Frequently asked questions

About the data

Where the numbers come from, what coverage looks like today, and how often the data is refreshed.

Where do these prices come from?

Every dollar value comes from a hospital's own published machine-readable file (MRF), required under 45 CFR §180.50. We do not model, estimate, or crowdsource any prices.

What is a hospital machine-readable file (MRF)?

An MRF is a single comprehensive list of standard charges for every item and service the hospital provides — gross charge, payer-specific negotiated rate, de-identified minimum/maximum, and discounted cash price. CMS requires every hospital in the US to publish one in a machine-readable format.

Why only Colorado right now?

ClearPrice Health started with Colorado so we could prove out our methodology and editorial standards on one state before scaling. Additional states roll out once we are confident the data quality holds at the same bar.

How often does the data refresh?

We re-scan every quarter. Hospitals that republish MRFs in between cycles are picked up at the next refresh.

Why are some hospitals missing?

They either don't publish a CMS-mandated MRF, or publish in a format the parser hasn't yet onboarded — most commonly ZIP archives or non-UTF-8 CSVs. Coverage expands each cycle. The methodology page lists the exact files that failed to parse in the most recent run.

How prices work

How we turn raw MRF rows into the bands, medians, and percentiles you see on each page.

What is the percentile band?

We compute each Colorado hospital's median commercial negotiated rate for the procedure, then take the 25th-to-75th percentile across those hospital medians. The headline 'Colorado median' is the 50th percentile of the same distribution. We use median-of-hospital-medians (not row-weighted) so a single MRF with thousands of plan/payer permutations doesn't dominate the band.

What does the percentile bar on a hospital page mean?

It's the hospital's percentile rank among Colorado hospitals' commercial negotiated medians for that procedure. 0% means cheapest CO hospital reporting; 100% means most expensive. Ties are split evenly. Hospitals appear on the rank only when at least two CO hospitals report a median for the same code.

What is a negotiated rate, cash price, and gross charge?

The gross charge (or 'chargemaster') is the hospital's list price — almost no one actually pays it. The negotiated rate is what the hospital has agreed to with a specific insurer for a specific plan. The discounted cash price is what an uninsured or self-pay patient is charged. All three are required disclosures under CMS's hospital price transparency rule.

What is a CPT, HCPCS, MS-DRG, or APC code?

CPT and HCPCS are codes for individual outpatient procedures, supplies, and drugs. MS-DRG groups inpatient stays by diagnosis and severity for payment under Medicare. APC groups outpatient services for the OPPS payment system. The site shows whichever coding system the hospital reports for that service.

Why are Medicare and Medicaid rates excluded from the band?

Government rates are statutory floors set by federal/state fee schedules — including them would pull the displayed median far below what a commercially-insured patient will actually be charged. Workers' Comp and VA are excluded for the same reason. The full data including those rates is in the per-hospital downloadable Parquet for analysts.

What does 'median of hospital medians' mean?

For a given procedure, we first compute one negotiated-rate median per hospital (across that hospital's commercial payers). The 'Colorado median' on the procedure page is the median of those per-hospital medians, not the median of every individual rate row. This treats each hospital as one data point, regardless of how many rows it published — which is more representative for cross-hospital shopping.

Insurance and coverage

What MRF data does and doesn't tell you about your insurance, and how to use a hospital's posted negotiated rate as a real-world reference.

Will my actual bill match these numbers?

It rarely will, exactly. These are aggregates from regulatory filings, not pre-authorisations or quotes. Your bill depends on your specific plan, deductible, copay, coinsurance, and the clinical circumstances of the visit. The numbers here are a credible reference point, not a guarantee.

If a payer is in a hospital's MRF, does the hospital accept it?

Probably, but not always. The MRF lists payers the hospital has a posted rate for; that does not strictly equate to active in-network status today, nor that every plan from that payer is honoured. Confirm coverage with the payer or the hospital before scheduling.

Is [a specific procedure] covered by Medicare?

Many preventive services are covered by Medicare with no cost-sharing — see the 'Medicare preventive · no cost-sharing' collection. Diagnostic and therapeutic services have separate rules. The procedure pages flag CMS preventive status when applicable; use it as a starting point and verify with your plan.

What does 'in-network negotiated' mean for me as a patient?

It's the rate the hospital has agreed to charge the insurer for that procedure. Your actual out-of-pocket cost is some combination of the negotiated rate and your plan's deductible, copay, and coinsurance. Two patients with different plans at the same insurer can pay different amounts for the same procedure at the same hospital.

How do I use these numbers when calling the hospital?

Ask for the price for the specific CPT/HCPCS/DRG code (we list them on every procedure page), under your specific plan, in the specific setting (inpatient/outpatient/ambulatory). Compare the answer to our band — anomalies are worth pushing back on.

Reading our pages

How do I compare two hospitals for the same procedure?

Open the procedure page; the per-hospital table shows each hospital's median, percentile rank, and 25-75th band. Click any hospital row for its full profile. Or use the workspace view if you're a hospital pricing/finance team.

What does CMS-shoppable mean?

CMS designates 70 services as 'shoppable' — services patients can plan in advance, like an MRI or a colonoscopy. The site flags shoppable status on every procedure page; the 'CMS shoppable' collection lists the full set we cover.

What's the difference between a procedure page and a collection page?

A procedure page shows one CPT/HCPCS/DRG code with hospital-by-hospital prices. A collection page groups related procedures (cancer screening, cardiology, vaccines, etc.) for shoppers who don't yet know the specific code.

Where can I download the raw data?

Each hospital workspace page has a Parquet download button with that hospital's full MRF rows. The Parquet format is readable by pandas, DuckDB, Apache Arrow, Polars, R-arrow, and Tableau — the methodology page documents the schema.

Hospital workspace

Can hospitals correct their data?

Yes. Send corrections to clear-price-corrections@geninspired.com — we re-pull every quarter, but corrections that involve a re-published MRF can be picked up sooner. The compliance scorecard on each workspace page shows what we found in the most recent ingest.

How do I claim my hospital's profile?

The workspace is currently in invite-only preview. Email clear-price-corrections@geninspired.com with your role and the hospital — we'll confirm and grant access. There is no payment to claim a profile, ever.

Is the workspace free during the preview?

Yes. Hospital workspace access during the preview phase is free. We will publish pricing before charging, and existing previewers will be notified well before any change.

Does ClearPrice Health take payment to influence rankings?

No. We do not take payment from hospitals, payers, or insurers to elevate, hide, or alter any data on the site. See the editorial policy for the full disclosure.