answer:One reason is most people with insurance do NOT pay the posted rates. The insurance companies negotiate rates with hospitals, so in your example, the patient’s insurance would have paid the $182,000 hospital just $30,000, and that would be it. The man who had to cover the 20,000 difference has a pretty good claim against the insurance company, especially if it was an emergency, which most appendicitis situations are. That usually only happens if you go out of network and don’t get pre-approval. But t get back to your original question, hospital accounting is bizarre, and has to do with capitalization of the facility. So the cost of the ER and the room may be much greater at one hospital than another. When I spent time in the hospital, I understood paying for all the services, but the total cost of the services sure wasn’t $2,500 a day. The professionals spent about an hour and a half with me all day.