Hospital Price Transparency

Under federal law, hospitals must publish their prices — including cash rates for uninsured patients. Here's what that data reveals, and how to use it.

Federal Law: Hospital Price Transparency Rule

Effective January 1, 2021, CMS requires all ~6,120 US hospitals to publish machine-readable files (MRFs) with their complete price lists. This includes cash/self-pay rates, negotiated rates with each insurer, gross charges, and min/max rates. Penalties reach $2 million/year for non-compliance.

1
Hospitals with MRF Data
in PlainProcedure
65.2K
Price Records
from published MRFs
72%
Compliance Rate
CMS estimate, 2024
887
CMS Warning Letters
issued through 2024

What Must Be in a Machine-Readable File

Gross Charges
The undiscounted chargemaster rate for each item or service — often 4-10x what anyone pays.
Cash / Self-Pay Price
The discounted price available to uninsured patients or those choosing to pay out-of-pocket.
Payer-Negotiated Rates
The specific rate negotiated with each health insurer and each plan, by procedure code.
De-identified Min/Max
The lowest and highest negotiated rates across all payers — without identifying the insurer.
300 Shoppable Services
A consumer-friendly display of common planned procedures (non-emergency) in plain language.
All Items & Services
Every billable service: procedures, supplies, room charges, medications, labs, and more.

Highest Published Cash Prices

The most expensive procedures by cash/self-pay rate, from hospitals that have published their MRFs.

CPT Code Procedure Cash Price
20939 Aspiration of bone marrow for spine bone graft $53,030.16
22850 Removal of stabilizing device from back of spine $53,030.16
22633 Fusion of spine in lower back with partial removal of spine bone and disc $50,878.09
22632 Fusion of lower back spine bone and partial removal of spine bone or disc through back, each additional disc $49,156.65
22840 Placement of stabilizing device to back of 1 spine bone in neck $46,941.81
63052 Partial removal of bone of single segment of spine in lower back with release of spinal cord and/or nerves during fusion of spine in lower back $46,380.34
22842 Placement of stabilizing device to back, 3-6 spine bone segments $46,116.50
22634 Fusion of additional segment of spine with partial removal of spine bone and disc $45,759.54
22630 Fusion of lower spine bone and partial removal of spine bone or disc through back, 1 disc $45,664.05
22846 Placement of stabilizing device to front, 4-7 spine bone segments $45,108.68
20936 Sp bone agrft local add-on $42,116.07
22853 Insertion of cage or mesh device to spine bone and disc space during spine fusion $40,016.26
15777 Implantation of biologic implant to soft tissue $37,920.45
19330 Removal of ruptured breast implant and implant material $37,920.45
19370 Revision of capsule around breast implant $37,920.45

MRF Data by State

States with hospital price transparency data in PlainProcedure's database.

AL 1 hospital
65,151 records

How to Use Price Transparency Data

  1. 1
    Find the cash price before scheduling
    Look up your procedure on PlainProcedure or the hospital's own price tool. If the cash price is lower than your cost-sharing under insurance, it may be worth paying out-of-pocket.
  2. 2
    Compare across hospitals in your area
    Cash prices for the same procedure can vary 3-10x between hospitals in the same metro. For elective or planned procedures, it's worth calling 2-3 hospitals for price quotes.
  3. 3
    Use the cash price to negotiate
    If you're insured but facing a large out-of-pocket cost, you can request the cash rate — especially if you're uninsured or your deductible hasn't been met. Many billing departments will honor it.
  4. 4
    Ask for an itemized bill
    After any service, request a complete itemized bill. Medical billing errors are common. Compare each line item against published MRF prices.
  5. 5
    Request financial assistance
    Nonprofit hospitals (which make up about 60% of US hospitals) are legally required to offer charity care for patients below certain income thresholds. Always ask about financial assistance programs.

Frequently Asked Questions

What is the Hospital Price Transparency Rule?

The Hospital Price Transparency Rule, effective January 1, 2021, requires all US hospitals to publish machine-readable files (MRFs) containing their standard charges for all items and services. This includes payer-specific negotiated rates, gross charges, discounted cash prices, and de-identified minimum and maximum negotiated charges.

What is a Machine-Readable File (MRF)?

A Machine-Readable File is a structured data file — typically JSON or CSV — that hospitals publish on their websites containing their complete price lists. CMS requires the file to include: gross charges, payer-specific negotiated rates, cash/self-pay discounted prices, and de-identified min/max negotiated charges for all covered items and services.

What is a cash price at a hospital?

The cash price (or self-pay discounted price) is the amount a hospital will accept as payment in full from a patient without insurance, or from an insured patient choosing to pay out-of-pocket. Cash prices are typically much lower than gross chargemaster rates but often higher than negotiated insurer rates. They vary enormously by hospital.

Are hospitals actually complying with price transparency requirements?

Compliance has improved significantly since 2021 but remains incomplete. CMS estimates approximately 72% of hospitals are now compliant. Hospitals that fail to comply face civil monetary penalties of up to $2 million per year. CMS has issued over 887 warning letters and penalty proposals through 2024.

How can I use hospital price data to lower my medical bill?

You can use published hospital cash prices to negotiate your bill. If you see a hospital charges $500 cash for a procedure, but your insurer's EOB shows a negotiated rate of $800, you may be able to request the lower cash rate — especially if you're uninsured or your deductible hasn't been met. Always ask the billing department before paying, and compare estimates across hospitals in your area.

Where can I find a hospital's machine-readable file?

Each hospital is required to post its MRF on its website. You can usually find it by searching "[Hospital Name] price transparency" or "[Hospital Name] machine readable file". CMS also maintains a list of non-compliant hospitals. PlainProcedure publishes cash prices from hospitals that have made their MRFs publicly accessible.

Related Guides

Hospital Markup Explained
Why hospitals bill 3-10x what Medicare pays and what it means for patients.
How to Read a Medical Bill
A practical guide to understanding every line item on your bill.
Negotiating Your Medical Bill
Proven scripts and tactics for reducing hospital and provider bills.

MRF price data sourced from hospital-published machine-readable files per CMS Hospital Price Transparency Rule (45 CFR 180). Compliance statistics from CMS Hospital Price Transparency enforcement reports. Medicare procedure pricing from CMS Medicare Physician & Other Practitioners by Geography & Service (2023).