By Craig Gottwals – Attorney & RBP Expert
In looking at the 15 largest hospital systems in the U.S., the data reveals a persistent, significant delta between commercial and Medicare pricing, with the average commercial price hitting 282% of the Medicare rate. This is not a slight variation; select systems are charging up to a massive 410% of what Medicare pays for equivalent services. This pricing has profound financial consequences for large-group plans.
As a healthcare consultant, the analysis of these figures shows that nearly every one of these massive systems is generating substantial wealth, with all but one reporting average annual net income in the millions per hospital. This range is staggering, from $3.3 million to an immense $70.3 million plus per location. The largest, HCA Healthcare, commanding 158 hospital locations across 20 states from 2018-2023, is a primary example of this model. Charging an average of 339% of the Medicare rate translates directly to a remarkable $70.3 million in average annual net income per hospital over that period, and they reported over $5 billion in total net income in 2023 alone.
Even nonprofit systems, such as the second-largest, CommonSpirit Health, exhibit similar pricing behaviors. Growing to their present size after a series of mergers, they are charging over three times what Medicare pays, contributing to an average annual net income per hospital of over $17 million and a total of $283 million in net income reported for 2023.
Source: FamiliesUSA. Big Systems, Bigger Profits: Consumers Are Paying the Price of Corporate Hospital Power. May 2026 analysis.
