Methodology

The one thing most cost sites get wrong

American medical bills have several different "prices," and they are wildly different numbers:

• Billed charge (list price) — the hospital's sticker price. Largely fictional. Roughly 2–3× what anyone actually pays.
• Allowed amount — the price actually negotiated with an insurer. This is what the care really costs: your share plus your insurer's share. This is the number we use everywhere on this site.
• Hospital cost — what it costs the hospital to deliver the care. Not a price at all.
• Cash price — what an uninsured person is quoted.

Sites that mix these produce numbers that are off by hundreds of percent. We don't mix them, and we label every figure.

Where the prices come from

Every scenario price is an allowed amount published by one of:

• Peterson-KFF Health System Tracker — pregnancy & childbirth costs — 2021–23
• Peterson-KFF Health System Tracker — cost of common health services — 2018
• Peterson-KFF Health System Tracker — cost of respiratory hospitalization — 2018
• Health Care Cost Institute — NICU use and spending — 2021
• Health Care Cost Institute — emergency room spending & price trends — 2021
• Health Care Cost Institute — commercial ground ambulance prices — 2022
• Health Care Cost Institute — HealthPrices.org — 2021–2022 vintage (HCCI does not publish the exact data year)
• CMS Medicare Inpatient Hospitals — by Geography and Service — 2024

Some figures are older than we'd like. Peterson-KFF's common-services data is from 2018 and has not been refreshed; those scenarios are flagged on their own pages. We show the data year rather than quietly implying the number is current.

How the insurance calculator works

We apply your plan's deductible, then coinsurance on the remainder, then cap the total at the out-of-pocket maximum:

you pay = min( out-of-pocket max, deductible + 20% × (price − deductible) )

The deductibles and out-of-pocket maximums are real published figures — 2026 ACA marketplace averages from KFF, the 2026 legal out-of-pocket cap of $10,600, and KFF's 2025 employer survey.

Coinsurance is our one modelling assumption, and we'd rather tell you than hide it. 20% is KFF's measured average coinsurance for a hospital admission among workers with employer coverage. We apply it to every insured plan as a modelling assumption. Your real plan may differ.

We deliberately do not use the widely-repeated "Bronze 40% / Silver 30% / Gold 20%" coinsurance split. We went looking for its source and there isn't one — the ACA sets a plan's actuarial value, not its coinsurance, and insurers can pick any design that hits the target. It appears to be internet folklore, so we don't repeat it.

The uninsured number

Hospitals' cash prices average 64% of their list price, while insurer-negotiated rates average 58% of list. So the cash price an uninsured person is quoted is typically about 10% HIGHER than the price an insurer would have negotiated. Being uninsured doesn't just remove your safety net — it can mean a worse price for the exact same care.

Source: Health Affairs — hospital cash prices vs negotiated rates (2,379 hospitals).

If you're uninsured, ask the hospital about charity care. Nonprofit hospitals are legally prohibited from billing list price to patients who qualify for financial assistance — and billions of dollars of that aid goes unclaimed every year simply because nobody asks.

State prices

State multiplier = (state private allowed amount ÷ state simulated Medicare allowed amount) ÷ national 254%. Computed directly from RAND Table 2. Our scenario prices are national commercial allowed amounts, so scaling by relative commercial price level is the defensible way to localise them.

Why we don't use the easy data. We deliberately do NOT use state health spending per capita, even though that table is easier to get. It measures spending (which blends utilisation, age and illness), not price. It actively misleads: Florida has the nation's HIGHEST commercial hospital prices but BELOW-average per-capita spending.

Source: RAND Hospital Price Transparency Study, Round 5.1 — Table 2 (State-Level Averages) (2022 claims, published Dec 2024). Caveats: Based on 2022 claims — the most recent RAND has published. Round 6 is not due until September 2027. This is a statewide hospital price level, not a per-scenario state price. It tells you roughly how much pricier your state is, not your exact bill. Maryland is not covered.

We check our own arithmetic. Our computed values reproduce RAND's published figures exactly: Florida 346%, Indiana 300%, Arkansas 162%.

Range: Arkansas is the cheapest state in the country at 162% of Medicare rates; Florida is the most expensive at 346%. That means the identical procedure costs more than twice as much in Florida as in Arkansas — which is the single most useful thing this site can tell you.

What we refuse to make up

There is no published negotiated price in the US for several extremely common things. We show them as gaps rather than inventing a number:

• Having a stroke — No commercial negotiated price is published anywhere in the US. Medicare paid an average of $13,906 in 2024 (facility only), but that is a Medicare rate for an older population — not what your insurer pays, and we will not dress it up as one.
• Breaking a bone — Astonishingly, no source publishes an all-in negotiated price for a fracture ER episode. The only figures available are billed charges, which are fiction.
• Gastric sleeve — No published price. We have gastric bypass at $27,954 and we refuse to reuse that number and call it a sleeve — they are different operations with different facility fees. Every "gastric sleeve cost" page we checked was quoting a cash price or was a lead-generation site with no source.
• Ventral & umbilical hernias — We have a real price for inguinal (groin) hernias only. The other types are not separately published.