Methodology

Transparency about our transparency. Here's exactly how we collect, process, and present hospital pricing data.

Data Sources

How We Process Pricing Data

1. Collection

We aggregate pricing data from hospital transparency files. Under the CMS Hospital Price Transparency Rule (effective January 1, 2021), all hospitals must publish their standard charges in a machine-readable format.

2. Identification

We match procedures using CPT (Current Procedural Terminology) codes — the standardized billing codes used across all US healthcare facilities. For each procedure page, we specify the exact CPT code being analyzed.

3. Price Classification

Hospital transparency files contain multiple price types:

• Gross charges — the "sticker price" (chargemaster rate). Almost no one pays this. It's the starting point for negotiation.
• Cash/self-pay prices — what the hospital charges patients paying out of pocket. These are typically the most relevant for uninsured patients.
• Negotiated rates — what insurance companies have agreed to pay. These vary by insurer and plan.
• De-identified minimum and maximum — the range of all negotiated rates at that facility.

4. Statistical Analysis

For each procedure, we calculate:

• 10th percentile (Low) — what you might pay with good negotiation or at a lower-cost facility
• 50th percentile (Typical/Median) — the middle of the range, representing a typical price
• 90th percentile (High) — the upper range, often seen at premium facilities or without negotiation

We primarily use cash/negotiated prices for the main range displayed on procedure pages. Gross charges are shown separately when available, as they represent the theoretical maximum.

5. Medicare Benchmarking

For context, we compare hospital prices to Medicare reimbursement rates from the Medicare Physician Fee Schedule. Important notes about this comparison:

• Medicare rates are not the "true cost" of a procedure
• They represent the rate negotiated by the largest single payer (the federal government)
• We show the national facility rate — the amount Medicare pays when a procedure is performed in a hospital or facility setting
• Actual Medicare payments vary by geography due to Geographic Practice Cost Index (GPCI) adjustments
• The "markup" figure (e.g., "8-26x Medicare") divides hospital prices by the Medicare rate to show relative magnitude

Limitations

What Our Data Captures

• National price ranges aggregated across multiple facilities
• General pricing trends and relative cost differences
• Useful benchmarks for negotiation and comparison

What Our Data Does NOT Capture

• Prices at any specific individual hospital (coming soon with our search tool)
• Your specific insurance plan's negotiated rate
• Physician professional fees (which are separate from facility fees)
• Anesthesia, laboratory, pathology, or other ancillary charges
• Regional variations within states (rural vs. urban, etc.)
• Quality of care differences between facilities

Known Data Quality Issues

Hospital price transparency compliance is still imperfect. As of 2026:

• Not all hospitals publish complete or accurately formatted files
• Some files contain errors or use non-standard formatting
• Price transparency enforcement by CMS is increasing but still limited
• Some prices may be outdated if hospitals haven't updated their files recently

Updates

We update our pricing data periodically as new transparency files become available and CMS releases updated fee schedules. The date on each procedure page indicates when that page's data was last refreshed.

Questions?

If you have questions about our methodology, notice any errors, or want to suggest improvements, please contact us at hello@americanmedicalcosts.com.

Last updated: March 2026