How to Use Hospital Price Transparency Files

What the price transparency rule requires

The CMS Hospital Price Transparency rule (45 CFR Part 180) has applied since January 1, 2021. Under it, every hospital in the United States has to publish a machine-readable file listing its standard charges for all items and services. The same rule requires a consumer-friendly display of shoppable services, or an online price estimator tool instead.

Enforcement tools available to CMS include warning notices, corrective action plans and civil monetary penalties. Compliance varies from hospital to hospital, so some files are easier to use than others. More detail is in our overview of hospital price transparency compliance.

What is inside the machine-readable file

The machine-readable file is a large data file built for computers, so it can be hard to read on its own. Standard charges in it generally include:

• Gross charge: the hospital's list price, taken from its chargemaster.
• Discounted cash price: what the hospital may charge a patient who pays without insurance.
• Payer-specific negotiated charges: the rates the hospital has negotiated with individual insurers.
• De-identified minimum and maximum negotiated charges: the lowest and highest negotiated rates across payers.

A chargemaster is the hospital's master list of gross charges. Gross charges are list prices, while insurers pay negotiated rates and many hospitals offer a discounted cash price. For how those figures differ, see cash price vs. insured rate.

What the shoppable services list contains

The consumer-friendly display covers 300 shoppable services. CMS specifies 70 of them, and the hospital selects the rest. A hospital can instead offer an online price estimator tool. In CMS's wording, a shoppable service is one a patient is able to schedule ahead of time. Our guide to shoppable services goes into more detail.

This display is meant to be easier to read than the data file. It is often organized by service name, which can help readers who are unfamiliar with billing codes.

Where hospitals post their files

Hospitals generally post these files on their own websites. Places people often look include:

• A link in the website footer labeled something like "Price Transparency" or "Standard Charges."
• The patient billing or financial information section.
• A search of the hospital's site for "price transparency" or "machine-readable file."

Large systems may post a separate file for each hospital location, so it helps to confirm the file matches the facility in question. If a file cannot be found, the hospital's billing or patient financial services office may be able to say where it is posted.

Clear Hospital Costs publishes hospital prices for Texas and Florida, refreshed from the hospitals' own files twice a week. Pages show gross charges, cash prices and insurer negotiated rates by hospital, and insurer rates can include Medicare Advantage and Medicaid managed care plans. Clear data errors are left out, as described on our methodology page.

Reading the codes in the file

Files usually identify services by code rather than plain names. A few code types come up often:

• CPT codes: five-character codes maintained by the American Medical Association. See what CPT codes are.
• HCPCS Level II codes: maintained by CMS, covering items such as supplies, drugs and some services.
• MS-DRG: inpatient hospital stays are often paid by MS-DRG.
• Revenue codes: hospital bills often list these for the department or type of service.

An itemized bill or good faith estimate may let a reader match its codes against the file. Our guide to reading an itemized hospital bill shows how those codes appear in practice. The procedures section of our site also lists examples, such as MRI costs in Houston or colonoscopy costs in Tampa and St. Petersburg.

Practical limits of the files

Price files are a starting point, but they do not tell the whole story.

• Facility charges only. A hospital or hospital outpatient department may bill a facility fee, and physicians such as surgeons, radiologists and anesthesiologists usually send a separate professional fee. Every price shown on Clear Hospital Costs is a hospital facility charge drawn from the hospital's own file, so it is not a total cost. See facility fee vs. professional fee.
• Negotiated rates are not a final bill. With a high-deductible plan, a member often pays the plan's negotiated rate for a service before the deductible is met. Many plans pay for certain preventive services with no cost sharing if an in-network provider delivers them, and the way a visit is billed, preventive or diagnostic, can change what a member owes. Actual cost depends on the individual plan, which this site cannot see. High-deductible plan tips offer some context.
• Emergency visits are billed by level. The site shows hospital ER visit facility charges, not urgent care prices. For background, see ER vs. urgent care costs. This site does not advise on where to seek care. If someone faces a medical emergency, the step to take is to call 911 or head to the closest emergency room.
• Files can contain gaps. Entries may be blank, unclear or inconsistent between hospitals.
• Not every service is shoppable. Emergency care cannot be scheduled in advance, so it falls outside the shoppable services concept.

Related protections and resources

A file price is a reference point. Several related topics may be useful to read about:

• Self-pay prices. Some hospitals quote a self-pay price on request. See how to ask for the self-pay price.
• Good faith estimates. Under the No Surprises Act, people who are uninsured or who choose not to use insurance can get a good faith estimate of expected charges for scheduled items and services. A provider is required to supply one when the service is booked at least 3 business days out, or whenever the patient requests it. If a final bill is at least $400 more than the estimate, the patient may be able to use the patient-provider dispute resolution process, which generally must be started within 120 calendar days of the bill date. CMS runs a No Surprises help desk. Our good faith estimate guide has details.
• Surprise bills. For people with most private health plans, the No Surprises Act generally protects against surprise bills for emergency services and for certain out-of-network services at in-network facilities. Those protections do not extend to ground ambulance services.
• Financial assistance. Nonprofit hospitals must meet IRS section 501(r) requirements, including a widely publicized written financial assistance policy. Eligibility rules are set hospital by hospital, and many other hospitals offer assistance too, though terms vary. See hospital financial assistance.
• Comparing and negotiating. Our guide on how to compare hospitals by price and our page on negotiating a hospital bill cover related topics.