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VA price data · 8 hospitals

Review of medical records for care cost in VA

What a review of medical records for care costs at VA hospitals — and the fair price to aim for.

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
1.16×vs. Fair Market Price
Position vs. 1.00× Fair Price+16% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +16% above the fair benchmark (1.16×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Riverside Walter Reed Hospital prices routine shoppable procedures near 1.3× Medicare (p50 1.17×) while skewing captive emergency, lab, and upper-quartile codes to 2.2× Medicare (p75 1.56×, +33% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#30 of 75 in VA · 38th State Percentile#1,900 of 3,385 in U.S. · 56th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 1.06× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 0% of shoppable procedures (99/100 Cash Honesty)
  • 4-Star CMS clinical rating with 79% patient recommendation (76/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (15.9% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 1.6× markup over Medicare rates
  • Captive ER (1.9×) & laboratory (1.7×) services average 1.69× higher multiples than routine shoppable care (1.3×)
  • Upper-quartile procedures (Q75 1.56×) jump +33% above the median procedure ratio (Q50 1.17×)
  • Consolidated metro market (HHI 2,784) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.3× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.69× Divergence
2.2× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+33% Upper Tail
Q25 1.06× · Q50 1.17× · Q75 1.56×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
1.3× MedicareGood
Outpatient Surgery & ORBack-Door Captive
1.6× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
1.4× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
1.9× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
1.7× MedicareGood
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
3.8× MedicareElevated
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
0% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
4 CMS · 76/100Fair
The BaseRate · VA 8 hospitals
Fair price · the BaseRate
$132
what it should cost in VA
Typically charged
$132
median across VA hospitals

In general, VA hospitals charge about the fair price for this. how we calculate the BaseRate →

modeled estimate · not a bill or quote

Compared with the rest of the country, VA’s fair BaseRate ($132) is above the national fair price of $108.

Cheapest VA hospitals for a review of medical records for care

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at VA Hospital Benchmark (Zero PHI Required)

Fair BaseRate™ $132
Medicare Rate $77
Self-Pay Cash Request Quote
Insurer Median $132
Pre-filled with VA Hospital Benchmark’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $115 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $115

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $115).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask VA Hospital Benchmark's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$185 Above Fair BaseRate

Negotiate Toward $132 Fair BaseRate ($77 Medicare)

Your bill ($317) is $185 above the denoised Fair BaseRate ($132) and 4.1× the $77 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Review of medical records for care cost nationally → All VA hospital prices →