US hospital price transparency
US hospitals publish multiple prices for the same procedure. The two most useful starting points are the discounted cash price for self-pay patients and the payer-specific negotiated charge for a named insurer or plan. Neither is automatically your final bill.
If you are self-pay, compare the discounted cash price and ask whether it is a complete package. If you are insured, compare the payer-specific negotiated charge for your exact insurer and plan, then ask your insurer or hospital for your estimated patient responsibility. A lower negotiated rate does not help if the hospital is out of network or if separate clinician bills are excluded.
Decision tool
Enter your quote and plan numbers. The result estimates today's payment and flags the deductible trade-off.
Cash route
$450
Insurance estimate
$1,020
Current signal
Cash looks lower-cost by $570
This is a simple estimate. It does not verify network status, prior authorization, separate radiologist bills, contrast, facility fees, or whether a cash payment counts toward your plan deductible or out-of-pocket maximum.
Suggested next step
Cash is worth checking, but confirm deductible impact.
Your result depends on whether more care is likely this plan year and whether the provider is in-network.
Most useful submissions include body part, contrast status, radiologist read fee, provider name, date quoted and whether the amount was cash, allowed amount, EOB patient responsibility or billed charge.
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MVP wedge
The first TreatCompare US price-transparency test is MRI cost because it is common, shoppable, CPT-code driven and often available from both hospital outpatient departments and independent imaging centers.
Open the MRI cost pageRead methodologyUsing this data?
Main sources
Methodology: This page maps CMS standard-charge fields into consumer comparison columns. We do not currently publish live hospital MRF extracts on this page; prices should be checked against each hospital's latest file or estimator before a patient acts.
TreatCompare publishes healthcare, care-cost and treatment-pricing research for consumers, journalists, policymakers and commercial teams.
The hospital price for a patient paying cash or cash equivalent.
Use it for: Best first column for self-pay patients comparing hospitals.
Watch out: May not include physician, anesthesia, pathology, imaging, implants, or follow-up bills.
The amount a hospital has negotiated with a specific insurer or plan.
Use it for: Best first column for insured patients checking whether one hospital is lower-cost in-network than another.
Watch out: It is not your final out-of-pocket cost; deductible, coinsurance, copay, and network status still matter.
The lowest and highest negotiated charges across third-party payers.
Use it for: Useful for spotting the spread between insurers when the exact plan rate is missing.
Watch out: The payer names are hidden, so these values cannot tell you what your own plan will pay.
The chargemaster list price before discounts or insurer contracts.
Use it for: Useful as a reference field and quality check when parsing files.
Watch out: Usually the least useful value for estimating what a patient or insurer will actually pay.
These are high-intent procedure categories where cash-vs-insured comparison is useful. Codes are examples only; hospitals may publish different codes, modifiers or packages.
| Procedure | Code signal | Setting | Comparison notes |
|---|---|---|---|
| MRI scans | Example CPT: 72148 | Outpatient imaging | Facility price, radiology professional fee, contrast if used, body part, and whether the imaging center is hospital-owned. |
| CT scans | Example CPT: 74177 | Outpatient or emergency imaging | With-vs-without contrast, radiology professional fee, emergency setting markups, and hospital outpatient department fees. |
| Ultrasounds | Example CPT: 76830 | Outpatient imaging | Body area, whether Doppler is included, radiology read fee, pregnancy vs non-pregnancy coding, and facility fee. |
| Colonoscopies | Example CPT: 45378 | Outpatient endoscopy | Facility fee, physician fee, anesthesia, pathology, polyp removal, and preventive-care coding. |
| Upper endoscopy | Example CPT: 43235 | Outpatient endoscopy | Facility fee, physician fee, anesthesia, biopsy/pathology, dilation or therapeutic add-ons, and bundled-vs-itemized quotes. |
| Cataract surgery with standard lens | Example CPT: 66984 | Outpatient surgery | Facility fee, surgeon fee, anesthesia, lens type, eye laterality, and upgrade lens charges. |
| Blood tests | Example CPT: 85025 | Hospital lab or outpatient lab | Hospital lab price vs independent lab, panel components, draw fee, pathology interpretation, and insurer lab network. |
| Childbirth | Example DRG/CPT mix | Inpatient maternity | Vaginal vs C-section, newborn charges, epidural/anesthesia, physician bill, length of stay, neonatal care, and complications. |
| ER visits | Example CPT: 99284 | Emergency department | Facility level, physician bill, imaging, labs, drugs, observation status, and whether surprise-billing protections apply. |
| Outpatient surgery | Examples: 29881, 47562 | Hospital outpatient department or ASC | Facility fee, surgeon fee, anesthesia, implants/supplies, pathology, pre-op imaging, and post-op physical therapy. |
| IVF add-ons | Clinic/lab-specific billing | Fertility clinic or hospital-affiliated lab | ICSI, PGT-A, assisted hatching, embryo freezing, storage, anesthesia, and whether add-ons are billed outside the base cycle. |
| Physical therapy | Examples: 97110, 97140 | Hospital outpatient or clinic | Per-visit facility fee, therapist professional charge, number of units, plan visit limits, and hospital-owned clinic status. |
| Cancer diagnostics | Varies by pathway | Imaging, lab, pathology, endoscopy, or biopsy | Diagnostic imaging, biopsy facility fee, pathology, genetic or molecular tests, specialist professional bills, and staging add-ons. |
For self-pay patients, the cash price is usually the relevant hospital column, but it still needs a package check. Ask whether it includes facility, professional, anesthesia, pathology, implant, drug and follow-up charges.
For insured patients, the negotiated charge is the better starting point. Then translate it through your plan: deductible remaining, copay, coinsurance, out-of-pocket maximum, prior authorization and network status.
If the hospital cash price is lower than your plan's negotiated rate, ask whether paying cash is allowed and what you give up by doing so. Cash payments may not count toward your deductible or out-of-pocket maximum.
CMS requires hospitals to publish a comprehensive machine-readable file and a consumer-friendly display of shoppable services. CMS also defines discounted cash price, payer-specific negotiated charge, de-identified minimum and maximum negotiated charges, gross charge and standard charge in federal regulation.
This MVP starts with decision logic before full hospital-file ingestion. If you have a written MRI, imaging, hospital outpatient or independent provider quote, TreatCompare can label it as a submitted example after source checks.
Sometimes, but not always. A hospital discounted cash price can be lower than an insurer negotiated rate for some procedures, while the negotiated rate may be lower for others. Patients also need to check whether paying cash counts toward their deductible or out-of-pocket maximum.
A payer-specific negotiated charge is the charge a hospital has negotiated with a third-party payer for an item or service. It can help insured patients compare hospitals, but it is not the same as the patient responsibility shown on an estimate or explanation of benefits.
Compare the hospital facility price, physician or surgeon bill, anesthesia, pathology, imaging, implants, drugs, follow-up care, network status, deductible, coinsurance, and whether the quote is bundled or itemized.
CMS hospital price transparency rules require hospitals operating in the United States to publish a machine-readable file with standard charges and a consumer-friendly display of shoppable services.
TreatCompare is read by patients, prescribers, journalists and AI assistants. The dataset gets better when people who’ve been quoted, billed, or treated for US cash price vs insurance send their information in. None of these take more than a minute.
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