179 | $74,493 | $11,464 | $7,926 – $55,573 |
| Utah | 22 | $37,709 | $11,433 | $7,790 – $14,972 |
| Vermont | 6 | $33,721 | $9,426 | $4,714 – $15,154 |
| Virginia | 66 | $44,680 | $11,067 | $8,256 – $19,951 |
| Washington | 42 | $54,417 | $12,459 | $10,659 – $17,761 |
| West Virginia | 21 | $41,524 | $10,349 | $7,896 – $14,565 |
| Wisconsin | 53 | $40,569 | $11,266 | $8,602 – $16,522 |
| Wyoming | 7 | $35,267 | $14,626 | $12,157 – $16,771 |
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg charge | Avg payment |
|---|---|---|---|
| NYU Hospitals CenterNew York, NY | 465 | $127,394 | $19,876 |
| Christiana Care Health Services, INC.Newark, DE | 437 | $38,520 | $12,627 |
| New York-Presbyterian HospitalNew York, NY | 371 | $143,424 | $20,672 |
| University HospitalStony Brook, NY | 351 | $100,053 | $18,074 |
| Adventhealth OrlandoOrlando, FL | 338 | $81,153 | $11,902 |
| Glendale Adventist Medical CtrGlendale, CA | 321 | $114,907 | $14,373 |
| Methodist HospitalSan Antonio, TX | 314 | $103,634 | $10,916 |
| Southcoast Hospital Group, INCFall River, MA | 304 | $30,795 | $11,253 |
| Sarasota Memorial HospitalSarasota, FL | 284 | $52,024 | $10,015 |
| Norton Healthcare PavilionLouisville, KY | 284 | $50,104 | $9,620 |
| South Shore HospitalSouth Weymouth, MA | 270 | $20,001 | $11,047 |
| Northeast Georgia Medical Center, INCGainesville, GA | 265 | $64,034 | $13,592 |
| Martin Memorial Health SystemsStuart, FL | 258 | $43,035 | $9,043 |
| Community Medical CenterToms River, NJ | 254 | $88,535 | $11,889 |
| Morristown Memorial HospitalMorristown, NJ | 251 | $104,251 | $13,548 |
Questions
How much does simple pneumonia and pleurisy with major complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for simple pneumonia and pleurisy with major complications (DRG 193) at 2,442 hospitals in the U.S. was billed at $60,101 on average, while the average total payment was $12,020, of which Medicare paid $9,868. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for simple pneumonia and pleurisy with major complications?
Among states with at least three hospitals reporting, the average total payment was highest in Alaska ($16,879), Hawaii ($16,180), New York ($15,898) and lowest in Vermont ($9,426), Arkansas ($9,529), Louisiana ($9,767).
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 5.0 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.