New York / Peconic Bay Medical Center

CMS certification 330107 · Riverhead, NY · 3 entries in CMS's price-transparency list

Peconic Bay Medical Center: charges and Medicare payments

Peconic Bay Medical Center reported 3,478 Medicare inpatient stays across 93 DRGs in 2024. Across them it charged 5.51 times what it was paid — among the higher ratios in New York, number 25 of 123 hospitals with at least 100 stays (state median 2.74×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 448 stays at an average charge of $108,715, 20% above the national average. It also billed 3,023 outpatient services, charging 7.12 times what Medicare paid.

1Medicare inpatient stays 3,478
2Charge ÷ paid, inpatient 5.51×
3Rank in NY (highest ratio = 1) 25 of 123
4CMS price-transparency actions 3

Average charge per stay at Peconic Bay Medical Center, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 93 DRGs that can be compared with the national average, Peconic Bay Medical Center charged more than the national average in 71 (76%). Payments follow Medicare's rates, so they usually vary far less than charges.

DRG	Stays	Avg charge	vs US	Avg paid
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	448	$108,715	+20%	$19,348
470 Major Hip and Knee Joint Replacement or Reattachment of...	229	$72,227	-22%	$18,856
291 Heart Failure and Shock with MCC	207	$73,323	+30%	$12,575
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	129	$64,681	+32%	$10,251
690 Kidney and Urinary Tract Infections without MCC	126	$50,765	+34%	$7,958
193 Simple Pneumonia and Pleurisy with MCC	85	$92,276	+54%	$12,890
689 Kidney and Urinary Tract Infections with MCC	78	$64,126	+25%	$11,549
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	76	$42,434	+6%	$8,233
603 Cellulitis without MCC	74	$41,305	+11%	$8,584
177 Respiratory Infections and Inflammations with MCC	73	$109,349	+55%	$16,206
378 Gastrointestinal Hemorrhage with CC	71	$59,808	+23%	$9,689
312 Syncope and Collapse	66	$47,862	+5%	$8,854
683 Renal Failure with CC	62	$60,593	+49%	$8,764
190 Chronic Obstructive Pulmonary Disease with MCC	59	$79,323	+57%	$10,956
682 Renal Failure with MCC	51	$76,202	+16%	$14,223
552 Medical Back Problems without MCC	49	$56,381	+15%	$9,467
698 Other Kidney and Urinary Tract Diagnoses with MCC	49	$80,975	+10%	$15,144
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	47	$74,254	+23%	$13,251
377 Gastrointestinal Hemorrhage with MCC	43	$89,065	+4%	$16,851
309 Cardiac Arrhythmia and Conduction Disorders with CC	41	$46,232	+28%	$7,193
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	40	$51,894	+22%	$8,436
481 Hip and Femur Procedures except Major Joint with CC	39	$100,299	0%	$18,571
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	39	$48,117	+30%	$9,041
322 Percutaneous Cardiovascular Procedures with Intraluminal...	38	$75,635	-34%	$19,634
287 Circulatory Disorders except AMI, with Cardiac...	37	$59,735	-7%	$11,379
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	33	$77,322	+39%	$10,467
189 Pulmonary Edema and Respiratory Failure	33	$79,756	+39%	$12,859
194 Simple Pneumonia and Pleurisy with CC	33	$57,750	+50%	$8,375
699 Other Kidney and Urinary Tract Diagnoses with CC	33	$49,639	+5%	$9,918
853 Infectious and Parasitic Diseases with O.R. Procedures with...	30	$179,323	-22%	$45,367
638 Diabetes with CC	29	$62,534	+50%	$9,827
948 Signs and Symptoms without MCC	28	$38,712	+2%	$7,805
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	26	$100,004	0%	$16,590
286 Circulatory Disorders except AMI, with Cardiac...	26	$105,553	-6%	$18,750
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	26	$105,301	+3%	$17,879
069 Transient Ischemia without Thrombolytic	25	$54,900	+9%	$7,894
310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC	25	$32,363	+13%	$5,363
178 Respiratory Infections and Inflammations with CC	24	$63,767	+41%	$8,944
191 Chronic Obstructive Pulmonary Disease with CC	24	$57,772	+46%	$8,413
308 Cardiac Arrhythmia and Conduction Disorders with MCC	23	$69,106	+22%	$10,819
536 Fractures of Hip and Pelvis without MCC	23	$51,572	+37%	$7,247
812 Red Blood Cell Disorders without MCC	23	$48,854	+10%	$8,251
329 Major Small and Large Bowel Procedures with MCC	22	$231,157	+8%	$38,653
394 Other Digestive System Diagnoses with CC	22	$66,862	+42%	$10,019
149 Dysequilibrium	21	$43,358	-2%	$7,257
176 Pulmonary Embolism without MCC	21	$47,806	+15%	$7,398
305 Hypertension without MCC	20	$44,795	+12%	$7,186
313 Chest Pain	20	$31,838	-20%	$7,496
389 Gastrointestinal Obstruction with CC	20	$56,053	+44%	$8,408
467 Revision of Hip or Knee Replacement with CC	20	$107,927	-32%	$33,183
811 Red Blood Cell Disorders with MCC	20	$72,874	+7%	$13,350
057 Degenerative Nervous System Disorders without MCC	19	$85,986	+52%	$13,100
100 Seizures with MCC	19	$93,456	-1%	$18,189
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	18	$67,780	+11%	$13,587
393 Other Digestive System Diagnoses with MCC	18	$77,930	+1%	$16,964
605 Trauma To The Skin, Subcutaneous Tissue and Breast without...	18	$48,078	+4%	$8,704
092 Other Disorders of Nervous System with CC	17	$52,941	+3%	$11,757
101 Seizures without MCC	17	$59,228	+21%	$9,498
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	17	$82,672	+27%	$12,218
884 Organic Disturbances and Intellectual Disability	16	$60,022	-4%	$15,431

Showing the 60 most frequent of 93 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 1 Intraocular Procedures	886	$14,300	$2,363
Comprehensive Observation Services	598	$35,187	$2,841
Level 5 Musculoskeletal Procedures	348	$52,092	$13,252
Level 1 Endovascular Procedures	209	$21,955	$3,407
Level 1 Laparoscopy and Related Services	114	$27,370	$5,949
Level 2 Musculoskeletal Procedures	87	$12,470	$1,694
Level 2 Excision/ Biopsy/ Incision and Drainage	74	$16,774	$1,631
Level 2 Pacemaker and Similar Procedures	68	$53,216	$8,755
Level 1 Nerve Procedures	59	$10,281	$1,953
Level 3 Endovascular Procedures	49	$60,185	$11,276
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	49	$17,245	$3,676
Level 4 Urology and Related Services	49	$21,458	$3,640
Level 3 Vascular Procedures	44	$14,425	$3,160
Level 4 Musculoskeletal Procedures	42	$35,092	$7,440
Level 5 Urology and Related Services	40	$29,718	$5,779
Level 3 Pacemaker and Similar Procedures	29	$61,869	$8,721
Level 3 Urology and Related Services	28	$10,791	$2,249
Level 2 Upper GI Procedures	27	$10,425	$2,086
Level 3 Musculoskeletal Procedures	25	$16,938	$3,615
Level 4 Gynecologic Procedures	25	$18,204	$3,380
Level 6 Musculoskeletal Procedures	24	$93,145	$19,965
Level 3 Lower GI Procedures	23	$15,706	$2,710
Level 4 Endovascular Procedures	20	$88,862	$17,747
Level 2 Vascular Procedures	19	$8,926	$1,714
Level 2 Endovascular Procedures	18	$35,633	$6,101

Against the New York average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Peconic Bay Medical Center charged $108,715 on average, 7% less than the New York average of $116,930, and was paid $19,348 against a state average of $24,426. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Peconic Bay Medical Center charged $72,227 on average, 33% less than the New York average of $107,202, and was paid $18,856 against a state average of $23,235. For Heart Failure and Shock with MCC (DRG 291), Peconic Bay Medical Center charged $73,323 on average, 10% less than the New York average of $81,161, and was paid $12,575 against a state average of $16,034. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Peconic Bay Medical Center charged $64,681 on average, 6% more than the New York average of $61,129, and was paid $10,251 against a state average of $12,692. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $14,300 was 12% below the state average of $16,178. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $35,187 was 32% above the state average of $26,675. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $52,092 was 23% below the state average of $67,926. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $21,955 was 13% below the state average of $25,359.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Peconic Bay Medical Center in Riverhead, NY, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

Met Requirements — 2024-10-07 (CMS case 2773)
Warning Notice — 2025-07-31 (CMS case 6046)
Closure Notice — 2025-11-12 (CMS case 6046)

A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.

Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.

Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.