Half of American hospitals still won't post their prices — and of the ones that do, only 18% post an actual dollar amount

The federal rule is almost six years old. Every hospital in the country has to post what it charges — the gross price, the rate it negotiated with each insurer, the cash price if you pay without a plan — and post prices for the 300 most common shoppable services in a form a patient can use.

As of this week, 1,012 of the 2,000 hospitals reviewed by PatientRightsAdvocate.org are still not fully complying. That is 51%, and it is the good news, because it is the best number the group has recorded since it started counting in 2021.

Compliance went up. Usefulness did not.

Two numbers in this report are doing different jobs, and the gap between them is the entire story.

The first, 49%, measures whether a hospital posted the required files in the required format. That number is genuinely improving, and the reason is not a change of heart. CMS has fined 28 hospitals, nearly double its count from two years ago, and in June it sent warning letters with corrective-action requests to more than 500 more. Hospitals that ignore those can be billed up to $2 million a year. Enforcement works, which was always the objection to the previous six years of not doing much of it.

The second number, 18%, measures whether the posted file contains a price you could actually read. Only 360 of the 2,000 hospitals published dollars-and-cents amounts for at least half the items and services in their files. The rest are allowed, under the current rule, to post an algorithm instead — a formula that says your price is some percentage of a Medicare rate, or of a charge master figure, or of a number you would need another document to find.

That is legal. It is also the hospital equivalent of answering "how much is this?" with "it depends on a variable I am not going to show you."

Why hospitals fought this for six years

The stated reasons are real, if not sympathetic: the upfront investment, the ongoing maintenance, the technical complexity of publishing tens of thousands of negotiated rates in a machine-readable file.

The unstated reason is that those rates are the most sensitive numbers in American health care. A hospital's negotiated price with one insurer is its leverage against every other insurer, and against every hospital in the metro area. Publishing them means every counterparty learns what you settled for. Price transparency was designed to make patients into shoppers; what it actually does first is make payers into better negotiators, and hospitals understood that before anyone else did.

The theory behind the 2021 rule — issued under the first Trump administration, and tightened under the current one — was that visibility alone would produce a competitive market. Six years in, the honest verdict is that visibility produced files. Whether it produces lower prices depends on whether the files contain numbers, and 82% of them mostly don't.

What the system names tell you

The system-level breakdown in this report is worth reading twice, because it shows compliance and transparency are separable.

HCA Healthcare, the largest for-profit system in the country, had 85% of its hospitals fully compliant with the rule — and not one that met the dollars-and-cents standard. CommonSpirit Health was 73% compliant, with about a quarter meeting the price-sufficiency rating. Bon Secours Mercy Health, Ochsner Health and ScionHealth posted no fully compliant hospitals at all.

A system with 85% compliance and 0% usable prices has not been dragged into transparency. It has staffed a compliance function, read the rule carefully, and done exactly what it says. That is a policy problem, not a hospital problem, and PatientRightsAdvocate.org has asked CMS to write guidance specifying what the disclosures must contain. In Congress, a bill introduced last year — the Patients Deserve Price Tags Act — would write the regulations into statute and extend them beyond hospitals.

Cynthia Fisher, the group's founder and chairman, put it plainly: "CMS has made progress enforcing its hospital transparency rules, but this report shows that most hospitals still owe patients clear, usable dollars-and-cents prices they can look up before receiving care."

What to do when the file is useless

You have a rule on your side even when the spreadsheet is a formula. Use it in this order.

Ask for a good faith estimate in writing, before the procedure. This is the single highest-yield move, and it does not depend on any posted file. Get the CPT or billing code for what is planned, then ask the hospital's billing office for a written estimate for that code, at that facility, on your plan. Our guide to hospital price transparency walks through where the files live and how to ask when they fail you.

Check the machine-readable file anyway — for one thing. Even hospitals posting formulas sometimes post a clean cash price, the amount they take from someone with no insurance. If that cash price is lower than your deductible exposure, you are allowed to ask for it.

Confirm every provider in the room is in network. A transparent hospital price means nothing if the anesthesiologist bills separately from out of network. Start with in-network vs. out-of-network, and know your protections under the No Surprises Act.

Keep the estimate. When the bill arrives, compare it against what you were quoted, line by line, before you pay anything.

The number to remember

Enforcement moved compliance from 21% to 49% in under two years. That is the clearest evidence available that hospitals respond to fines and not to deadlines, and it argues for more of the same.

But a rule that a hospital can satisfy with a formula is a rule about filing, not about prices. The regulation asked hospitals to tell you what things cost. Four out of five answered with the method by which the cost could theoretically be computed. Until CMS closes that gap, the only price you can rely on is the one you got in writing with your name on it.