Wilkes-barre General Hospital
WILKES-BARRE GENERAL HOSPITAL in Wilkes-Barre, PA charges 9.7x the Medicare reimbursement rate across 75 analyzed procedures, representing a significant markup for this for-profit facility.
Wilkes-barre, PA 18764 · Acute Care Hospitals · CMS Rating: 1/5
About the analyst
David Park researches procedure pricing and insurance reimbursement patterns at BillRazor Research. He specializes in cost comparison across care settings and metropolitan areas. Expertise: procedure pricing, insurance reimbursement, cost comparison.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
F
Very high
Avg markup vs Medicare
9.73x
Charge / Medicare rate
Max markup
16.95x
Worst procedure
Procedures analyzed
75
With pricing data
Outlier procedures
5.3%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $71,073 | $35,537 | — | 17x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $157,574 | $78,787 | — | 16.3x |
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC | 191 | $54,584 | $27,292 | — | 15.1x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 066 | $43,528 | $21,764 | — | 14.9x |
| PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | 274 | $320,329 | $160,164 | — | 14.3x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $161,790 | $80,895 | — | 14.1x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $58,688 | $29,344 | — | 13.6x |
| HYPERTENSION WITHOUT MCC | 305 | $39,614 | $19,807 | — | 12.1x |
| DISORDERS OF THE BILIARY TRACT WITH CC | 445 | $74,826 | $37,413 | — | 12x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $67,123 | $33,562 | — | 11.9x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $223,278 | $111,639 | — | 11.9x |
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 190 | $63,658 | $31,829 | — | 11.6x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $45,824 | $22,912 | — | 11.6x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | 243 | $168,459 | $84,229 | — | 11.5x |
| ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | 267 | $553,972 | $276,986 | — | 11.5x |
| RED BLOOD CELL DISORDERS WITH MCC | 811 | $87,579 | $43,789 | — | 11.2x |
| LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | 418 | $104,747 | $52,373 | — | 11.1x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | 242 | $234,596 | $117,298 | — | 11x |
| PERITONEAL ADHESIOLYSIS WITH CC | 336 | $136,688 | $68,344 | — | 11x |
| OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | 314 | $139,612 | $69,806 | — | 11x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | 330 | $152,313 | $76,156 | — | 11x |
| RENAL FAILURE WITHOUT CC/MCC | 684 | $30,900 | $15,450 | — | 11x |
| EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | 039 | $64,331 | $32,166 | — | 10.9x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $98,047 | $49,023 | — | 10.9x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC | 391 | $75,398 | $37,699 | — | 10.9x |
| CHEST PAIN | 313 | $39,253 | $19,627 | — | 10.7x |
| BRONCHITIS AND ASTHMA WITH CC/MCC | 202 | $50,213 | $25,107 | — | 10.6x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $46,972 | $23,486 | — | 10.6x |
| MEDICAL BACK PROBLEMS WITHOUT MCC | 552 | $53,429 | $26,714 | — | 10.6x |
| PERIPHERAL VASCULAR DISORDERS WITH CC | 300 | $65,896 | $32,948 | — | 10.2x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $41,131 | $20,566 | — | 10.2x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $133,587 | $66,793 | — | 10.2x |
| TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | 069 | $43,805 | $21,903 | — | 10.1x |
| DIABETES WITH CC | 638 | $44,969 | $22,485 | — | 10.1x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $24,366 | $12,183 | — | 10.1x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $76,184 | $38,092 | — | 10x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $57,086 | $28,543 | — | 9.9x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $67,020 | $33,510 | — | 9.6x |
| GASTROINTESTINAL HEMORRHAGE WITH MCC | 377 | $99,443 | $49,722 | — | 9.4x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $53,288 | $26,644 | — | 9.2x |
| RENAL FAILURE WITH CC | 683 | $45,541 | $22,770 | — | 9.1x |
| CELLULITIS WITHOUT MCC | 603 | $39,810 | $19,905 | — | 9.1x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $49,532 | $24,766 | — | 9x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | 329 | $315,642 | $157,821 | — | 8.9x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $35,758 | $17,879 | — | 8.9x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $107,952 | $53,976 | — | 8.8x |
| SYNCOPE AND COLLAPSE | 312 | $40,517 | $20,259 | — | 8.8x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | 286 | $96,998 | $48,499 | — | 8.7x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $60,135 | $30,067 | — | 8.6x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | 699 | $48,240 | $24,120 | — | 8.6x |
Showing 50 of 75 procedures
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use