Why I Built HospitalCost.com

The Hospital Price Transparency Rule took effect in January 2021. Every hospital in the United States now has to publish machine-readable files listing its negotiated rates for all services and all insurance plans.

Five years on, most patients still walk into a procedure with no idea what it will cost. Not because the data isn't there. Because "published" and "usable" are two completely different things, and the rule only delivered the first one.

I built HospitalCost.com to close the distance between them. It's a free, independent pricing tool that joins federal pricing, quality, and safety data into one facility-level view, so a patient in Virginia or North Carolina can see real costs before they pick 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 because the law says they have to. But they publish for compliance, not for comprehension. What you find is 500MB JSON files with nested rate structures, CSVs whose columns are named differently from one system to the next, and formats that need a developer just to open.

Picture the person searching "how much does an MRI cost in Virginia Beach." She is not going to download Sentara's 200MB pricing file and cross-reference it against her plan's negotiated rates. The rule intended transparency. What it produced, in practice, was a data engineering problem handed to people who never asked for one.

That's the gap. The data is public. The understanding requires someone to build the infrastructure that makes it legible.

A price by itself isn't a decision

A colonoscopy costs $3,200 at this hospital. Useful, on its own. Now add that the same hospital has a 4-star quality rating, no infection penalties, and offers financial assistance up to 400% of the federal poverty level. That's no longer a number. That's a decision.

HospitalCost.com joins the federal sources at the facility level, pricing, quality, safety, and financial assistance, so a single page answers the question a patient is actually asking: is this hospital good, affordable, and within reach for me? No single government dataset answers all three. The join is the product.

What the data shows

Three findings held up once the sources were joined.

27% of insured rates are higher than the hospital's own cash price

This one surprised me. Across the dataset, more than one in four negotiated insurance rates comes in above what the hospital charges someone paying cash. The insurer, the entity whose entire job is to negotiate a lower price on your behalf, is paying more than you would by walking in with no coverage at all.

It isn't a fluke at the margins. It's structural. And it stays invisible to the patient unless someone lines up the cash price file against the payer rate file and compares them row by row. Nobody was doing that.

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

For the 13 procedures where CMS publishes ASC (Ambulatory Surgery Center) Medicare rates, the gap is hard to believe. A cataract surgery that runs $15,000 inside a hospital system can be $1,800 at a surgery center across the street. Same surgeon, same outcome. The facility fee is the difference.

This isn't my opinion. It's CMS-verified rate data. But the patient never weighs the surgery center, because no one ever puts the two prices side by side.

Market concentration is the price lever

In Hampton Roads, Virginia, Sentara Health runs roughly 80% of the hospital beds. When one system owns a market like that, the negotiated rates carry the weight of it. The data shows a clean correlation between market share and average price. Not because the dominant system delivers more expensive care, but because it has less reason to compete on price.

That's the kind of finding that only shows up when you join the pricing data with ownership and geographic coverage. Hold any one of those apart and you'd never see it.

Why it's free

HospitalCost.com is free. No email gate, no paywall. Every comparison, every hospital profile, every downloadable report is there without an account.

I chose that on purpose. The people who need this most, the uninsured, the underinsured, the patient blindsided by a procedure, are the least able to pay for it. The trusted-advisor posture only holds if the advice actually reaches the person in trouble. Put a gate in front of it and you've quietly excluded the exact reader you built it for.

What comes next

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

CMS has tightened enforcement of the rule every year since 2021, and penalties now reach $2 million per year for non-compliance. More hospitals are publishing, and the quality of what they publish keeps improving. That's the part that compounds: the infrastructure gets more valuable as the underlying data gets better, and I don't have to do anything to earn that.

The builder's thesis

I built HospitalCost.com because I kept seeing the same pattern in my day job: the data exists, and nobody has done the work to make it decision-ready. In enterprise marketing, that work is reconciling platform data into one source of truth. In healthcare, it's joining public files into a view that answers what the patient came to ask: what will this cost me, and is the hospital any good?

The skill underneath is the same in both. Find the gap between the data that exists and the decision someone actually has to make. Build the thing that closes 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 has required all US hospitals to publish machine-readable files with negotiated rates for every service and every insurance plan. Since July 2022, the Transparency in Coverage Rule has required insurers to publish their negotiated rates too. The data exists. It's just buried in massive JSON and CSV files that were never meant for a patient to read.

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

Every insurer negotiates independently with every hospital, and there's no standard benchmark to anchor any of it. An MRI can cost $400 at one facility and $4,200 at another in the same city. Same machine, same radiologist reading the scan. What moves the number is hospital system bargaining power, how concentrated the local market is, whether the facility is for-profit or nonprofit, and old pricing that simply never got renegotiated.

What is HospitalCost.com?

HospitalCost.com is an independent hospital price transparency tool covering Virginia and North Carolina. It joins federal pricing, quality, safety, and financial assistance data into one facility-level view, so a patient can actually compare hospitals before choosing one. It's free, no email gate, and it includes downloadable reports for specific procedures.