Methodology and sources
Data
| What | Source | Checked |
|---|---|---|
| Inpatient stays, average charge, total payment and Medicare payment by hospital and DRG; national and state figures | CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024 | 2026-10-24 |
| Outpatient services, average charge, allowed amount and Medicare payment by hospital and APC | CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024 | 2026-10-24 |
| Price-transparency enforcement actions | CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026 | 2026-10-24 |
What the figures mean
Average charge is the hospital's own list price (its "submitted covered charges"), averaged over its Medicare fee-for-service cases in 2024. Average total payment (inpatient) is what the stay brought in: Medicare's payment plus the patient's deductible and coinsurance and any other payer's share. Medicare payment is Medicare's part alone. For outpatient services the comparison figure is the allowed amount, the fee-schedule total. CMS suppresses any hospital–service combination with fewer than 11 cases.
Ratios
A hospital's inpatient charge-to-payment ratio is its total charges divided by its total payments across all its reported DRGs, weighting each DRG by stays. State and national medians use hospitals with at least 100 reported stays, so a handful of cases cannot dominate. The "vs US" column compares a hospital's average charge for one DRG with CMS's national average for that DRG.
Enforcement matching
CMS's enforcement list identifies hospitals by name and address, not certification number. An action appears on a hospital page only when the normalised name, city and state match exactly one hospital in the claims data; 5,003 of the 13,355 actions match. All actions appear on the enforcement page and in state totals regardless.
Which pages exist
Hospitals with at least twelve reported DRGs and outpatient service groups combined (2,546), DRGs and APCs reported by at least 20 hospitals, and all 50 states and DC. Smaller hospitals appear in their state's table and in the comparison tool.
Timing
CMS publishes each year's claims summaries about 16 months after the year ends; the files used here cover services in 2024. Prices and payment rates have changed since, so treat the figures as a comparison between hospitals and services in the same year, not as current prices. The enforcement list is more current: CMS refreshes it every few months, and this copy runs to the end of July 2026.
Left out, and why
- Commercial negotiated rates from hospitals' machine-readable files: each hospital publishes its own format and parsing them reliably is a project of its own — phase 2.
- Medicare Advantage, Medicaid and uninsured prices: not in these files.
- Quality: charges and payments say nothing about outcomes.