Simple pneumonia and pleurisy with major complications in Maine
What 13 hospitals in Maine 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
$40,972
Hospital list price billed
Average payment
$11,946
Medicare + patient + other payers
Medicare paid
$9,725
Average per stay
State rank
#33 of 50
1 = lowest average payment
Hospitals in Maine billed an average of $40,972 for simple pneumonia and pleurisy with major complications, about 3.4 times the average total payment of $11,946. That payment is about the same as the U.S. average 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 $11,946Billed $40,972
About 29¢ was paid for every $1 hospitals in Maine billed for this stay.
Medicare prices this stay in 3 versions, by how sick the patient was. Compare them in Maine:
Maine hospitals: simple pneumonia and pleurisy with major complications
Every Maine hospital that billed Medicare for this stay at least 11 times. Click a column to sort.
| Hospital | Stays | Avg charge | Avg payment | Medicare paid |
|---|---|---|---|---|
| Maine Medical CenterPortland | 111 | $38,253 | $13,248 | $9,377 |
| Eastern Maine Medical CenterBangor | 70 | $64,452 | $10,527 | $9,234 |
| Central Maine Medical CenterLewiston | 54 | $28,094 | $10,935 | $8,696 |
| Maine General Medical CenterWaterville | 46 | $49,233 | $14,355 | $12,534 |
| St Joseph HospitalBangor | 45 | $32,696 | $12,111 | $10,914 |
| Mid Coast HospitalBrunswick | 44 | $33,284 | $10,480 | $8,315 |
| York HospitalYork | 34 | $39,240 | $8,988 | $7,740 |
| Northern Light a R Gould HospitalPresque Isle | 31 | $37,107 | $11,942 | $10,706 |
| Mercy HospitalPortland | 24 | $49,141 | $12,638 | $9,470 |
| Southern Maine Health CareBiddeford | 21 | $44,278 | $12,658 | $8,969 |
| Maine Coast Memorial HospitalEllsworth | 15 | $35,360 | $13,998 | $12,912 |
| St Marys Regional Medical CenterLewiston | 14 | $31,215 | $10,542 | $9,262 |
| Penobscot Bay Medical CenterRockport | 13 | $26,981 | $12,978 | $11,723 |
Lowest and highest payments in Maine
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
| York HospitalYork, ME | $8,988 |
|---|---|
| Mid Coast HospitalBrunswick, ME | $10,480 |
| Eastern Maine Medical CenterBangor, ME | $10,527 |
| St Marys Regional Medical CenterLewiston, ME | $10,542 |
| Central Maine Medical CenterLewiston, ME | $10,935 |
Highest
| Maine General Medical CenterWaterville, ME | $14,355 |
|---|---|
| Maine Coast Memorial HospitalEllsworth, ME | $13,998 |
| Maine Medical CenterPortland, ME | $13,248 |
| Penobscot Bay Medical CenterRockport, ME | $12,978 |
| Southern Maine Health CareBiddeford, ME | $12,658 |
Simple pneumonia and pleurisy with major complications in other states
Questions
How much does simple pneumonia and pleurisy with major complications cost in Maine?
In 2024 Medicare data, a hospital stay for simple pneumonia and pleurisy with major complications (DRG 193) at 13 hospitals in Maine was billed at $40,972 on average, while the average total payment was $11,946, of which Medicare paid $9,725. 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 Maine, average charges were 3.4 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.