Clearcharge

Hospital prices, out in the open.

Glossary of billing terms

The vocabulary this site (and every hospital bill) uses, in plain language.

Gross charge / chargemaster price

The hospital's full list price for a service, before any insurance negotiation or discount. Almost nobody actually pays this — it's mainly a starting point for negotiating with insurers.

Negotiated rate

The specific dollar amount a hospital and a particular insurance plan have privately agreed the hospital will be paid for a service. This is usually the number that determines your actual out-of-pocket cost, since your deductible and coinsurance are calculated against it.

Cash price / self-pay price

What a hospital charges patients who are paying without using insurance at all. Often discounted from the gross price, but set independently of any insurer's negotiated rate.

Deductible

The amount you have to pay out of pocket for covered care each year before your insurance starts paying its share. A $2,000 deductible means you generally pay the first $2,000 of negotiated-rate charges yourself.

Coinsurance

The percentage of a bill you're responsible for after your deductible is met — e.g., a plan with 20% coinsurance has you pay 20% of the negotiated rate, with insurance covering the rest.

Copay

A fixed dollar amount (like $30) you pay for a specific type of visit or service, regardless of the negotiated rate behind it — common for office visits and prescriptions, less common for major procedures.

In-network vs. out-of-network

A provider or facility that has a negotiated contract with your specific insurance plan is "in-network" — your plan pays more of the bill and your cost-sharing is lower. "Out-of-network" providers have no such contract, and historically could bill you for the full difference — though the No Surprises Act now blocks that in several common situations.

Explanation of Benefits (EOB)

A statement your insurer sends after a claim, showing what was billed, what they paid, and what you owe. It is not a bill — the hospital bills you separately, and the two documents should roughly match.

Balance billing

When an out-of-network provider bills you for the gap between what your insurer paid and their full charge. Now illegal in the situations covered by the No Surprises Act.

Financial assistance / charity care

Free or discounted care that qualifying patients (usually based on household income) can get from a hospital — a legal requirement for nonprofit hospitals. See how it works and who has to offer it.

Good Faith Estimate

A required upfront cost estimate a hospital must give uninsured or self-pay patients for a scheduled service, before they receive it.

CPT / HCPCS code

The standardized codes hospitals use to bill for specific procedures and services — the "code" this site lets you search by, e.g. 59400 for a vaginal delivery with prenatal and postpartum care.

Payer

The entity paying the claim — usually an insurance company (like Aetna or Blue Cross), but sometimes Medicare, Medicaid, or a workers' compensation carrier. Each payer typically negotiates its own rate with a given hospital.