Charges versus payments, state by state

The median hospital in Nevada charged Medicare 8.44 times what it was paid for inpatient stays — the widest gap in the country. In Maryland, where the state sets hospital rates for every payer, it was 1.12 times.

1Widest gap: Nevada 8.44×
2Narrowest: Maryland 1.12×
3National median hospital 4.15×
4States + DC 51

Median hospital's inpatient charge-to-payment ratio, 15 highest states (hospitals with 100+ Medicare stays), bars to scale. Source: CMS DY2024.

State	Hospitals	Medicare stays	Median ratio	Enforcement actions
Nevada	21	43,206	8.44×	226
Florida	174	444,244	7.04×	765
Colorado	54	44,567	6.33×	222
New Jersey	62	176,887	6.25×	271
Texas	308	334,970	5.35×	1,350
California	288	462,315	5.18×	1,127
Arizona	65	96,271	5×	280
Georgia	101	129,123	4.44×	337
Tennessee	80	116,069	4.42×	316
Washington	48	83,621	4.37×	196
Pennsylvania	137	223,776	4.27×	474
Alabama	81	67,132	4.24×	278
Louisiana	89	60,578	4.2×	503
Idaho	15	17,464	4.16×	107
New Mexico	25	19,057	4.13×	104
South Carolina	52	91,788	4.13×	175
Indiana	84	107,459	4.08×	362
Illinois	120	216,831	4.06×	414
Kentucky	63	73,307	4.06×	228
Oklahoma	76	70,610	4.03×	247
Ohio	126	174,926	4.01×	478
Arkansas	47	54,526	3.99×	254
Nebraska	27	32,058	3.9×	143
West Virginia	25	36,604	3.88×	106
Missouri	67	105,310	3.85×	295
District of Columbia	8	16,270	3.83×	48
Vermont	6	9,016	3.83×	45
Utah	34	23,818	3.69×	109
Virginia	72	153,759	3.6×	204
Alaska	8	9,804	3.57×	53
North Carolina	84	149,256	3.55×	330
New Hampshire	14	25,764	3.54×	97
South Dakota	16	21,042	3.53×	112
Delaware	7	27,539	3.5×	64
Mississippi	61	55,291	3.49×	213
Wisconsin	68	64,901	3.47×	211
Connecticut	27	53,479	3.43×	80
Montana	10	15,714	3.38×	130
Kansas	49	52,642	3.35×	300
Iowa	31	45,476	3.32×	262
Maine	17	14,554	3.18×	57
North Dakota	7	15,904	3.17×	81
Michigan	95	130,044	3.09×	391
Oregon	32	36,581	3.05×	107
Minnesota	48	74,740	2.98×	239
Hawaii	13	11,470	2.84×	38
Rhode Island	10	13,973	2.81×	32
New York	131	328,890	2.74×	427
Wyoming	11	5,987	2.01×	67
Massachusetts	61	183,218	2×	246
Maryland	44	130,650	1.12×	83

Sources: CMS Medicare Inpatient 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.