How MyCareCost Calculates Prices

Price Types We Show

• Standard (Gross) Price: the hospital's list price (often not what insured patients pay).
• Discounted Cash Price: a self-pay price (varies by hospital policy).
• Negotiated Range: min/max of published negotiated rates across payer rows for that code.
• Payer Rates (Published): payer names and rates found inside the hospital's published negotiated-rate rows.

What “Payers Listed” Means

When MyCareCost shows a payer (e.g., Aetna, UnitedHealthcare) for a hospital and code, it means the payer appears in the hospital's published negotiated-rate rows. This does not guarantee your plan is in-network.

Why Your Out-of-Pocket Cost Can Differ

• Plan design (deductible, coinsurance, copays, out-of-pocket maximum).
• In-network vs out-of-network status.
• Facility vs professional fees (and what is bundled).
• Billing codes/modifiers and how the claim is adjudicated.
• Prior authorization and coverage rules.

CMS Quality Star Ratings

Where available, MyCareCost displays CMS Hospital Compare overall star ratings (1–5 stars). These ratings are published by the Centers for Medicare & Medicaid Services and reflect a composite of quality measures including mortality, safety of care, readmission, patient experience, timely & effective care, and efficient use of medical imaging.

• Star ratings are updated periodically by CMS (typically annually) and may not reflect the most recent quality data.
• Not all hospitals receive a star rating—smaller or specialty facilities may not have sufficient data for CMS to calculate a score.
• Star ratings are one factor among many; they should not be the sole basis for choosing a hospital. Consult your doctor and insurer for personalized guidance.

Data Freshness & Source Snapshots

Each hospital listing may show a data freshness badge indicating how recently MyCareCost successfully ingested and verified the hospital's price transparency file:

• Fresh — data was ingested within the last 90 days.
• Aging — data is 91–180 days old and may not reflect the hospital's most current file.
• Stale — data is over 180 days old. The hospital may have updated its file since our last ingestion.

When shown, the “source snapshot” link points to the underlying published file so you can verify directly.

Source Data

We ingest hospital price transparency files published pursuant to the CMS Hospital Price Transparency Rule (45 CFR Parts 180). Hospitals are required to make machine-readable files publicly available and update them at least annually. MyCareCost stores point-in-time snapshots and re-ingests files as they are updated.