Where the prices come from
Since 2021, federal rules (45 CFR Part 180) require every US hospital to publish a machine-readable file with its standard charges: the list price (gross charge), the discounted cash price, and the rate negotiated with each insurer and plan. Since July 2024 the files follow a CMS template. We find each file through the cms-hpt.txt index the hospital publishes on its website, download it, and keep the file name and its “last updated” date. Every price on this site shows that date and links to the hospital's price page.
How we read them
- We look up each procedure by its CPT code (for example 70551 for a brain MRI without contrast). We search every code column, because hospitals label CPT codes inconsistently, but only codes marked as CPT or HCPCS: some hospitals number their own chargemaster items with five digits that collide with CPT codes (in one file, item 85025 is a shoulder implant, not a blood count).
- A single CPT code can appear dozens of times in one file. Some hospitals list it twice over: once in the chargemaster (with the list and cash price) and many times in contract lines (with the rates of each insurer). We use both. Sites that read only the chargemaster lines miss most negotiated rates.
- We compare the same thing at every hospital: the hospital's full charge for the service. We leave out lines billed as professional fees (the doctor's part, whether the file marks them as professional or bills them under revenue codes 096x–098x), emergency lines billed under the urgent-care revenue code (0456), and lines with modifiers that change what is billed — for example 26 (professional component only), 50 (both sides), 52 (reduced service) or ER (an off-campus emergency department). We do count lines marked TC (technical component): in a hospital's own price file that is the hospital's part of the service, and the doctor's part is billed separately. Some academic hospitals list both their facility charges and their doctors' fees in the same file.
- Published cash price is the amount in the file's discounted cash price field. When a hospital lists the same CPT code on several lines, we keep the standard line and leave out the variants the file itself labels: tests sent to an outside lab, a different test billed under the same code, bilateral or whole-body versions, trauma activations, forensic exams, and freestanding-ER or urgent-care price schedules. If the file only has variants, we show them. If several standard lines have different prices, we show the range. The list price and the cash price always come from the same line.
- Negotiated rates: we keep one rate per insurer and plan. If the same plan appears with different amounts in different lines, we use the most frequent one (the lowest, on a tie). Rates expressed only as a percentage or a formula, without a dollar amount, are not included. We also leave out transplant network contracts (a case rate for the whole transplant episode), behavioral health, dental and hospice contracts, and the hospital system's own employee health plan, which is not negotiated between independent parties. When a hospital lists the same contract under several insurers or employers that use it (Methodist Health System does), the contract counts once.
- Typical insured rate is the median of all commercial plan rates (every plan counts once). Medicaid/CHIP, Medicare Advantage, workers' compensation, military plans and public programs (county programs, refugee and correctional health care, tribal health plans, the federal fund for uninsured COVID-19 care) are grouped separately and are not part of that median.
What the numbers do not include
- Bills from doctors who are not hospital employees, such as the radiologist who reads an imaging study.
- Other services on the same day (contrast agents, injections, consultations), which have their own codes.
- Discounts or financial assistance that a hospital offers but does not list in its file.
- Independent imaging centers and labs, which are not covered by the hospital rule.
Known problems in the files
- Some files pair location names and street addresses in the wrong order, or repeat the same NPI for different facilities. We do not publish addresses or NPIs taken from price files until we verify them against the federal NPI registry.
- Some hospitals list most insurer rates by billing group (for example an APC imaging level) or as a formula, not as a dollar amount per procedure. We only show dollar rates per procedure, so at those hospitals the typical insured rate can rest on few plans. Every table shows how many plans each number is based on.
- Some list prices look implausible. We publish them as the hospital wrote them, with the file date, and do not correct them.
When a city is published
We publish a city only when it covers at least three different hospital systems, and a procedure page only when at least three hospitals from two systems list a price. A page built on one hospital system would not show you the range of prices you can actually choose from.