Reference
Glossary
Hospital files use technical names for several different prices. Here is what each term means in plain language.
- List price
- The hospital's full undiscounted charge before any insurance discount or cash discount. Few people actually pay this amount.
- Cash / self-pay price
- The price the hospital has disclosed for someone paying directly, without using insurance.
- Insurance-negotiated rate
- A rate the hospital has disclosed for a specific payer and plan. Your share of this depends on your benefits.
- Lowest disclosed insurance rate
- The lowest negotiated rate the hospital disclosed across payers for this item, with payer identity removed.
- Highest disclosed insurance rate
- The highest negotiated rate the hospital disclosed across payers for this item, with payer identity removed.
- Median historical allowed amount
- A historical reference figure for what was actually allowed for this item, where the hospital chose to disclose it.
- Lower-end historical allowed amount
- A lower-end historical allowed-amount reference, where disclosed.
- Upper-end historical allowed amount
- An upper-end historical allowed-amount reference, where disclosed.
- Allowed-amount records used
- How many historical records the disclosed allowed-amount figures are based on.
- Machine-readable file (MRF)
- The structured file (CSV or JSON) each hospital must publish listing its standard charges under CMS price transparency rules.
- CPT / HCPCS code
- Standardized codes that identify a specific medical service or item. We use them to match services across hospitals.
- Setting (inpatient / outpatient)
- Where the service is delivered. This is separate from billing class.
- Billing class (facility / professional)
- Whether the charge is for facility use or a professional service. It does NOT mean inpatient or outpatient.
CMS term: Gross charge
CMS term: Discounted cash price
CMS term: Payer-specific negotiated charge
CMS term: De-identified minimum negotiated charge
CMS term: De-identified maximum negotiated charge
CMS term: Median allowed amount
CMS term: 10th percentile allowed amount
CMS term: 90th percentile allowed amount
CMS term: Allowed amount count
CMS term: Standard charges file
CMS term: Procedure code
CMS term: setting
CMS term: billing_class
Setting values
inpatient— Inpatientoutpatient— Outpatientboth— Inpatient & outpatientunknown— Setting not specified
Billing class values
facility— Facilityprofessional— Professionalboth— Facility & professionalunknown— Not specified