I Built a Hospital Price Database Because the Data Was Public and Nobody Was Using It

The Hospital Price Transparency Rule took effect in January 2021. It requires every hospital in the United States to publish machine-readable files listing their negotiated rates for all services and all insurance plans.

Five years later, most patients still have no idea what their procedure will cost before they commit to it. Not because the data doesn't exist — but because "published" and "usable" are entirely different things.

I built HospitalCost.com to close that gap. It's a free, independent hospital price database that joins federal pricing, quality, and safety data into a single facility-level view, so patients in Virginia and North Carolina can compare real costs before choosing a hospital.

Here's what I learned building it, and what the data actually shows.

The data exists. The understanding doesn't.

Hospitals publish their prices as required by law. But they publish them in formats designed for compliance, not comprehension. You'll find 500MB JSON files with nested rate structures, CSVs with inconsistent column naming across systems, and machine-readable formats that require a developer to parse.

A patient searching "how much does an MRI cost in Virginia Beach" isn't going to download Sentara's 200MB pricing file and cross-reference it with their insurance plan's negotiated rates. The regulatory intent was transparency. The implementation created a data engineering problem.

That's the gap I saw: the data is public, but the understanding requires someone to build the infrastructure to make it legible.

Price alone doesn't tell you enough

Knowing a hospital charges $3,200 for a colonoscopy is useful. Knowing it also has a 4-star quality rating, no infection penalties, and offers financial assistance up to 400% of the federal poverty level — that's a decision.

HospitalCost.com joins multiple federal data sources at the facility level — pricing, quality, safety, and financial assistance — so that a single page answers the question a patient is actually asking: is this hospital good, affordable, and accessible? No single government dataset answers that. The join is the product.

What the data shows

Three findings stood out once the sources were joined.

27% of insured rates exceed the hospital's own cash price

This was the most surprising finding. Across the dataset, more than one in four negotiated insurance rates is higher than what the hospital charges a patient paying cash. Your insurance company — the entity that exists to negotiate lower prices on your behalf — is paying more than you would walking in without coverage.

This isn't an edge case. It's structural. And it's invisible to patients unless someone joins the cash price file with the payer rate file and compares them row by row.

Surgery centers are 3x to 29x cheaper than hospitals for the same procedures

For the 13 procedures where CMS publishes ASC (Ambulatory Surgery Center) Medicare rates, the price gap is enormous. A cataract surgery that costs $15,000 at a hospital system might cost $1,800 at a surgery center across the street. Same surgeon, same outcome, different facility fee.

This isn't opinion — it's CMS-verified rate data. But most patients never consider a surgery center because nobody surfaces the comparison.

Market concentration drives pricing power

In Hampton Roads, Virginia, Sentara Health operates approximately 80% of hospital beds. When one system dominates a market, negotiated rates reflect that leverage. The data shows a clear correlation between market share and average prices — not because dominant systems provide more expensive care, but because they have less incentive to compete on price.

This is the kind of insight that only emerges when you join pricing data with ownership data and geographic coverage.

Why I built this as a free product

HospitalCost.com is completely free. No email gate. No paywall. Every procedure comparison, hospital profile, and downloadable report is available without creating an account.

This was a deliberate choice. The people who need hospital price information the most — the uninsured, the underinsured, patients facing unexpected procedures — are the least likely to pay for it. The trusted advisor framing only works if the advice is genuinely accessible.

What comes next

Virginia and North Carolina are live. More states are coming.

CMS enforcement of the price transparency rule has increased every year since 2021, with penalties now reaching $2 million per year for non-compliance. More hospitals are publishing, and the data quality is improving. The infrastructure gets more valuable as the underlying data gets better.

The builder's thesis

I built HospitalCost.com because I saw a pattern I've seen repeatedly in my day job: the data exists, but nobody has done the work to make it decision-ready. In enterprise marketing, that means reconciling platform data into one source of truth. In healthcare, it means joining public data into a view that answers the question a patient is actually asking: how much will this cost me, and is this hospital any good?

The skillset is the same. Find the gap between what data exists and what decisions people need to make. Build the infrastructure to close it. Ship it.

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Frequently asked questions

Are hospital prices really public?

Yes. Since January 2021, the CMS Hospital Price Transparency Rule requires all US hospitals to publish machine-readable files containing negotiated rates for every service and every insurance plan. Since July 2022, the Transparency in Coverage Rule also requires insurers to publish their negotiated rates. The data exists — but it's buried in massive JSON and CSV files that weren't designed for patients to read.

Why do hospital prices vary so much for the same procedure?

Hospital prices vary because every insurer negotiates independently with every hospital, and there's no standard benchmark. An MRI can cost $400 at one facility and $4,200 at another in the same city — same machine, same radiologist read. Factors include hospital system bargaining power, local market concentration, whether the facility is for-profit or nonprofit, and historical pricing that was never renegotiated.

What is HospitalCost.com?

HospitalCost.com is an independent hospital price transparency database covering Virginia and North Carolina. It joins multiple federal data sources — pricing, quality, safety, and financial assistance — into a single facility-level view so patients can compare hospitals before choosing. The site is free with no email gate, and includes downloadable reports for specific procedures.