Healthcare Insights
Top hospitals by total operating expense
As you can imagine, running a hospital is expensive, regardless of whether the hospital is a small rural facility or is central to a big city. Operating expenses for hospitals, as defined by the Health Resource and Services Administration (HRSA), are expenses incurred as part of the delivery of care. Operating expense examples include salaries and benefits of staff and providers, employed and contracted physicians, medical supplies, and interest and depreciation on buildings and equipment used in care delivery.
What costs hospitals the most money?
A hospital’s operating cost breakdown may differ among facilities. However, the list of operating expenses generally includes:
- Construction and renovation
- Food service
- Hospital salaries
- Hospital and medical equipment
- Medical and surgical supplies
- Patient medications
- Software and IT solutions
Of these operating costs, the three biggest expenses for hospitals are salaries, medical and surgical supply costs, and fringe benefits. Understanding what drives hospital expenses and which hospitals cost the most to operate can help map the financial landscape of the American healthcare system.
Using the Definitive Healthcare HospitalView product, we have listed the top 25 hospitals in the U.S. with the highest total operating expenses. The data is from the Medicare Cost Report and reflects 2023 operating expenses, the most recent year with complete reporting across hospitals.
Rank | Hospital | City | State | Total operating expenses | Explore dataset |
---|---|---|---|---|---|
1 | New York-Presbyterian Weill Cornell Medical Center | New York | NY | $9.82B | Explore |
2 | Tisch Hospital | New York | NY | $8.96B | Explore |
3 | Cleveland Clinic Main Campus | Cleveland | OH | $8.32B | Explore |
4 | Stanford Hospital - 300 Pasteur Dr | Palo Alto | CA | $7.43B | Explore |
5 | Vanderbilt University Medical Center | Nashville | TN | $6.94B | Explore |
6 | Massachusetts General Hospital | Boston | MA | $6.04B | Explore |
7 | Memorial Sloan Kettering Cancer Center | New York | NY | $6.03B | Explore |
8 | UCSF Helen Diller Medical Center at Parnassus Heights | San Francisco | CA | $5.84B | Explore |
9 | Advent Health Orlando | Orlando | FL | $5.60B | Explore |
10 | University of Texas MD Anderson Cancer Center | Houston | TX | $5.47B | Explore |
11 | IU Health Methodist Hospital | Indianapolis | IN | $5.25B | Explore |
12 | Montefiore Hospital - Moses Campus | Bronx | NY | $5.02B | Explore |
13 | University Hospital | Ann Arbor | MI | $4.90B | Explore |
14 | Cedars-Sinai Medical Center | Los Angeles | CA | $4.51B | Explore |
15 | Yale New Haven Hospital | New Haven | CT | $4.38B | Explore |
16 | Hospital of the University of Pennsylvania | Philadelphia | PA | $4.22B | Explore |
17 | Brigham and Women's Hospital | Boston | MA | $4.10B | Explore |
18 | Orlando Health Orlando Regional Medical Center | Orlando | FL | $4.08B | Explore |
19 | Long Island Jewish Medical Center | New Hyde Park | NY | $4.00B | Explore |
20 | The Mount Sinai Hospital | New York | NY | $3.99B | Explore |
21 | The University of Kansas Hospital | Kansas City | KS | $3.94B | Explore |
22 | University of California Davis Medical Center | Sacramento | CA | $3.86B | Explore |
23 | Children's Hospital of Philadelphia | Philadelphia | PA | $3.77B | Explore |
24 | Duke University Hospital | Durham | NC | $3.74B | Explore |
25 | UC San Diego Medical Center | San Diego | CA | $3.70B | Explore |
Fig 1. Data is from the Definitive Healthcare HospitalView product. Data reflects 2023 operating expenses, the most recent year with complete reporting across hospitals. Data was accessed in July 2025.
Which hospitals have the highest operating expense?
The top hospital by total operating expense is New York-Presbyterian Weill Cornell Medical Center, with over $9.8 billion in reported 2023 operating costs. Located in New York City, this major academic medical center serves a densely populated urban area and offers a broad range of specialized services and advanced treatments. Its large patient volume, extensive research activity, and high cost of operations in NYC all contribute to its significant expenses. The hospital consistently appears near the top of other expense categories, such as salary, operating room, and medical supply costs.
In second place is Tisch Hospital, also based in New York City and part of NYU Langone Health, with more than $8.9 billion in operating expenses. As a nonprofit academic hospital, Tisch delivers a high volume of complex care and invests heavily in research, clinical innovation, and medical education. These factors, combined with NYC’s high cost of labor and services, likely drive its overall expense level.
Rounding out the top three is the nonprofit, academic medical center Cleveland Clinic Main Campus, reporting $8.3 billion in 2023 operating expenses. As one of the largest hospital-based research programs in the U.S., Cleveland Clinic is widely recognized as one of the top hospitals in the United States and globally, and supports a high number of patient procedures, beds, and operating rooms. The system’s integrated care model and emphasis on specialty services likely contribute to its high resource utilization and operating costs.
How does non-profit hospital status influence operating expenses?
The three top hospitals by operating expense listed above are all non-profit hospitals affiliated with major academic medical centers, which invest heavily in medical research and education. They are also located in urban areas. Urban hospitals, whether non-profit or for-profit, generally face higher costs related to staffing, real estate, and facilities maintenance. This is particularly true in cities like New York, where the cost of living is significantly higher. Non-profit hospitals’ focus on community service, research, and education can also contribute to their overall higher operating expenses compared to many for-profit hospitals.
Additionally, these top three hospitals rank as the top three non-profit hospitals by net patient revenue (NPR). Based on the high NPR for these hospitals, it is reasonable to conclude that they see a higher volume of patients, requiring that they have more providers, staff, equipment, and facility space.
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