How Our Data Worksfrom hospital file to your screen.
Every price on Panopticare traces back to a public source file. Here is exactly where the numbers come from, how we check them, and what they can — and can't — tell you.
Where Prices Come From
Hospital price files (MRFs)
Federal law — the Hospital Price Transparency rule (45 CFR §180) — requires every U.S. hospital to publish a Machine-Readable File listing its prices: the list price, the cash price, and the rate negotiated with each insurance plan. These files are the backbone of our data.
Insurer files (Transparency in Coverage)
A second federal rule requires health insurers to publish the rates they pay providers. We collect these Transparency in Coverage files from insurers like Blue Cross Blue Shield, Cigna, and UnitedHealthcare, and use them to double-check what hospitals report.
CMS public datasets
We also use public data from the Centers for Medicare & Medicaid Services: provider information, hospital star ratings, and Medicare fee schedules. Medicare rates give us a stable benchmark for judging whether other prices look reasonable.
Every price we display traces back to a specific source file. We do not invent numbers — when a figure is modeled rather than published, we label it as an estimate.
What the Price Types Mean
Gross charge
The hospital's list price — like the sticker price on a car. Almost nobody actually pays this amount. It's mainly useful as a reference point.
Discounted cash price
What the hospital charges if you pay yourself, without insurance (self-pay). For common procedures, this can sometimes be the best deal available — even if you have insurance.
Payer-negotiated rate
The price a specific insurance company has agreed to pay the hospital. This is what the insurer pays — your share of it depends on your plan's deductible, copay, and coinsurance. The same procedure at the same hospital can have very different rates depending on the insurer.
Estimate
Our modeled figure for cases where a direct price isn't published. Estimates are always labeled so you can tell them apart from prices that come straight from a source file.
Our Quality Checks
Hospital files are messy. Before a price reaches you, it goes through several layers of checking:
- Benchmark comparison. Prices are checked against Medicare benchmarks and against statistics from other hospitals for the same procedure. A price far outside the expected range gets flagged for review.
- Error exclusion. Obviously erroneous values — unit errors (a price entered per-pill instead of per-course), percent-of-charge artifacts (a "rate" that is really a percentage, not a dollar amount), and similar glitches — are excluded rather than shown.
- Rebuild verification. Every time we rebuild the database, automated integrity checks run — including random row-level spot checks that trace prices back to the original hospital files to confirm nothing was distorted along the way.
Labels You'll See
Verified
The hospital's filing and the insurer's filing report the same rate (or very close to it). Two independent sources agree — this is our highest-confidence label.
Sources differ
The hospital and the insurer report meaningfully different rates for the same procedure. We show you the disagreement instead of hiding it. If you're planning care, this is a good reason to request a Good Faith Estimate before scheduling.
Plausible
The price falls within the expected range of Medicare benchmarks for that procedure, but only one source published it, so we couldn't independently verify it.
Estimated
A modeled figure, not a published price. Useful for ballpark comparison; not a substitute for a quote.
You can see how each hospital scores on verification on our data accuracy page.
Data Freshness
Hospitals update their price files on their own schedules — some monthly, some once a year. Where a hospital publishes a file date, we show it alongside that hospital's prices so you know how current the data is.
If a price looks wrong or out of date, use the report button on any result — those reports go straight into our review queue.
What This Is NOT
Panopticare is not a quote, not a guarantee, not a Good Faith Estimate, and not medical or insurance advice. (“Good Faith Estimate” is a specific legal document with dispute rights under the No Surprises Act — only your provider can issue one.) Your final cost depends on your exact plan, where you stand on your deductible, and the care you actually receive — which can differ from what was planned.
Under the No Surprises Act, you have the right to a binding Good Faith Estimate from your provider before scheduled care. Our bill check guide walks you through requesting one and what to do if your final bill comes in higher.
Care Quality
Price is only half the picture. Where CMS publishes an overall hospital star rating, we show it next to the hospital's prices.
Unrated does not mean bad. Many specialty hospitals, children's hospitals, and newer facilities simply don't have enough of the measures CMS requires to receive a rating.
Corrections
Spotted an error? Whether you work at a hospital and see your data misrepresented, or you're a patient who was quoted something different — we want to know. Report it through our contact page and we'll investigate against the source files.