Since January 1, 2021, most U.S. hospitals have been required to post their prices online in two ways: a complete machine-readable file of all their standard charges, and a consumer-friendly list of at least 300 "shoppable" services, or a price estimator tool. People with Original Medicare can also use Medicare's Procedure Price Lookup tool to compare national average costs for some procedures in hospital outpatient departments and ambulatory surgical centers. These tools give estimates, so check with the hospital and your plan before you schedule.
What do hospitals have to post?
The Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency rule requires most hospitals to post standard charges on a public website in two ways:
A machine-readable file with standard charges for all items and services. CMS says this includes gross charges, discounted cash prices, payer-specific negotiated charges, and the minimum and maximum negotiated charges. These files are large and made for computers, so they're hard to use by hand.
A consumer-friendly display of shoppable services. CMS says hospitals must show at least 300 shoppable services, or all of them if they offer fewer. Shoppable services are ones you can schedule in advance, like a magnetic resonance imaging (MRI) scan, a colonoscopy, or a knee replacement. The display must include plain-language descriptions and group related services together.
Instead of the consumer-friendly list, a hospital can offer an online price estimator tool. Federal rules say the tool must cover at least 300 shoppable services, give you an estimate of what you'd owe the hospital, and be free to use without creating an account.
How do I find a hospital's prices?
- Go to the hospital's website and search for "price transparency," "price estimator," or "standard charges."
- Look for the shoppable services list or estimator tool.
- Search for your service by name or code. Ask your doctor's office for the Current Procedural Terminology (CPT) code to get a closer match.
- If you use an estimator, enter your insurance details if asked.
Prices must be updated at least once a year, and the hospital must show the date it last updated them.
How do these tools help people with Medicare?
The posted prices are most useful for people with private insurance or no insurance, since they show negotiated rates and cash prices. With Original Medicare, your costs are based on Medicare-approved amounts, not the hospital's list price.
Even so, the tools can help you:
- See which services are bundled together.
- Spot charges on a later bill that weren't part of the estimate.
- Compare prices if you're paying for a service Medicare doesn't cover.
If you have a Medicare Advantage plan, the hospital's estimator or your plan's own cost tool may show your plan's rates.
What is Medicare's Procedure Price Lookup tool?
Medicare.gov's Procedure Price Lookup tool lets you compare national average costs for certain procedures done in hospital outpatient departments and ambulatory surgical centers. It shows the total Medicare-approved amount and what a person with Original Medicare might pay without other coverage.
This can show why the same procedure may cost you less at an ambulatory surgical center than at a hospital outpatient department. Your actual costs depend on your coverage, your doctor, and the facility.