Just under half of U.S. hospitals now fully comply with the federal rule requiring them to publish what they charge, the highest rate recorded since tracking began in 2021. The finding comes from PatientRightsAdvocate.org's latest compliance report, a nonprofit advocacy group, not from a government agency, and it is worth reading with that attribution attached.
The jump is large. Compliance rose from 21% in the group's previous review to 49.4% in this one, its eighth report, based on a scorecard of 2,000 hospitals, according to reporting on the eighth compliance scorecard. The organization credits the improvement largely to federal enforcement and to extensive updates the Centers for Medicare and Medicaid Services made to its technical specifications and guidance for how the files must be built.
For a patient trying to find out what a knee MRI or a colonoscopy will cost, though, the more relevant number is a different one. Only 18% of hospitals reviewed publish dollar-and-cents prices for at least half of the items and services in their pricing file.
The Gap Between a Posted File and a Usable Price
Full compliance under the rule is a technical standard rather than a plain-language one. A hospital must post a comprehensive machine-readable file covering all items and services, with each negotiated rate clearly associated with the specific payer and plan, plus a consumer-friendly display of 300 shoppable services.
The failure mode that PRA identified this time was not missing files. It was files containing algorithms and formulas instead of prices. Many hospitals published a method for calculating a rate that requires additional information the hospital did not provide. In most cases reviewed, that supporting information was absent, which leaves the file technically populated and practically unusable.
Federal rules do allow a hospital to express a negotiated rate as a percentage or an algorithm when the dollar amount is not known in advance. PRA assesses hospitals separately on what it calls pricing data sufficiency, meaning whether real dollar figures are actually present, which is why its two headline numbers diverge so sharply.
Enforcement has expanded but remains small in scale. CMS has now fined 28 hospitals, up from 15 at the time of the group's previous review, and in June the agency sent warnings and corrective action requests to more than 500 hospitals. Facilities that stay out of compliance can face penalties of up to $2 million a year.
The trajectory has been uneven throughout. Healthcare Dive has tracked the same scorecard across several cycles, recording 34.5% compliance in early 2024 and an earlier report that found compliance had slipped to 21.1% that November, before this rebound to roughly half. A measure that moves that much in two years is describing a shifting technical standard as much as it is describing hospital behavior.
Prices That Swing Inside the Same Building
The reason any of this matters to a household is spread. In PRA's earlier analysis of negotiated price ratios, the average gap between the highest and lowest negotiated price for the same service was 2,347 times, meaning one insurer might pay $1 where another pays $2,347 at the same hospital on the same day.
That variation is not theoretical for insured patients. Anyone with a high-deductible plan pays the negotiated rate out of pocket until the deductible is met, so the difference between two facilities in the same city is money the patient spends directly. Deductibles in marketplace plans have climbed sharply, and employer plan deductibles are expected to rise again in 2027.
Hospitals have contested advocacy scorecards before. Hospital groups have argued that compliance is higher than these reviews suggest, and individual systems have disputed specific findings, saying their pricing information was available and compliant. Those disagreements generally turn on whether a price estimator tool satisfies a requirement written for machine-readable files, which is a real interpretive question rather than a simple factual dispute.
The improvement in this report is genuine either way. Nearly half of hospitals meeting a standard that fewer than a quarter met two years ago is a substantial change, and it happened alongside more detailed federal technical guidance rather than a change in the underlying law.
Using the Data as a Patient Right Now
For a scheduled, non-emergency procedure, the practical path starts with the procedure code. Ask the ordering physician's office for the CPT code and, for hospital outpatient care, whether the service will be billed as hospital-based or office-based, since those are priced differently.
Then call the hospital's billing or financial counseling department and request a good faith estimate for that code under your specific plan, not your plan family. Federal law entitles uninsured and self-pay patients to a good faith estimate in advance, and many hospitals will produce one for insured patients on request.
Calling the insurer separately is worth the second phone call. The insurer can confirm the negotiated rate, whether the facility is in network for that specific service, and how much of the cost applies to the deductible. A facility can be in network while an individual clinician inside it is not.
Machine-readable files are downloadable from hospital websites, usually under a heading like standard charges or price transparency. They are large spreadsheets rather than consumer tools, and several free third-party sites now parse them. Treat any figure found that way as a starting point for a conversation, not a final bill.
Uninsured and self-pay patients often have more leverage than they expect. Many hospitals publish a discounted cash price that is lower than the rate billed to insurance, and nonprofit hospitals are required to maintain financial assistance policies. Asking for both, in writing, before a scheduled procedure is the step most likely to change what a household actually pays.
What remains unresolved is whether CMS will require dollar-and-cents prices rather than algorithms, how far enforcement will expand beyond the hospitals fined so far, and whether compliance holds at this level in the next review. Congress has also been weighing price transparency legislation that would write parts of the rule into statute. PRA says it will continue publishing periodic scorecards, and CMS maintains its own enforcement list.
Key Questions Answered
Who produced this report? PatientRightsAdvocate.org, a nonprofit advocacy organization. It is not a federal audit, though it reviews compliance with a federal rule.
What does full compliance require? A complete machine-readable file of all items and services, with each negotiated rate tied to a named payer and plan, plus a consumer-friendly display of 300 shoppable services.
Why does 49% compliance still leave patients without prices? Many hospitals post algorithms or formulas rather than dollar figures. Only 18% published dollar-and-cents prices for at least half of their listed services.
Has the government fined anyone? CMS has fined 28 hospitals, up from 15 at the previous review, and has sent warnings to more than 500 others.
How can I find the price of a procedure? Get the CPT code from your doctor's office, request a good faith estimate from the hospital, and confirm the negotiated rate with your insurer.
Does this affect insured patients? Yes. Anyone with a deductible pays the negotiated rate directly until the deductible is met, so facility choice can change what they owe.
Do hospitals agree with the findings? Not entirely. Hospital groups have argued compliance is higher than advocacy scorecards show, often disputing whether price estimator tools satisfy the file requirement.
