Simple pneumonia and pleurisy without complications
What 115 hospitals in the U.S. charged and were paid for a Medicare hospital stay for simple pneumonia and pleurisy without complications (DRG 195), from 2024 Medicare claims.
Average charge
$29,430
Hospital list price billed
Average payment
$6,019
Medicare + patient + other payers
Medicare paid
$4,015
Average per stay
Volume
1,837
Medicare hospital stays
Hospitals in the U.S. billed an average of $29,430 for simple pneumonia and pleurisy without complications, about 4.9 times the average total payment of $6,019.
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 $6,019Billed $29,430
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
| Wakemed, Cary HospitalCary, NC | $4,202 |
|---|---|
| Physicians Regional Medical Center - Pine RidgeNaples, FL | $4,299 |
| Floyd Memorial Hospital and Health ServicesNew Albany, IN | $4,435 |
| Boca Raton Regional HospitalBoca Raton, FL | $4,870 |
| Monroe County Medical CenterTompkinsville, KY | $4,928 |
| Naples Community HospitalNaples, FL | $5,218 |
| South Shore HospitalSouth Weymouth, MA | $5,247 |
| Sarasota Memorial HospitalSarasota, FL | $5,379 |
| St Francis Hospital, RoslynRoslyn, NY | $5,462 |
| Winchester Medical Center INCWinchester, VA | $5,478 |
Highest
| Jackson Health SystemMiami, FL | $14,730 |
|---|---|
| Anne Arundel Medical CenterAnnapolis, MD | $8,494 |
| Frederick Memorial HospitalFrederick, MD | $8,457 |
| Methodist HospitalSan Antonio, TX | $7,402 |
| Northeast Georgia Medical Center, INCGainesville, GA | $6,876 |
| Adventhealth OrlandoOrlando, FL | $6,768 |
| Wakemed, Raleigh CampusRaleigh, NC | $6,526 |
| Christiana Care Health Services, INC.Newark, DE | $6,122 |
| Evanston HospitalEvanston, IL | $5,837 |
| Virtua West Jersey HospitalVoorhees, NJ | $5,830 |
Simple pneumonia and pleurisy without 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 | 2 | $21,922 | $5,267 | $4,862 – $5,602 |
| Arizona | 4 | $34,988 | $5,842 | $4,197 – $8,767 |
| California | 5 | $46,479 | $6,969 | $6,224 – $7,596 |
| Connecticut | 1 | $39,140 | $7,214 | – |
| Delaware | 2 | $22,545 | $5,946 | $5,729 – $6,122 |
| Florida | 14 | $36,268 | $6,025 | $4,118 – $14,730 |
| Georgia | 3 | $26,030 | $6,105 | $4,812 – $6,876 |
| Illinois | 5 | $24,591 | $6,463 | $4,752 – $9,763 |
| Indiana | 3 | $21,974 | $4,675 | $4,435 – $5,095 |
| Iowa | 1 | $15,568 | $4,145 | – |
| Kansas | 1 | $34,418 | $4,789 | – |
| Kentucky | 5 | $20,227 | $4,623 | $4,019 – $5,072 |
| Louisiana | 2 | $23,034 | $5,039 | $4,234 – $5,760 |
| Maryland | 6 | $8,941 | $8,177 | $5,725 – $9,638 |
| Massachusetts | 8 | $14,589 | $5,532 | $5,129 – $5,899 |
| Michigan | 1 | $21,701 | $4,523 | – |
| Minnesota | 1 | $22,235 | $5,709 | – |
| Mississippi | 1 | $17,664 | $5,119 | – |
| Missouri | 5 | $29,240 | $5,300 | $4,006 – $6,431 |
| Nebraska | 1 | $16,823 | $5,118 | – |
| New Jersey | 9 | $49,031 | $6,153 | $5,020 – $8,530 |
| New York | 12 | $43,529 | $7,218 | $5,330 – $10,226 |
| North Carolina | 5 | $23,634 | $5,419 | $4,202 – $6,526 |
| Ohio | 3 | $19,018 | $4,948 | $4,386 – $5,567 |
| Oklahoma | 2 | $30,560 | $5,647 | $4,886 – $6,245 |
| Pennsylvania | 4 | $27,382 | $5,553 | $4,680 – $6,040 |
| Rhode Island | 1 | $21,166 | $7,155 | – |
| South Carolina | 1 | $31,564 | $6,360 | – |
| Tennessee | 1 | $30,849 | $4,951 | – |
| Texas | 3 | $36,852 | $6,442 | $4,891 – $7,402 |
| Virginia | 1 | $13,883 | $5,478 | – |
| West Virginia | 1 | $19,724 | $4,281 | – |
| Wisconsin | 1 | $25,606 | $4,344 | – |
Hospitals that treat the most Medicare patients for this
| Hospital | Stays | Avg charge | Avg payment |
|---|---|---|---|
| Anne Arundel Medical CenterAnnapolis, MD | 36 | $9,158 | $8,494 |
| Boca Raton Regional HospitalBoca Raton, FL | 33 | $28,393 | $4,870 |
| Evanston HospitalEvanston, IL | 30 | $22,312 | $5,837 |
| South Shore HospitalSouth Weymouth, MA | 30 | $13,390 | $5,247 |
| Christiana Care Health Services, INC.Newark, DE | 27 | $19,202 | $6,122 |
| Bethesda Memorial HospitalBoynton Beach, FL | 27 | $41,185 | $5,622 |
| Physicians Regional Medical Center - Pine RidgeNaples, FL | 27 | $48,220 | $4,299 |
| Wakemed, Cary HospitalCary, NC | 27 | $24,775 | $4,202 |
| Adventhealth OrlandoOrlando, FL | 26 | $45,275 | $6,768 |
| Monroe County Medical CenterTompkinsville, KY | 26 | $14,712 | $4,928 |
| Virtua West Jersey HospitalVoorhees, NJ | 25 | $55,774 | $5,830 |
| Wakemed, Raleigh CampusRaleigh, NC | 24 | $20,966 | $6,526 |
| Beebe Medical CenterLewes, DE | 22 | $26,648 | $5,729 |
| Sarasota Memorial HospitalSarasota, FL | 22 | $29,518 | $5,379 |
| Floyd Memorial Hospital and Health ServicesNew Albany, IN | 22 | $26,687 | $4,435 |
Questions
How much does simple pneumonia and pleurisy without complications cost in the U.S.?
In 2024 Medicare data, a hospital stay for simple pneumonia and pleurisy without complications (DRG 195) at 115 hospitals in the U.S. was billed at $29,430 on average, while the average total payment was $6,019, of which Medicare paid $4,015. Your own cost depends on your insurance, deductible and the hospital.
Which states pay the most and least for simple pneumonia and pleurisy without complications?
Among states with at least three hospitals reporting, the average total payment was highest in Maryland ($8,177), New York ($7,218), California ($6,969) and lowest in Kentucky ($4,623), Indiana ($4,675), Ohio ($4,948).
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.