Data sources

Everything here is public: hospitals, insurers and CMS publish it because the law requires them to. That matters when you put a number in front of a client, because they can open the same file and find the same figure.

Hospital price transparency filesCopy Anchor Link

The data is what hospitals publish themselves. US hospitals must post their standard charges, including what they negotiate with each insurer, as a machine-readable file and on a price page. We collect those files, read each hospital's layout into one common format, and load them. Every row links back to the hospital's own page and file (transparency_page_url, mrf_source_url), so you can check any figure at its source.

CMS utilizationCopy Anchor Link

How often each code is billed to Medicare, from the CMS public files: physician services by state and by metro area, and inpatient stays by state and by hospital. We load the latest year CMS has released (2024 today).

Medicaid dentalCopy Anchor Link

Dental (CDT) volume comes from the HHS Medicaid Provider Spending file, with each provider placed in a state by its NPPES practice address, plus the under-19 dental rate series from data.medicaid.gov. Medicare has almost no dental codes, so Medicaid is the source.

Insurer published ratesCopy Anchor Link

Every health plan has to publish its in-network rates (Transparency in Coverage). We read those files and keep the rates for the hospitals we hold price files for. Self-insured plan administrators are left out, since they repeat the carriers' networks. Georgia and Florida are loaded so far.

DRG prices by insurerCopy Anchor Link

Hospitals often write an inpatient rate as a per diem, or a percent of Medicare, rather than a dollar figure. For hospitals in Kansas, Georgia and Florida we turn each one into a price per DRG case, and keep stop-loss and lesser-of terms next to it.

What is coveredCopy Anchor Link

Hospitals that publish a price file, state by state as we load them. A hospital we haven't loaded yet, or one whose file we couldn't read, returns no rows. We don't fill gaps with estimates.

Reading the numbersCopy Anchor Link

• Gross charge is a list price. Few patients pay it.
• Cash price is the self-pay price the hospital publishes.
• Negotiated rates come from the payers each hospital lists. Hospitals differ in which payers and plans they list, so compare payer_count along with the rate.
• Estimated rates are CMS estimated allowed amounts that some hospitals publish in place of a negotiated figure. They are kept in their own fields and never mixed with negotiated rates.
• Hospitals make mistakes in their own files. A value that looks odd is worth checking at the source link.