CHARLESTON, W.Va. -- A distance of three miles between competing hospitals in downtown Huntington means nearly $24,000 in added charges for a patient needing a bowel procedure.
For a patient in Morgantown, the one mile between Mon General Hospital and the main facility of West Virginia University Hospitals means an extra $28,000 in charges for a bowel procedure.
In Beckley, four days on a ventilator costs $54,000 more at Raleigh General Hospital than it does four miles away at Beckley ARH Hospital.
These numbers come from Medicare data, released for the first time last week, which shows that hospital charges fluctuate wildly, not just in different regions of the country, but within cities.
West Virginia hospitals are hardly alone in their price disparities, they can be found all over the country -- and almost every hospital in West Virginia charges below national averages.
There is a big difference between the prices a hospital charges, the figures cited above, and the amount that Medicare pays hospitals -- almost always a fraction of what the hospital requests.
That's because Medicare, unlike private insurers or the uninsured, does not negotiate with hospitals over prices. Medicare collects cost data from each hospital and then estimates what it costs the hospital to perform a procedure and reimburses it at that rate.
So, even though St. Mary's Medical Center charges $34,000 for that bowel procedure and Cabell Huntington Hospital charges $58,000, Medicare won't pay either of them more than about $21,000.
Hospitals are not obligated to accept Medicare patients, but if they do accept them, they also accept Medicare's lower rates.
Joe Letnaunchyn, president of the West Virginia Hospital Association, said hospitals that provide a wider variety of services -- burn wards, trauma units, teaching hospitals -- have to charge more.
That might explain why Charleston Area Medical Center -- a teaching hospital with a burn ward, cancer center and trauma unit -- charges an average of 45 percent more than Saint Francis Hospital, a much smaller hospital five blocks away in downtown Charleston.
Larry Hudson, chief financial officer at CAMC, said those costly services are built into the rate structure across the hospital.
However, Cabell Huntington and St. Mary's have between 300 and 400 beds each, they both have trauma centers and cancer centers and they both are teaching hospitals, affiliated with Marshall University. Cabell Huntington has a neonatal intensive-care unit and a burn unit, which are very expensive, while Huntington has a neuroscience center.
Cabell Huntington charges more for 59 of the 63 conditions that were reported for both hospitals in the Medicare data. Cabell Huntington charges an average of 25 percent more than St. Mary's for comparable conditions.
In an email statement, Charles Shumaker, a spokesman for Cabell Huntington said, "When comparing hospital charges and payments, the only way to make accurate 'apples to apples' comparisons is to compare hospitals with similar missions and cost structures."
If the charges seem arbitrary, some health-policy analysts say, it's because they are.