Ranked by average markup ratio — how much hospitals charge vs. what Medicare pays. Based on CMS data covering 3,400+ hospitals nationwide.
Source: CMS Medicare Hospital Outpatient and Inpatient Charges by Provider and Service, 2022. "Avg markup" = avg hospital submitted charge ÷ avg Medicare allowed/total payment, averaged across all hospitals reporting ≥5 cases. Click any row to compare hospitals for that procedure.
Procedures with the highest markup ratios tend to be elective or high-volume surgical services: spinal injections, joint aspirations, cardiac catheterization, certain imaging services (CT with contrast), and minor surgical procedures. These procedures have high gross charges in hospital chargemasters but relatively modest Medicare reimbursement.
Markup ratio = total submitted charges ÷ total Medicare allowed amount, aggregated across all claims for that procedure (by CPT code) across participating hospitals. A markup ratio of 10 means the hospital billed 10 times what Medicare considers a reasonable payment for the same service.
High markup ratios reflect chargemaster pricing strategy — not necessarily actual realized revenue. Hospitals negotiate discounts with payers, and most insured patients pay contracted rates far below the chargemaster. However, uninsured patients and out-of-network patients may be billed at or near the gross charge, meaning the markup directly affects their out-of-pocket costs.