St Vincent Hospital
ST VINCENT HOSPITAL in Worcester, MA charges 5.5x the Medicare reimbursement rate across 66 analyzed procedures, according to our analysis of this for-profit facility's pricing data.
Worcester, MA 01608 · Acute Care Hospitals · CMS Rating: 2/5
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
5.53x
Charge / Medicare rate
Max markup
10.3x
Worst procedure
Procedures analyzed
66
With pricing data
Outlier procedures
4.5%
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 INTRALUMINAL DEVICE WITHOUT MCC | 322 | $186,103 | $93,052 | — | 10.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $39,221 | $19,610 | — | 9.9x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $168,932 | $84,466 | — | 9x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $77,705 | $38,852 | — | 8.4x |
| PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | 274 | $299,679 | $149,840 | — | 8.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $84,840 | $42,420 | — | 8.1x |
| EXTRACRANIAL PROCEDURES WITH CC | 038 | $115,992 | $57,996 | — | 8.1x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $59,313 | $29,656 | — | 7.8x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $208,697 | $104,348 | — | 7.7x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | 331 | $107,784 | $53,892 | — | 7.5x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $132,859 | $66,429 | — | 7.4x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $44,047 | $22,024 | — | 6.9x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | 330 | $130,059 | $65,030 | — | 6.8x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $56,675 | $28,338 | — | 6.8x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $43,988 | $21,994 | — | 6.7x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC | 640 | $76,836 | $38,418 | — | 6.6x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $43,275 | $21,637 | — | 6.6x |
| CHEST PAIN | 313 | $36,731 | $18,366 | — | 6.3x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | 244 | $141,889 | $70,944 | — | 6.2x |
| PULMONARY EMBOLISM WITHOUT MCC | 176 | $39,042 | $19,521 | — | 6.1x |
| PERIPHERAL VASCULAR DISORDERS WITH CC | 300 | $51,550 | $25,775 | — | 5.9x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $39,439 | $19,719 | — | 5.8x |
| POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | 917 | $95,867 | $47,933 | — | 5.7x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $73,986 | $36,993 | — | 5.6x |
| OTHER VASCULAR PROCEDURES WITH MCC | 252 | $206,349 | $103,175 | — | 5.6x |
| SEIZURES WITHOUT MCC | 101 | $40,607 | $20,304 | — | 5.5x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $37,299 | $18,649 | — | 5.5x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $104,445 | $52,222 | — | 5.5x |
| DIABETES WITH CC | 638 | $41,064 | $20,532 | — | 5.4x |
| KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 689 | $53,924 | $26,962 | — | 5.3x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $44,710 | $22,355 | — | 5.3x |
| OTHER VASCULAR PROCEDURES WITH CC | 253 | $119,587 | $59,793 | — | 5.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $33,389 | $16,695 | — | 5.2x |
| SYNCOPE AND COLLAPSE | 312 | $38,769 | $19,385 | — | 5.2x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | 286 | $103,236 | $51,618 | — | 5.2x |
| OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | 092 | $46,113 | $23,057 | — | 5.2x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $43,573 | $21,786 | — | 5.2x |
| MAJOR CHEST PROCEDURES WITH CC | 164 | $110,609 | $55,304 | — | 5.1x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $46,376 | $23,188 | — | 5x |
| OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC | 091 | $78,856 | $39,428 | — | 4.9x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC | 391 | $55,443 | $27,722 | — | 4.8x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 064 | $89,429 | $44,715 | — | 4.8x |
| RENAL FAILURE WITH CC | 683 | $37,396 | $18,698 | — | 4.7x |
| CELLULITIS WITHOUT MCC | 603 | $36,595 | $18,297 | — | 4.7x |
| ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | 897 | $36,291 | $18,146 | — | 4.6x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | 699 | $39,548 | $19,774 | — | 4.5x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $34,665 | $17,332 | — | 4.4x |
| PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | 175 | $53,864 | $26,932 | — | 4.4x |
| EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | 981 | $231,653 | $115,827 | — | 4.4x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | 698 | $65,873 | $32,937 | — | 4.3x |
Showing 50 of 66 procedures
How ST VINCENT HOSPITAL 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