Spotsylvania Regional Medical Center
Spotsylvania Regional Medical Center in Fredericksburg, VA charges 6.5x the Medicare reimbursement rate across 43 analyzed procedures, reflecting the pricing structure at this for-profit hospital.
Fredericksburg, VA 22408 · Acute Care Hospitals · CMS Rating: 3/5
About the analyst
Priya Iyengar leads the billing code review team at BillRazor Research. She analyzes NCCI bundling edits, DRG coding, and regional rate variation. Expertise: NCCI bundling, DRG analysis, regional pricing.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
D
High
Avg markup vs Medicare
6.52x
Charge / Medicare rate
Max markup
13.18x
Worst procedure
Procedures analyzed
43
With pricing data
Outlier procedures
0%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $140,496 | $70,248 | — | 13.2x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | 282 | $42,624 | $21,312 | — | 13x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $56,384 | $28,192 | — | 8.7x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $152,583 | $76,291 | — | 8.6x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $24,602 | $12,301 | — | 8.4x |
| TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | 069 | $41,199 | $20,600 | — | 8.3x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $47,739 | $23,870 | — | 8.2x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $52,028 | $26,014 | — | 8x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $35,729 | $17,864 | — | 7.6x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $37,898 | $18,949 | — | 7.2x |
| CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC | 036 | $91,260 | $45,630 | — | 7.2x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $46,522 | $23,261 | — | 7.1x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $102,450 | $51,225 | — | 6.9x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $30,934 | $15,467 | — | 6.9x |
| SEIZURES WITHOUT MCC | 101 | $36,093 | $18,047 | — | 6.8x |
| RED BLOOD CELL DISORDERS WITH MCC | 811 | $64,212 | $32,106 | — | 6.8x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $41,809 | $20,904 | — | 6.8x |
| SYNCOPE AND COLLAPSE | 312 | $36,374 | $18,187 | — | 6.6x |
| CHEST PAIN | 313 | $27,996 | $13,998 | — | 6.4x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $32,126 | $16,063 | — | 6.3x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 064 | $71,144 | $35,572 | — | 6.3x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $52,712 | $26,356 | — | 6.2x |
| RENAL FAILURE WITH CC | 683 | $34,786 | $17,393 | — | 6.1x |
| CELLULITIS WITHOUT MCC | 603 | $33,028 | $16,514 | — | 6.1x |
| INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | 853 | $159,130 | $79,565 | — | 6x |
| HYPERTENSION WITHOUT MCC | 305 | $27,754 | $13,877 | — | 6x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $37,963 | $18,982 | — | 6x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $58,269 | $29,135 | — | 5.9x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $29,919 | $14,960 | — | 5.9x |
| DIABETES WITH CC | 638 | $32,218 | $16,109 | — | 5.9x |
| RENAL FAILURE WITH MCC | 682 | $53,661 | $26,831 | — | 5.6x |
| PERIPHERAL VASCULAR DISORDERS WITH CC | 300 | $38,371 | $19,186 | — | 5.5x |
| KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 689 | $41,990 | $20,995 | — | 5.3x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $43,836 | $21,918 | — | 5.1x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | 699 | $36,282 | $18,141 | — | 5.1x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC | 640 | $41,941 | $20,970 | — | 5.1x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | 871 | $64,126 | $32,063 | — | 4.9x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $37,062 | $18,531 | — | 4.9x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | 177 | $53,259 | $26,629 | — | 4.6x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | 698 | $50,503 | $25,252 | — | 4.5x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $30,738 | $15,369 | — | 4x |
| ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY | 884 | $36,229 | $18,115 | — | 3.6x |
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | 455 | $97,861 | $48,931 | — | 3.1x |
How SPOTSYLVANIA REGIONAL MEDICAL CENTER compares to nearby hospitals
Comparison based on average markup ratios from federal hospital pricing data (FY 2024). Chargemaster rates are gross charges — they are not what most insured patients pay. Actual costs depend on your insurance plan, negotiated rates, and coverage terms. This comparison is for informational purposes only and does not constitute medical, financial, or legal advice. Verify costs directly with your provider and insurer.
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use