Hospital bills and price files are full of jargon. Here are the terms you will see on this site, in plain English. For a fuller walkthrough, see our price guide.
Price types
Chargemaster (gross) price. The hospital's full list price for a service before any discount — like a sticker price. Almost nobody pays it directly.
Cash / self-pay price. What the hospital will accept from a patient paying directly without insurance. Often far below the chargemaster price, and the key number if you are uninsured or have a high deductible.
Insurer-negotiated rate. The price a specific health plan has negotiated with the hospital. It is the basis for what you and your insurer split.
Medicare rate. What the government's Medicare program pays for a service. We show it as a benchmark to judge whether a price is reasonable.
Billing codes
CPT. Current Procedural Terminology — a 5-digit code identifying a specific medical procedure or service (e.g. an MRI of the brain).
HCPCS. Healthcare Common Procedure Coding System — codes for services, drugs and supplies, building on CPT.
DRG / MS-DRG. Diagnosis-Related Group — a code that bundles an entire inpatient hospital stay into one payment category (e.g. a vaginal delivery). We price inpatient stays from the DRG, not individual line items.
Insurance terms
Deductible. The amount you pay out of pocket each year before your insurance starts paying.
Coinsurance. The percentage of a bill you pay after meeting your deductible.
Copay. A fixed amount you pay for a service (e.g. $30 for a visit).
Out-of-pocket maximum. The most you will pay in a year; after this, your plan covers 100% of covered services.
Transparency terms
Machine-readable file (MRF). The standardized price file every US hospital must publish under federal law, listing its standard charges.
Shoppable service. A non-urgent service you can schedule and price-compare in advance — the focus of this site.
45 CFR §180. The federal Hospital Price Transparency regulation requiring hospitals to publish prices, in effect since January 1, 2021.