Hospital Price Transparency in 2026: What You Need to Know

Updated September 24, 2026. Regulatory text checked against the Electronic Code of Federal Regulations and CMS on that date.

Since January 1, 2021, federal rules at 45 CFR Part 180 have required every hospital in the United States to publish its standard charges online. The Centers for Medicare & Medicaid Services (CMS) enforces the rule. For a self-pay patient, the most useful number in those files is the discounted cash price, which the regulation defines as the charge that applies to an individual who pays cash for a hospital item or service.

What hospitals must publish

• A machine-readable file (MRF) listing all standard charges for all items and services, in a CMS template (CSV or JSON).
• A consumer-friendly list of at least 300 shoppable services, including as many of the 70 CMS-specified shoppable services as the hospital offers. A hospital can meet this part with an online price estimator tool that covers the same 300 services instead.
• Annual updates. Both must be updated at least once a year and show the date of the last update.
• Findable links. The hospital must place a .txt file in the root folder of its website pointing to the file, and a footer link labeled "Price Transparency" that goes directly to the page hosting it.

The five price types in a hospital file

What changed on January 1, 2026

The CY 2026 Hospital Outpatient Prospective Payment System final rule, issued November 21, 2025, changed what the machine-readable file must contain. The changes took effect January 1, 2026, and CMS set enforcement to start April 1, 2026, giving hospitals three months to update their files (CMS fact sheet).

• Attestation. Each MRF must include a statement that the hospital has included all applicable standard charges and that the information is true, accurate, and complete as of the date in the file, with the name of the chief executive officer or a designated senior official.
• Allowed-amount percentiles. When a negotiated charge is set as a percentage or formula instead of a dollar amount, the hospital must now encode the 10th percentile, median, and 90th percentile allowed amounts it actually received, based on 12 to 15 months of remittances, plus the number of remittances used. These replace the single estimated allowed amount required in 2025.
• Organizational NPIs. Hospitals must encode their organizational (Type 2) National Provider Identifiers in the file.

Penalties written into the regulation

Under 45 CFR 180.90, CMS can issue a warning notice, request a corrective action plan, and impose a civil monetary penalty. The regulation sets these maximum daily amounts, which are adjusted each year for inflation:

At the base $5,500 daily maximum, a full year of noncompliance adds up to more than $2 million for the largest hospitals. CMS posts notices of imposed penalties on its website.

How to choose which hospital price to use

Pick the row that matches how you will pay, then confirm it in writing.

1. Paying cash or uninsured? Use the discounted cash price. Ask the hospital whether that price covers the facility fee only, or also the physician, anesthesia, and pathology fees.
2. Insured and staying in network? Find the payer-specific negotiated charge for your exact plan, then apply your deductible and coinsurance to it. The negotiated charge is not your out-of-pocket cost.
3. Negotiated charge shown as a percentage or formula? Use the new 10th percentile, median, and 90th percentile allowed amounts to see what the hospital actually collected for that service.
4. Scheduling at least 3 business days ahead without insurance? Ask for a Good Faith Estimate. It is required on request or when you schedule, and it is the document you need to dispute a bill later.
5. Compare settings, not just hospitals. Many outpatient procedures are also done in ambulatory surgical centers. Medicare's Procedure Price Lookup shows national average payments for both settings side by side.

Where to find the file

• Scroll to the hospital website footer and look for the link labeled "Price Transparency".
• Check the root folder of the hospital's website for the required .txt file, which lists the hospital location, the page hosting the file, a direct link to it, and a contact.
• Or use a service that has already parsed the files. FairVisitHealth imports hospital machine-readable files alongside other public price data; see our methodology for sources and refresh schedules, and our same-city price spread report for what the files show when you compare hospitals in one metro.

Limitations to keep in mind

• A hospital price is often the facility fee only. Physicians can bill separately.
• Files must be updated only once a year, so a posted price can be up to a year old.
• Emergency care is not shoppable in practice. The shoppable-services list is for care you can schedule.
• A posted price is not a guarantee. Get the price for your CPT code in writing before care.

Sources

• Electronic Code of Federal Regulations, 45 CFR Part 180, Hospital Price Transparency (sections 180.20, 180.50, 180.60, 180.90). Checked September 24, 2026.
• CMS, Hospital Price Transparency and CY 2026 OPPS and ASC final rule: Hospital Price Transparency policy changes. Checked September 24, 2026.
• CMS, Good Faith Estimate guide. Checked September 24, 2026.
• Medicare.gov, Procedure Price Lookup. Checked September 24, 2026.