Chargemaster analysis across — hospitals
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Gross charge = cash price. No markup built in. Chargemaster set at cost floor, often by county commission. Payer fee schedules may exceed listed prices.
Mixed pricing — some service lines at cost floor, others with standard markup. Partial governance where the board reviews certain items but not the full chargemaster.
Traditional inflated chargemaster with negotiating room. Cash patients receive 10–40% discount. Payer rates are always below gross charge. Most hospitals operate this way.
| Hospital | State | Type | Control | Archetype | CTC | Gross=Cash | Op margin | Payers | Completeness |
|---|
Analysis of charge records across all hospitals
Kansas hospitals publish price lists as required by federal law. But our analysis reveals these lists follow fundamentally different pricing philosophies that make raw comparisons misleading without context.
Listed price = cash price = at or below actual cost. The county commission sets the chargemaster artificially low. Payer fee schedules routinely pay above the sticker price — sometimes 4–6x higher — because their rates are derived from external benchmarks, not the hospital's price list.
Hamilton County, Stafford County, Clay County, Meade District
Some service lines priced at cost floor, others with standard markup. Lab tests are suppressed while imaging carries traditional markup — suggesting partial board oversight where commissioners review certain categories but not the full chargemaster.
Cheyenne County
Traditional inflated chargemaster with built-in negotiating room. Cash patients receive 10–40% discounts. Insurance companies negotiate rates below the sticker price. The gross charge is a starting point, not an actual price anyone pays.
All nonprofits, all system-affiliated, most government hospitals
Detection method: We calculate the percentage of charge rows where gross charge equals discounted cash price. If they match on >95% of items, the chargemaster is suppressed (no markup to discount from). This test was correct on all hospitals tested with zero false positives.
At Hamilton County Hospital (suppressed chargemaster), a nebulizer treatment (CPT 94640) has a gross charge of $57.50. Here is what every payer actually pays:
| Payer | Rate paid | % of gross ($57.50) | Methodology | vs. cost |
|---|---|---|---|---|
| Aetna | $366.03 | 637% | Fee schedule | Above |
| Aetna | $340.00 | 591% | 170% of billed charges | Above |
| BCBS Kansas | $254.03 | 442% | Fee schedule | Above |
| VA Community Care | $200.00 | 348% | 100% of billed charges | Near |
| UnitedHealthcare | $190.00 | 330% | 95% of billed charges | Near |
| Cigna | $190.00 | 330% | 95% of billed charges | Near |
| First Health/Coventry | $170.00 | 296% | 85% of billed charges | Near |
| BCBS Choice Care | $39.29 | 68% | Fee schedule | Below |
| Cigna | $23.00 | 40% | Fee schedule | Below |
| BCBS Value Blue | $19.65 | 34% | Fee schedule | Below |
| UnitedHealthcare | $10.42 | 18% | Fee schedule | Below |
| VA Community Care | $7.72 | 13% | Fee schedule | Below |
Why this happens: Hamilton's estimated cost for this treatment is $213 (gross $57.50 × CTC ratio 3.706). The county commission holds the chargemaster at $57.50 — far below cost. Two contract mechanisms produce wildly different outcomes:
% of billed charges contracts
Multiply the suppressed chargemaster by a percentage (85–170%). When the chargemaster is $57.50 instead of a market-rate $350, even 170% only produces $97.75 on the base charge — but these contracts use an internal billed amount of $200, yielding $340. The multiplier interacts with the hospital's internal billing rules, not the published chargemaster.
Fee schedule contracts
Substitute the payer's own rate, ignoring the chargemaster entirely. BCBS Kansas pays $254.03 from their fee schedule — a normal market rate for a nebulizer. But BCBS Value Blue pays $19.65 from a thinner-network schedule, and VA pays $7.72. Same hospital, same day, same treatment — the contract methodology drives a 47x price spread.
For common services, the lowest and highest negotiated rates across Kansas differ by 95–120x. These spreads exist within the same state, for the same service, often within the same payer network.
| Service | Lowest rate | Highest rate | Spread | Hospitals |
|---|---|---|---|---|
| Nebulizer treatment (94640) | $6.64 | $800.00 | 120x | 18 |
| ED visit, Level 4 (99284) | $16.71 | $1,704.00 | 102x | 18 |
| CBC blood count (85025) | $1.54 | $148.50 | 96x | 17 |
| Chest X-ray, 2 views (71046) | $8.57 | $818.06 | 95x | 17 |
Why it matters: These are not different services or different levels of complexity. They are the same CPT code — the same procedure — at different hospitals with different payer contracts. A patient or employer cannot see these spreads without tools like this one. The price they pay depends entirely on which hospital they go to and which payer contract governs the claim.
Legal control type (county-owned, hospital district, nonprofit) does not predict chargemaster behavior. What matters is who actually sets the prices.
Allen County Regional Hospital
Legally a governmental county hospital. But operationally managed by Saint Luke's Health System out of Kansas City. Chargemaster is inflated (standard archetype) because Saint Luke's corporate team sets the prices, not the Allen County Commission. Despite its standard chargemaster archetype, genuine operational stress — not chargemaster distortion — explains its financial position.
Hamilton County Hospital
Also a governmental county hospital. Independently operated, with the county commission directly setting the chargemaster. Result: suppressed prices, CTC ratio of 3.706 (costs are 370% of charges), and payers paying above the sticker price. Same legal structure as Allen County — completely different pricing outcome.
The pattern: All 4 suppressed hospitals are independently governed with no system affiliation. Every system-affiliated hospital (Saint Luke's, Ascension, CommonSpirit) uses a standard inflated chargemaster — regardless of whether the hospital's legal charter says "governmental" or "nonprofit."
CTC (cost-to-charge) ratio is a widely used hospital financial metric. But its meaning inverts between archetypes, and using it without context leads to the wrong conclusions.
| Hospital | Archetype | CTC ratio | What it means |
|---|---|---|---|
| Hamilton County | Suppressed | 3.706 | Costs are 370% of charges. Charges are below cost because the county commission holds them artificially low. |
| Ashland Health Center | Standard | 1.979 | Costs are 198% of charges. Charges barely cover cost — genuinely thin margins on an inflated chargemaster. |
| Neosho Memorial | Standard | 0.380 | Costs are 38% of charges. Standard markup — charges are inflated well above cost with negotiating room. |
The takeaway: Hamilton's CTC of 3.706 and Ashland's CTC of 1.979 both appear alarming, but for opposite reasons. Hamilton's costs exceed charges because charges are suppressed. Ashland's costs exceed charges because costs are genuinely high relative to a standard chargemaster. Any policy analysis using CTC ratios must first identify the chargemaster archetype.
This analysis is based on machine-readable files (MRFs) published by Kansas hospitals as required under the Hospital Price Transparency Final Rule (CMS-1717-F2). Files were downloaded between January and March 2026, parsed across 6 distinct file formats (CSV v2/v3 tall, CSV v2 wide, JSON v2.0/v2.2/v3.0), and loaded into a unified analytical database. Hospital financial metadata (CTC ratios, risk scores, operating margins) comes from the Kansas Hospital Association cost report data. Estimated costs are derived by multiplying gross charges by the total CTC ratio — this is an approximation that varies by department. All findings should be validated against audited financial data before use in regulatory filings or contractual negotiations.
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