Show HN: What 482 hospitals charge vs. what insurers pay, from their own files

This report parses the machine-readable standard-charges files that 482 U.S. hospitals (in 48 states) publish and compares each hospital’s listed gross charge for common services with the hospital’s published median negotiated insurer rate. Across hundreds of hospitals, list prices far exceed what insurers actually pay: a typical moderate ER visit is listed at $1,285 while insurers pay a median $288 (4.5×), a comprehensive metabolic panel lists at $207 while insurers pay $11.46 (18.1×), and a CT abdomen/pelvis with contrast lists at $4,591 while insurers pay $438 (10.5×). For most common lab tests, imaging studies and ER codes, a large majority of hospitals list prices at three times or more the insurer rate (often 70-86% of hospitals for many services). The report tabulates typical list and insurer prices for dozens of CPT-coded services and shows the share of hospitals listing each at ≥3× the insurer rate.

The methodology uses only each hospital’s official machine-readable file (found via its cms-hpt.txt index) dated Jan 19, 2025-Sep 30, 2026, and counts only per-service fee-schedule negotiated rates backed by at least three insurers; case rates, per-diems, percent-of-charges and surgeries are excluded. Implausible values were filtered against Medicare references. Limits: the 482 hospitals are those with readable files, not a random sample; insurer figures are published negotiated rates, not actual paid claims, and physician fees aren’t included. If a bill shows charges near list price, insured patients should be billed their plan’s negotiated rate and uninsured patients can seek cash pricing or financial assistance.