About Our Data
Understanding the transparency laws and data sources that make healthcare pricing accessible
A New Era of Healthcare Transparency: Three Core Laws
In recent years, the U.S. government has passed landmark legislation to pull back the curtain on healthcare pricing. These three core pieces of legislation are the bedrock of the data you see on Healthcare Price Tool. They mandate that hospitals and insurance companies publish their pricing data, making it accessible to the public for the first time.
1. The Transparency in Coverage Rule
This rule requires most health insurance companies to disclose their pricing information, empowering consumers to better understand their health care costs before receiving care.
What it provides:Insurers must publish machine-readable files (data files formatted for computers to process) that contain:
- • Negotiated rates for all covered items and services between the plan and its network of providers. A "negotiated rate" is the special price an insurer agrees to pay for a service, and a "network" is the group of doctors and hospitals that have a contract with that insurer.
- • Historical payments to, and billed charges from, out-of-network providers (providers who do not have a contract with the insurer).
Official Resource: Learn more at the CMS Transparency in Coverage Page
2. The Hospital Price Transparency Rule
This rule requires U.S. hospitals to provide clear, accessible pricing information online about the items and services they provide. This is designed to help patients know the cost of a hospital item or service before receiving it.
What it provides:Hospitals must publish a comprehensive, machine-readable file that includes the following for all items and services:
- • Gross charges (the "sticker price").
- • Payer-specific negotiated charges (the rates the hospital negotiated with different insurance companies).
- • Discounted cash prices offered to patients who pay without insurance.
- • De-identified minimum and maximum negotiated charges.
In addition, hospitals must display prices for at least 300 common "shoppable services" in a consumer-friendly format.
Official Resource: Learn more at the CMS Hospital Price Transparency Page
3. The No Surprises Act
This act provides federal protections to shield patients from surprise medical bills. A "surprise bill" is an unexpected bill from an out-of-network provider or at an out-of-network facility.
What it provides for patients:
- • Protections against surprise billing for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
- • A ban on out-of-network cost-sharing for most emergency and some non-emergency services. Patients are only responsible for their in-network copayments, coinsurance, or deductibles.
- • A requirement for providers and facilities to give patients a "Good Faith Estimate" of costs for medical services if they are uninsured or not using their insurance.
Official Resource: Learn more at the CMS No Surprises Act Page
Enhancing Public Data with Best-in-Class Information
Public data is a powerful starting point, but it doesn't tell the whole story. To provide you with a comprehensive and user-friendly experience, we license additional data from trusted third-party partners.
These data sources—covering everything from provider directories and insurance benefits to quality information—have traditionally been very expensive. In the past, they were typically only accessible to large corporations that could afford sophisticated healthcare navigation tools for their employees.
Our goal is to break down these barriers. We take these high-quality data sources from our licensed partners, integrate them with public data, and make them available to all consumers for free. This allows you to find the high-quality, affordable care you deserve.
Learn More About Our Methodology
If you are a provider and see information on your profile that needs to be updated, you can submit a correction for free.