Why is the negotiated rate the upper bound and not what I pay?

The negotiated rate is what the hospital and your insurer have agreed the procedure costs in total. Your share of that total depends on your plan's deductible (you pay first), coinsurance (a percentage after deductible), and out-of-pocket maximum (a cap that, once hit, transfers all further cost to the insurer).

What if my hospital isn't listed on ClearPrice Health?

We cover Colorado hospitals whose machine-readable files we can parse cleanly. Some hospitals publish files that fail validation; we omit them rather than guess. If you don't see your hospital, check its own website for its MRF and consider emailing us a correction.

Does this work for inpatient stays (e.g., childbirth, surgery)?

The same math applies, but the bill is usually a sum of multiple line items (room rate per day + procedures + medications + professional fees). Ask the hospital for an itemized estimate before admission, then apply your deductible / coinsurance / OOP-max to the total.

If you're paying cash, the relevant number is the hospital's discounted cash price (also published in the MRF, separate from negotiated rates). On every procedure page, the cash median is shown alongside the negotiated band. Cash-pay can be cheaper than insurance for low-cost procedures with high deductibles, but you lose the deductible-credit toward your annual cap.

How accurate is this estimate, in practice?

Our estimates are typically within 20-30% of the actual bill. The biggest swings come from facility-fee vs professional-fee splits, separately-billed ancillary services (anesthesia, pathology), and last-minute changes in care plan. Treat the estimate as a comparison tool, not a quote.

How to estimate your hospital bill in Colorado

By Ashwin Pingali Updated May 8, 2026 6 min read

A step-by-step guide to estimating your out-of-pocket cost using a hospital's published negotiated rate, your plan's deductible and coinsurance, and a real Colorado example. An estimate, not a quote.

The negotiated rate a hospital publishes in its machine-readable file is the upper bound for what your insurer will pay — not what you'll pay. Your bill depends on three numbers from your insurance plan: how much of your annual deductible is left, your coinsurance percentage, and your out-of-pocket maximum. Here's how to combine those three with the published rate to estimate your bill.

Three numbers and one rate

Pull these four numbers before you start.

· Negotiated rate. Pulled from the hospital's published price. On ClearPrice Health, click any procedure page, find the hospital you'd use, and read the median negotiated rate for your insurer.
· Deductible remaining. From your insurer's web portal or your most recent EOB. The deductible is the amount you pay in full before insurance starts coinsuring.
· Coinsurance percentage. From your insurance card. Typical values are 10%, 20%, 30%. This is the share of cost you pay after meeting the deductible.
· Out-of-pocket maximum. Also from your insurer. Once you've paid this much in a calendar year, your insurance pays 100% of further covered care.

The math, three scenarios

Take an MRI of the knee at Denver Health on Anthem Blue Cross. The median negotiated rate is around $1,247. Here's what you'd pay in three scenarios.

Early in the year (deductible not met)

If you have not yet paid any of your annual deductible, and your deductible is $2,000, you pay the full $1,247 — it counts toward your deductible. Your bill estimate: ~$1,247.

Mid-year (deductible met, coinsurance applies)

If you've already paid your $2,000 deductible and your coinsurance is 20%, you pay 20% of $1,247 = ~$249. The insurer pays the remaining $998. Your bill estimate: ~$249.

Late in the year (out-of-pocket maximum hit)

If you've already paid your full annual out-of-pocket maximum (say $6,000), you pay $0 — your insurer covers the full $1,247. Your bill estimate: $0.

What can shift the estimate

· Facility fee vs professional fee. Hospital MRFs include the facility fee. The radiologist who reads the MRI may bill separately.
· Bundled vs separately-billed services. Anesthesia, biopsy, and pre-op labs are often billed separately for surgical procedures.
· Pre-authorization. Some procedures require pre-auth from your insurer; without it, the bill can be 100% your responsibility.
· In-network status. Hospitals listed on ClearPrice Health publish rates with payers — but "published" doesn't always mean "in-network for your specific plan." Confirm with your insurer.

Before you schedule

Use the estimate to compare hospitals and to budget. Then call your insurer with the procedure (CPT code if you have it; otherwise the description) and the hospital's name; ask them to confirm in-network status, your remaining deductible, your coinsurance for that hospital, and whether pre-authorization is needed. Their answer is the source of truth for your specific liability.

Why is the negotiated rate the upper bound and not what I pay?: The negotiated rate is what the hospital and your insurer have agreed the procedure costs in total. Your share of that total depends on your plan's deductible (you pay first), coinsurance (a percentage after deductible), and out-of-pocket maximum (a cap that, once hit, transfers all further cost to the insurer).
What if my hospital isn't listed on ClearPrice Health?: We cover Colorado hospitals whose machine-readable files we can parse cleanly. Some hospitals publish files that fail validation; we omit them rather than guess. If you don't see your hospital, check its own website for its MRF and consider emailing us a correction.
Does this work for inpatient stays (e.g., childbirth, surgery)?: The same math applies, but the bill is usually a sum of multiple line items (room rate per day + procedures + medications + professional fees). Ask the hospital for an itemized estimate before admission, then apply your deductible / coinsurance / OOP-max to the total.
What about cash pay?: If you're paying cash, the relevant number is the hospital's discounted cash price (also published in the MRF, separate from negotiated rates). On every procedure page, the cash median is shown alongside the negotiated band. Cash-pay can be cheaper than insurance for low-cost procedures with high deductibles, but you lose the deductible-credit toward your annual cap.
How accurate is this estimate, in practice?: Our estimates are typically within 20-30% of the actual bill. The biggest swings come from facility-fee vs professional-fee splits, separately-billed ancillary services (anesthesia, pathology), and last-minute changes in care plan. Treat the estimate as a comparison tool, not a quote.

Related procedures

Related collections

CMS-mandated shoppable services
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CMS requires every U.S. hospital to publish prices for a list of common shoppable services in plain-language format. These are the catalog items on that list.

Numbers and citations on this page trace back to hospitals’ own machine-readable files under 45 CFR §180.50. See the methodology page for how the prices are aggregated, and the editorial policy for what we will and won’t do as a publisher.