Average Hospital Costs by State 2026 — Complete Ranking

Most Expensive States for Hospital Care

Rank	State	Avg Payment	vs. National Avg	Hospitals
1	Massachusetts	$21,636	+36%	84
2	California	$21,491	+35%	378
3	New York	$21,448	+35%	190
4	District of Columbia	$20,781	+31%	10
5	New Jersey	$20,736	+31%	79
6	Hawaii	$20,551	+29%	24
7	Alaska	$20,163	+27%	25
8	Connecticut	$18,954	+19%	37
9	Maryland	$18,626	+17%	56
10	Rhode Island	$18,442	+16%	13
11	Washington	$17,541	+10%	100
12	Virginia	$17,397	+10%	95
13	Pennsylvania	$16,898	+6%	188
14	Oregon	$16,874	+6%	62
15	Florida	$16,859	+6%	222

Rank	State	Avg Payment	vs. National Avg	Hospitals
1	American Samoa	$8,913	-44%	1
2	Northern Mariana Islands	$9,415	-41%	1
3	Puerto Rico	$10,336	-35%	61
4	Guam	$10,650	-33%	2
5	West Virginia	$11,835	-25%	55
6	Virgin Islands	$12,142	-24%	2
7	Mississippi	$12,292	-23%	106
8	Iowa	$12,512	-21%	118
9	Oklahoma	$12,911	-19%	135
10	Wyoming	$13,165	-17%	30
11	Nebraska	$13,235	-17%	93
12	Montana	$13,252	-17%	63
13	Alabama	$13,264	-16%	102
14	Arkansas	$13,359	-16%	90
15	South Dakota	$13,386	-16%	61

Several structural factors explain state-level cost variation:

Cost of living — States with higher wages, real estate costs, and general cost of living have higher hospital operating expenses, which are passed to patients. California, New York, and Alaska consistently rank among the most expensive.
Hospital market concentration — States where a few hospital systems dominate the market have less price competition. Hospital mergers have increased prices by 20-40% in affected markets according to research published in the Journal of Health Economics.
Payer mix — States with higher shares of Medicare and Medicaid patients often shift costs to commercially insured patients. Hospitals in states with lower Medicaid reimbursement rates may charge commercial payers more to compensate.
For-profit vs. nonprofit — States with more for-profit hospitals (Florida, Texas, Tennessee) tend to have higher average prices. For-profit hospitals charge 12-20% more than nonprofits for the same services.
State regulations — Maryland operates an all-payer rate-setting system where prices are negotiated statewide. This has kept hospital cost growth below the national average for decades.
Rural vs. urban mix — Rural hospitals have lower costs but also lower volumes. States with large rural populations may have lower averages due to the mix of small rural facilities.