ClearPrice
USER GUIDE

How to Use ClearPrice

A plain-English guide to finding hospital prices, comparing them, and understanding what the numbers actually mean.

1. Quick Start — Find a price in 30 seconds

1

Type the procedure you're looking for in the search bar on the home page. For example: "MRI brain", "knee replacement", or a CPT code like "70553".

2

Browse the results. Each result shows the hospital, the city/state, and the four prices (see next section for what they mean).

3

Click a hospital to see all of its prices, filter by procedure category, and see what each insurance payer has negotiated.

4

Use Compare to put 2–5 hospitals side-by-side on the same procedure and see the potential savings.

2. The four prices you'll see

Every hospital publishes four different prices for the same procedure. Understanding the difference between them is the single most important thing you can learn here.

Gross Charge

Gross Charge — The "rack rate"

This is the hospital's list price — what they would theoretically bill an uninsured patient paying by mail. Almost nobody actually pays this amount. It's essentially a starting number from which insurers negotiate down.

Example: $4,200 for a basic MRI

Cash Price (a.k.a. Discounted Self-Pay)

Cash Price — What you'd pay without insurance, upfront

If you're uninsured and can pay at time of service, many hospitals offer this discounted rate. Ask for it explicitly — it's often 50–70% below the gross charge. In most states hospitals must give uninsured patients a "Good Faith Estimate" under the No Surprises Act.

Example: $2,100 for that same MRI (50% off gross)

Minimum / Maximum Negotiated

Min & Max Negotiated — The floor and ceiling of insured pricing

These are the lowest and highest rates the hospital has negotiated with any insurer. The difference between min and max is often 3× or more for the same procedure — showing how much pricing varies by plan.

Example: Min $1,800 / Max $3,900 — a 2.2× spread

Payer-Specific Rate

Per-Payer Rate — The contracted rate for a named insurance plan

The most useful number if your specific plan is listed. Each row shows the payer name (Aetna, BCBS, UnitedHealth, etc.) and the exact dollar amount that hospital has contracted for that procedure with that plan.

Example: "Aetna PPO: $2,800"

Which should you look at? In order of usefulness:
  • If you're insured → your specific payer's rate
  • If your payer isn't listed → somewhere between min and max negotiated
  • If you're uninsured → the cash price
  • Ignore gross charge for planning — it's almost never the real price

3. Medical codes decoded

You'll see different codes attached to procedures. Here's what they mean:

CPT (Current Procedural Terminology)

Five-digit codes for medical procedures and services. Created by the American Medical Association. Example: 70553 = MRI of the brain with contrast. When in doubt, a CPT code is the most precise way to match the same procedure across hospitals.

HCPCS (Healthcare Common Procedure Coding System)

Codes for supplies, drugs, and services that CPT doesn't cover (ambulance, durable medical equipment, etc.). Often start with a letter: J3301, A0428.

DRG (Diagnosis-Related Group)

A code Medicare uses to group inpatient stays into single payable bundles. Instead of paying line-by-line, Medicare pays a flat rate per DRG. Example: DRG 470 = major joint replacement of lower extremity. Useful if you're comparing inpatient stays.

Inpatient vs Outpatient (the "Setting")

The same procedure can cost very different amounts depending on where it happens:

  • Inpatient — you're admitted and stay overnight (or longer)
  • Outpatient — you go home the same day
  • ASC — Ambulatory Surgical Center, usually cheaper than hospital outpatient

Always check that the price you're comparing is for the same setting. An outpatient knee scope and an inpatient knee replacement are not the same product.

The search bar accepts several types of input:

  • Plain English: "MRI brain", "knee replacement", "colonoscopy"
  • CPT code: "70553", "27447" — exact match
  • Hospital name: "Providence Alaska" — jumps to that hospital's page

Search uses PostgreSQL full-text indexing plus fuzzy matching, so typos usually still find what you mean. Results are ranked by relevance, then by cash price (cheapest first).

Power tip: If you have a specific CPT code from your doctor's order, search for that code directly. It's the most precise cross-hospital comparison you can make.

5. Using Compare

The Compare page lets you put 2–5 hospitals side-by-side on the same procedure.

1

Type the procedure you want to compare in the top box.

2

Check the boxes next to 2–5 hospitals.

3

Click Compare Prices. You'll see a table with all four price tiers for each hospital and a "Potential Savings" callout showing the cheapest option and the spread.

If you have an Anthropic API key configured, you can click Explain this comparison and the AI will write a plain-English summary of the differences.

6. Reading a hospital's page

Each hospital page shows four sections from top to bottom:

Header stats

  • Procedures — how many unique procedures are in our copy of this hospital's data
  • Charges — total number of charge rows (a procedure can appear multiple times with different settings/payers)
  • Payers — how many distinct insurance plans have published rates for this hospital
  • Last Updated — when we last successfully re-parsed this hospital's file

Procedure search box

Filter the procedure list by keyword or CPT code. Press Enter to apply.

Procedure table

Every row is one procedure. Columns: description, CPT code, and the four prices. The cash price is highlighted in primary color because it's typically the most actionable for uninsured planning.

7. Using the AI assistant

The AI assistant (when an Anthropic key is configured) lets you ask questions in plain English like:

  • "How much does an MRI cost at Providence hospitals in California?"
  • "What's the difference between the cash price and gross charge for a colonoscopy?"
  • "Which hospital is cheapest for knee replacement?"

Behind the scenes, the AI searches the database, pulls top matches, and writes a response using actual pricing numbers. Every response includes a disclaimer.

AI responses can be wrong. They may miscount, misattribute a price to the wrong hospital, or misread a setting (inpatient vs outpatient). Always verify against the hospital detail page or the source MRF before making a decision.

8. Getting a real cost estimate

ClearPrice shows what the hospital publishes. Your actual out-of-pocket cost depends on many things we don't know. Here's the full workflow for a reliable personal estimate:

1

Find the procedure here first. Get the CPT code and see the price range across hospitals.

2

Call your insurance company. Ask: "For CPT code [X] at [hospital name], what will my out-of-pocket cost be given my plan and where I am in my deductible?"

3

Call the hospital's billing office. Ask for a Good Faith Estimate. Under the No Surprises Act, you're entitled to one if you're uninsured, and many hospitals will provide one for insured patients on request too.

4

Compare the estimate to what ClearPrice shows. If the estimate is wildly higher than the published negotiated rate, ask why. You have leverage.

9. Frequently Asked Questions

Why do different hospitals charge so differently for the same procedure?

Pricing reflects each hospital's overhead, its negotiating leverage with insurers, whether it's a teaching or rural hospital, and sometimes not much more. A 3× price spread for the exact same CPT code is common.

Why is my actual bill higher than what ClearPrice shows?

Your bill can include procedures and line items the original published price doesn't cover — anesthesia, pathology, radiology reads, facility fees, supplies, follow-up visits, etc. The MRF price is usually for a single specific procedure code, not an entire episode of care.

How up-to-date is this data?

We re-ingest every hospital's file nightly at 2am Pacific. But we're only as fresh as what the hospital has published. Some hospitals update monthly, some quarterly, some haven't updated since 2021. Each hospital page shows its "Last Updated" date.

Why isn't my hospital listed?

We've imported the full CMS directory of ~5,400 U.S. hospitals, but not all of them have a working, parseable MRF URL in our database yet. Many hospitals publish CSV or Excel files that our parser doesn't yet read. Email corrections@clearpricehealth.org with the hospital name and we'll try to add it.

I'm a researcher / journalist. Can I use this data?

The underlying CMS machine-readable files are public record. Our parsed, indexed version is free for personal use. For bulk data access or commercial use, please email hello@clearpricehealth.org.

Does ClearPrice negotiate or help with medical bills?

No. ClearPrice is an information tool only. We don't negotiate bills, appeal insurance denials, or provide financial assistance. For help with specific bills, look into patient advocacy services or your state's Consumer Assistance Program.

Is my personal data safe?

We collect the minimum we need (email + hashed password if you register) and never sell it. See our Privacy Policy for specifics.

I found an error. Can I report it?

Yes — please! Email corrections@clearpricehealth.org with the hospital, the procedure, and what looks wrong. We investigate and correct verified issues.

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