Trek Health has now added hospital price transparency files to our Query Builder Tool, giving users direct access to raw, hospital-published data for over 6,000 hospitals nationwide. These files are available alongside our existing payer Transparency in Coverage (TiC) files, enabling users to cross-reference and validate existing market intelligence.
What are hospital price transparency files?
In 2021, CMS began requiring hospitals to publish machine-readable files disclosing their prices across all items and services. This includes gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates, and discounted cash prices. The mandate covers every hospital operating in the U.S., including over 6,000 facilities, and is enforced through CMS audits and civil monetary penalties.This is distinct from what payers are required to disclose under the TiC rule. TiC files are published by insurers and reflect negotiated rates from the payer's perspective, across all in-network providers.
Hospital price transparency files are published by the hospital itself and reflect rates as the facility has recorded them, including, in many cases, rates across dozens of payers and plan types that a single TiC file may not fully capture.
Why hospital and payer files don't always match
In theory, a negotiated rate between a hospital and a payer should appear identically in both files. In practice, that's rarely the case.
The discrepancies stem from a few structural realities. Hospitals and payers often encode the same contract differently — different billing codes, different service line groupings, different effective date conventions. TiC files reflect what the payer has on record at the time of publication; hospital files reflect what the hospital has on record. When contracts are mid-renegotiation, recently amended, or tied to carve-out arrangements, the two sources can diverge in ways that are financially material.
For anyone making decisions based on a single data source, that gap is a blind spot.
What you can do with hospital price transparency data in Query Builder
With hospital price transparency data now integrated alongside TiC, users can:
- Validate payer file accuracy. Pull negotiated rates for a specific code and payer from both sources and flag discrepancies. This is particularly useful when auditing a payer's compliance or preparing for a contract dispute.
- Identify underpayment patterns. Compare what a payer's TiC file says the negotiated rate is versus what the hospital has on record. Persistent gaps across a payer and service line are a signal worth investigating.
- Benchmark across facilities. Hospital files include de-identified min/max rates even where specific payer rates aren't disclosed. This gives you a range for what a market will bear — useful context for any upcoming negotiations.
- Spot stale or misaligned contract terms. When rates in one file haven't been updated to reflect a renegotiated contract, the discrepancy between sources is often the first place that shows up.
Hospital price transparency data is live in Query Builder now. If you're not already using it, this is a good reason to log in.
