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America's Highest Markup Hospitals

Every hospital ranked by markup ratio: submitted charge ÷ Medicare allowed amount. A 10× markup means they billed 10 times the Medicare rate for the same service.

Source: CMS Medicare Outpatient & Inpatient Hospitals by Provider and Service, 2022. cms.gov

What is the markup ratio? For each procedure, we divide the hospital's average submitted charge by what Medicare considers a fair payment. A ratio of 10× means the hospital bills $10 for every $1 Medicare would pay. The ratios below are averaged across all procedures each hospital billed to Medicare.
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Hospitals Analyzed
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Avg Markup (All US)
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Highest Markup Found
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Frequently Asked Questions

How are hospitals ranked by markup ratio?

Hospitals are ranked by their overall markup ratio: total submitted charges ÷ total Medicare allowed amount across all procedures and all CMS-submitted claims. A ratio of 10 means the hospital billed 10 times the Medicare-allowed rate on average. Data is sourced from CMS Medicare Provider Utilization and Payment Data.

Which hospitals have the highest markups in America?

Hospitals with the highest markup ratios tend to be concentrated in Florida, Nevada, and California and are often for-profit systems. Chargemaster markups at some facilities exceed 10–15× the Medicare-allowed rate. Hospital chains including some for-profit health systems have faced investigations and lawsuits over these pricing practices.

Are hospitals with high markup ratios doing anything illegal?

High markup ratios are generally not illegal. Hospitals are permitted to set their own chargemaster prices. However, the Hospital Price Transparency Rule requires hospitals to publish these prices. Several state attorneys general have investigated billing practices that allegedly exploited uninsured patients by applying chargemaster rates without disclosing financial assistance options.

How do I find out if my hospital is on the high-markup list?

Search your hospital's name or CCN (CMS Certification Number) in the AccountableHub Hospital Lookup. You'll see its overall markup ratio, where it ranks among all 3,400+ hospitals in our database, and its Medicare billing data by procedure.

Not legal, medical, or financial advice. AccountableHub provides information and self-help tools. We are not a law firm, and using this site does not create an attorney-client relationship. Dispute letters are templates you review, edit, and send yourself. Markup figures compare a hospital's average charge with Medicare's average allowed amount from public CMS data (2022) and do not mean your specific bill is unlawful. Attorney grades summarize public bar records that may be incomplete or out of date. Always verify with the state bar. For legal advice, consult a licensed attorney in your state; for medical decisions, consult your clinician.