A study published earlier this week in Health Affairs found “astronomical” markups in for-profit hospitals. The researchers used Medicare cost reports and examined the fifty US hospitals with the highest charge-to-cost ratios in 2012. These hospitals had markups (ratios of charges over Medicare-allowable costs) approximately ten times their Medicare-allowable costs compared to a national average of 3.4 times. The high-charge hospitals are concentrated in Florida with a group called Community Health Systems. Community Health has challenged the study by stating that “no one” pays the 1,000 percent markups. However, Reuters reports that out-of-network patients and the uninsured are often handed list price bills and auto and workers’ comp insurers are also expected to pay nearly in full, contributing to a trickle down effect in the rates for those policies.