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Milestone Medical Costs

Milestone Medical Costs

The best and worst states for medical costs revealed

Have you ever wondered how much a hospital stay in New York might set you back compared to Texas or how much you might be expected to pay for an emergency room visit in California compared to Florida?

The expenses for healthcare services and procedures can differ significantly depending on the state. This reflects regional disparities and variations in healthcare affordability.

Medical costs in the United States vary dramatically from state to state. From the soaring expenses of childbirth to the hefty price tags on essential prescription drugs. Understanding the financial burden associated with different medical milestones is important.

The nation’s healthcare expenditures can sometimes paint an interesting and surprising picture when it comes to healthcare in America. That’s why we decided to take a deep dive into the most expensive and affordable states regarding some of life’s most common medical occurrences.

Taking a closer look at various factors, such as the cost of a hospital stay, an ER visit, and even the most expensive surgical procedures, we reveal the best and worst states for medical costs.

The best US states for medical costs

  1. North Dakota
    Medical costs score: 8.73/10

    North Dakota tops the list as the best US state for medical costs, scoring 8.73 out of 10. The midwestern state has plenty to offer when it comes to medical care. On average, North Dakotans pay $1,245 to visit the ER, one of the lowest prices compared to other states. Nicknamed the Peace Garden State, North Dakota also has the third most affordable average cost for childbirth in the US - less than $10,000.

  2. Iowa
    Medical costs score: 8.69/10

    Known for its landscape of rolling plains and cornfields, Iowa follows closely behind as one of the best states for medical costs, scoring 8.69 out of 10. Iowa ranks alongside Alabama as the fourth most affordable state for a hospital stay, at $8,037 for 4.6 days. This is over $10,000 less than in California. The Hawkeye State also has the second lowest rate of residents avoiding care due to medical costs of just 6%.

  3. Maine
    Medical costs score: 7.91/10

    Surrounded by rocky coastline and maritime history, Maine completes the top three, scoring 7.91 out of 10. The North Eastern state is the second most affordable for a visit to the emergency room ($952), being one of only two states where a visit to the ER costs less than $1,000. Maine is also in the top five most affordable states for childbirth, with an average cost of $9,623 - over two-thirds less than New Jersey.

The worst US states for medical costs

  1. Texas
    Medical costs score: 1.39/10

    Texas is the worst state for medical costs, scoring just 1.39 out of 10. The southern state is known for its legendary cowboy culture and large cities, but it has one of the highest costs for an ER visit, at an average of $2,318. The Lone Star State also has the lowest score among all 50 states regarding access to medical care, with a healthcare value score of -1.644. It also has the highest rate of residents who avoided care due to medical costs, with just under one in six (15.9%) people putting off procedures due to the expense.

  2. Florida
    Medical costs score: 1.79/10

    Situated in the southeastern region of the United States, Florida follows closely behind with a score of 1.79 out of 10. The Sunshine State is the most expensive for visiting the emergency room, costing an average of $3,102. It is also the third most costly for childbirth, averaging over $22,000. With a healthcare value score of -0.951 for access to care, it is no surprise that Florida is one of the worst states for medical care.

  3. Nevada
    Medical costs score: 1.92/10

    Nevada is ranked third with a score of 1.92 out of 10. The Silver State is the fifth most expensive for ER visits, averaging $2,583. It is also the fourth most costly state for giving birth, with expectant parents expected to pay more than $21,000 on average. Not only did 12.7% of the state’s population avoid care due to medical costs in 2022, but the state’s access to medical care (-1.114) is also the fifth lowest among all 50 states.

The most expensive state to visit the ER

  1. Florida
    Average cost of an ER visit: $3,102

    Florida tops the list as the most expensive state for ER visits. The Sunshine State costs a whopping $3,102 on average for an unexpected visit to the emergency room. Although the nation’s law requires hospitals to provide care for all patients regardless of their ability to pay, the medical costs depend on the level of care needed.

  2. New Jersey
    Average cost of an ER visit: $3,087

    If you live in New Jersey, you can expect to pay a hefty price for emergency room visits. On average, hospital bills in the US state can reach as high as $3,087 per visit before insurance. The state law states that residents of New Jersey must have health insurance, and there are a number of health plans that will offer the type of coverage you need.

  3. California
    Average cost of an ER visit: $2,960

    The Golden State completes the top three with an average cost of $2,960 for an ER visit. California has a Medicaid health care program that helps to pay for medical services for children and adults with limited income and resources. This program offers free or low-cost health coverage for California residents who meet the eligibility requirements.

The most expensive state for a hospital stay

  1. California
    Average hospital stay cost: $18,441

    California is the most expensive state for a hospital stay. On average, by staying for 4.6 days, patients can expect to pay an astronomical $18,441, equating to just over $4,000 daily.

    Despite the high prices, the sunny state has various hospitals for residents to consider, including Cedars-Sinai Medical Center and UCLA Medical Centre. Each hospital is ranked nationally in multiple specialties with high-performing procedures and conditions.

  2. Oregon
    Average hospital stay cost: $18,336

    Oregon is a top visitor location known for its diverse landscape, scenic forests, and beautiful lakes. However, when it comes to its healthcare, Oregon is one of the most expensive states in the US, averaging around $18,336 to afford a typical 4.6-day hospital stay.

    There are plenty of hospitals in and around the state, including OHSU Hospital, which has been described as Oregon's leading academic medical center, offering advanced treatments and expert care.

  3. Washington
    Average hospital stay cost: $17,753

    Washington state is also one of the most expensive places for a hospital stay. An average stay of just under five days in Washington can cost as much as $17,753, equating to more than $3,800 per day in hospital fees.

    If you are looking for specialized hospital care, Inova Fairfax Hospital and MedStar Washington Hospital Center have numerous medical specialties. From complex care to common procedures and conditions such as knee replacement and heart failure.

The most expensive states to give birth

  1. New Jersey
    Average cost of childbirth: $29,048

    New Jersey is the most expensive state to give birth in, costing a whopping average of almost $30,000. The state has the highest average price for hospital births and almost costs twice as much as the national average of $18,8653. This is mainly because the state’s room and board prices are significantly higher than other states.

  2. California
    Average cost of childbirth: $26,380

    On average, childbirth in California costs as much as $26,380, almost 40% higher than the national average. Much like New Jersey, California’s room and board charges play a significant role in the high cost as it is one of only two states that charge over $10,000 for room and board alone - more than triple the national average.

  3. Florida
    Average cost of childbirth: $22,015

    Florida is the third most expensive city for childbirth. It costs an average of $22,015 to give birth in the South Eastern state. This is almost 17% more than the national average. Like most other states, the average cost of childbirth in Florida is not just for the delivery itself but for everything that occurs during pregnancy, such as prenatal care and regular check-ups.

The most accessible states for medical care

  1. Massachusetts
    Access to medical care: 1.6

    Massachusetts is the most accessible state, with a healthcare value score of 1.595, the highest across all 50 states. Nicknamed the Old Bay State, Massachusetts offers its residents MassHealth, a combination of Medicaid and the Children’s Health Insurance Program. MassHealth members can get doctor visits, prescription drugs, hospital stays, and other essential services.

  2. Vermont
    Access to medical care: 1.21

    Dubbed the Green Mountain State, Vermont is very accessible regarding healthcare. The state offers various medical care programs, including its Long-Term Care Medicaid program, which helps eligible Vermonters pay for long-term care services, prescription assistance, and special needs access.

  3. Hawaii
    Access to medical care: 1.03

    Hawaii is one of the most accessible states for medical care. The Big Island has numerous community health and urgent care centers that provide affordable and accessible healthcare services such as behavioral health services, chronic disease management, and preventive care to low-income, uninsured, and underserved residents.

States where people are most likely to avoid care due to medical costs 

  1. Texas
    Avoided care due to medical cost: 15.9%

    People in Texas are most likely to avoid care due to soaring medical costs, with almost one in six Texans choosing to miss out on procedures due to the expense. This is unsurprising as the state is ranked in the top ten for the most expensive ER visits, with costs averaging $2,318. Hospital stays in Texas are also relatively high, costing an average of $13,154 for a stay of less than five days, while childbirth in the Lone Star State costs a whopping $17,738.

  2. Georgia
    Avoided care due to medical cost: 15.5%

    In 2022, 15.5% of Georgians avoided care due to medical costs. This makes Georgia one of the top states where residents are most likely to opt out of receiving the appropriate care they need. Interestingly, the medical cost in Georgia is not as high as in other states. For instance, a trip to the ER costs $1,596, while a hospital stay for over four and a half days costs $9,450 on average.

  3. Oklahoma
    Avoided care due to medical cost: 14.3%

    Oklahoma ranks third, with 14.3% of people avoiding care due to medical costs in the last year. Much like Georgia, the average hospital stay cost ($9,932) is lower than in most other states, as with an ER visit ($1,466). The cost of childbirth in the state averages $12,662.

Prescription drug spend by state

  1. Texas
    Percentage of prescription drug spend by state: 8.5%

    Texas is the US state with the highest prescription drug spend rate of 8.5% in 2022. The demand for prescription drug usage is one of the significant contributors to its sky-rocketing prices. Research suggests that antidiabetic drugs can cost as much as $154.09 for a brand name in the state. This is significantly higher than opting for a generic brand ($69.59)1, which could cut costs by over half.

  2. California
    Percentage of prescription drug spend by state: 8.3%

    Last year, the prescription drug spend in California was 8.3%, making it the second-highest state. The state offers a wide range of prescription drug coverage available to all residents with Medicare regardless of income and health status. Private companies provide insurance coverage, which depends on your chosen drug plan and can cost anywhere from $4.50 to $172.50 for prescriptions2.

  3. New York
    Percentage of prescription drug spend by state: 5.8%

    New York trails behind with a prescription drug spend of 5.8%. The state offers a Medicaid pharmacy program to all eligible New Yorkers, covering medically necessary FDA-approved prescription and non-prescription drugs, also known as over-the-counter (OTC).

The most expensive surgeries in the US

  1. Angioplasty
    Average cost: $282,000

    Various surgeries in the US come with a hefty price tag, but angioplasty takes the crown as the most expensive surgery. Angioplasty is a minimally invasive endovascular procedure to open up narrow or obstructed arteries or veins. The surgical procedure costs more than a quarter of a million dollars in the United States.

  2. Heart valve replacement
    Average cost: $170,000

    A heart valve replacement is one of the most expensive surgeries in the US, costing as much as $170,000. This is an open heart surgery where a surgeon repairs or replaces damaged or diseased heart valves to correct complications.

  3. Exploratory chest surgery
    Average cost: $137,533

    Chest surgery is another relatively expensive medical procedure as it requires making an incision to access the chest to reach the lungs or other organs in the chest. This surgical procedure is often performed to diagnose and treat problems in that area of the body. In the United States, performing an exploratory chest surgery costs $137,533 on average.

The most common reasons for hospital stays in the US

  1. Septicemia
    Number of stays: 2,218,800

    Septicemia, also known as sepsis, is the clinical name for blood poisoning by bacteria; surprisingly, it is the most common reason for hospital stays in the United States, with a shocking rate of over 2.2 million. Sepsis is a life-threatening infection that requires urgent medical treatment.

  2. Heart failure
    Number of stays: 1,135,900

    Another primary reason for hospital stays across the US is heart failure. This typically happens when the heart cannot adequately pump blood around the body, especially when it has become weak. In the United States, a staggering 1,135,900 hospital stays resulted from heart failure in 2018.

  3. Osteoarthritis
    Number of stays: 1,128,100

    With more than 1.1 million hospital stays, osteoarthritis is one of the most common reasons for visiting the hospital in the US. The condition causes joints to become painful and stiff. It is also one of the most common types of arthritis.


To determine the best and worst US states for medical costs we looked at various factors including the average cost of an ER visit, hospital stay, and childbirth as well as the rate of access to medical care and which states have the highest rates of people avoiding care due to medical costs.

We then calculated an overall average for each factor using a weighted ranking. Please note that the District of Columbia was not added to the list due to not having available data for each factor.

To find out the cost of an average hospital stay in the US, we gathered information from ValuePenguin. Using this data, we then ranked the figures based on the average cost of spending 4.6 days in the hospital. These figures were collected on 12/09/23.

From Talk to Mira, we collected data on the average cost of an emergency room visit by state, ranking all 50 states in order of the most expensive to the most affordable.

For childbirth costs, we used CBS News to gather figures on the average cost of giving birth in each state. We then ranked the data to find the most expensive states. This data was completed on 14/09/23.

To reveal the states with the least access to care and those with people most likely to avoid care due to medical costs, we looked at America’s Health Rankings. The data was gathered from the clinical care section. The annual access to care was based on a value score in which the higher the score, the healthier the state’s accessibility to care. We collected this data on 13/09/23. Additional information on the scoring system can be found in America’s Health Rankings Methodology.

Data for the states with the highest prescription drug spending was taken from Definitive Healthcare, which looked at the top 25 states in the country and ranked them by the percentage of prescription drug spending in 2022. This data was collected on 12/09/23.

To find out the cost of surgical procedures in the US, we used sources such as and CBS News to get the average prices of different surgeries, which we then ranked to find the most expensive in the country. This data was collected on 12/09/23.

For the most common reasons for hospital visits, we used to collect the 20 most frequent reasons for people visiting the hospital in the US, looking at the top primary diagnoses and how many hospital stays each diagnosis resulted in. This data was collected on 12/09/23.


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