The high cost of living.

• Position: North Carolina hospitals' highest-priced procedures - Focus on Health Care

What North Carolina's hospitals charge for some of their most expensive services is all over the map.

You get what you pay for, the old saw goes, but in the realm of hospital economics, you often pay for what others get. It's called cost shifting. Hospitals tack a portion of the bill for, say, a poor person's pneumonia onto the price of a paying patient's appendectomy.

In 1985, the General Assembly set up the North Carolina Medical Database Commission to make hospital charges more accessible. "We're trying to present information that educates all of us to be better consumers of medical services," Executive Director Jim Hazelrigs says.

Each time the commission crunches its numbers and releases its latest findings, many hospital administrators gnash their teeth. They contend average charges are meaningless: It's misleading to average the charge for open-heart surgery in with that for setting a broken finger.

In particular, administrators of regional medical centers argue that their charges shouldn't be compared with those of smaller hospitals that don't provide as many services or treat as many extremely ill patients.

To level the playing field, BUSINESS NORTH CAROLINA asked the commission for the 20 highest-priced procedures at each of the state's acute-care hospitals on the theory that they would reflect three things: hospitals' biggest revenue producers, their top-line services and those procedures prime for cost shifting. We also asked the commission to adjust the data, using a Medicare formula that accounts for the mix of a hospital's patients. The formula lowers the average charge for hospitals that do more time-consuming procedures.

Heading the list were three of the state's four hospitals with med schools, which handle some of the most complex procedures...