Hospital finances

The hospitals that charge the most for every dollar of care

Updated November 9, 2026

Every hospital keeps a price list, called the chargemaster, and every year it tells Medicare what its care actually cost. Comparing the two gives a hospital's markup: how much it lists for each dollar of cost.

Across 2,848 general hospitals, the typical one lists $4.74 for every $1 of cost. 261 list $10 or more. Insurers and Medicare pay far less than the list price, but the list price is the starting point for uninsured patients' bills and for many out-of-network charges.

The 50 highest markups

General (acute care) hospitals with Medicare stays. Net income is from all sources, including investments, for the same year.

By state

What it means for a bill

A high markup doesn't mean a hospital is paid more: Medicare sets its own rates, and insurers negotiate theirs. It matters most if you are uninsured, out of network, or billed before a discount. If that happens, ask for an itemized bill and the hospital's cash price, and ask about financial assistance: non-profit hospitals must have a written policy.

Sources: CMS hospital cost reports (HCRIS), latest report per hospital for 2024 (cost-to-charge ratio; ratios outside 0–5 are left out as reporting errors); hospital type from CMS Care Compare. How the numbers work.