About Our Data
Who We Are
MedicalPriceCheck.com is an independent project dedicated to making hospital pricing data accessible and understandable. We are not affiliated with any hospital, insurance company, or healthcare provider. Our goal is to help patients make informed decisions by presenting publicly available price transparency data in a clear, searchable format.
Data Sources
Our pricing data comes from two federally maintained sources:
- Hospital Price Transparency Files — Under the Hospital Price Transparency Rule (45 CFR Parts 180 and 182), hospitals have been required since January 1, 2021 to publish their standard charges in a machine-readable format. These files provide the cash prices, gross charges, and negotiated rates shown throughout the site.
- CMS Medicare Physician Fee Schedule — The Medicare Physician Fee Schedule published by the Centers for Medicare & Medicaid Services (CMS) provides national benchmark rates for over 7,700 procedures. Our bill checker uses these rates to identify potential overcharges on your medical bills.
What We Show
We display four types of pricing data:
- Cash Price — The price a hospital charges patients who pay out of pocket, without using insurance. This is sometimes called the "self-pay" or "uninsured" rate.
- Gross Charge — The hospital's list price before any discounts or negotiations. This is typically the highest price and rarely reflects what anyone actually pays.
- Negotiated Rates — The rates that hospitals have negotiated with specific insurance companies. Your actual cost depends on your specific plan, deductible, and copay structure.
- Medicare Rate — The national benchmark rate from the CMS Medicare Physician Fee Schedule, covering over 7,700 procedures. This provides a fair-price reference point for comparing hospital charges and is used across the site and in our bill checker to identify potential overcharges.
Methodology
We download machine-readable pricing files that hospitals publish, typically as CSV or JSON files. We extract pricing data for common shoppable medical procedures identified by CPT (Current Procedural Terminology) billing codes. Hospital facility information is cross-referenced with the CMS Provider of Services file for accurate location data.
Limitations
- Prices may be outdated. Hospitals update their transparency files on varying schedules. The prices shown reflect the most recent data available at the time we processed each hospital's file, but may not match current pricing.
- Not all hospitals are included. We currently cover a limited number of hospitals. Coverage will expand over time.
- Prices are not quotes. The prices displayed are published standard charges and do not constitute a price quote. Your actual cost may differ based on clinical circumstances, additional services, and your insurance coverage.
- Data quality varies. Hospital transparency files vary in format, completeness, and accuracy. We make reasonable efforts to parse and normalize this data, but errors may exist.
- CPT codes may not fully describe a procedure. A single billing code may correspond to slightly different services at different hospitals. Additional charges for anesthesia, facility fees, or other services are not always included.
Not Medical Advice
This site provides pricing information only and does not provide medical advice, diagnosis, or treatment recommendations. The information presented should not be used as a substitute for professional medical advice. Always consult with a qualified healthcare provider before making decisions about medical care.
We do not endorse any hospital, procedure, or treatment. The inclusion of a hospital or procedure on this site does not imply any recommendation regarding the quality of care provided.
Contact
Questions about our data or methodology? Reach us at andrew@medicalpricecheck.com.