=+4.22 ● Cost-to-charge ratios (see Example 4.9 for a definition of this ratio) were reported for the 10 hospitals in California with the lowest ratios (San Luis Obispo Tribune, December 15, 2002). These ratios represent the 10 hospitals with the highest markup, because for these hospitals, the actual cost was only a small percentage of the amount billed. The 10 cost-to-charge values (percentages) were