St Claire Regional Medical Center
ST CLAIRE REGIONAL MEDICAL CENTER in Morehead, KY charges 3.1x the Medicare reimbursement rate across 13 analyzed procedures at this government-federal facility.
Morehead, KY 40351 · Acute Care Hospitals · CMS Rating: 4/5
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
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Billing patterns — government-federal
Federal Government Hospitals (VA/DoD) in our dataset show distinct billing patterns compared to other ownership types. These 14 facilities demonstrate an average markup of 4.1x Medicare rates, which falls within the mid-range compared to other hospital categories. VA and DoD hospitals typically operate under federal pricing structures that may differ significantly from private healthcare facilities. Patients should be aware that while these hospitals serve specific populations (veterans and military families), their charge patterns can still vary considerably from Medicare benchmarks. The billing structure at federal facilities often reflects government healthcare pricing models, which may include different cost accounting methods and reimbursement frameworks. Veterans eligible for VA care and military beneficiaries using DoD facilities should verify their coverage status and understand any potential differences between posted charges and their actual financial responsibility under federal healthcare programs.
Pricing grade
C
Average
Avg markup vs Medicare
3.15x
Charge / Medicare rate
Max markup
5.43x
Worst procedure
Procedures analyzed
13
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 |
|---|---|---|---|---|---|
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $34,885 | $17,443 | — | 5.4x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $17,118 | $8,559 | — | 4.2x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $23,530 | $11,765 | — | 3.3x |
| KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 689 | $22,057 | $11,029 | — | 3.3x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | 698 | $33,055 | $16,527 | — | 3.2x |
| RENAL FAILURE WITH CC | 683 | $16,716 | $8,358 | — | 3.2x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | 871 | $37,084 | $18,542 | — | 2.9x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $16,134 | $8,067 | — | 2.7x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $20,092 | $10,046 | — | 2.7x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | 177 | $28,498 | $14,249 | — | 2.6x |
| RENAL FAILURE WITH MCC | 682 | $22,045 | $11,022 | — | 2.6x |
| INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | 853 | $77,093 | $38,547 | — | 2.5x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $17,914 | $8,957 | — | 2.3x |
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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.
FAQ — government-federal hospital billing
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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