Eighth annual compliance report · September 2026
Hospital price transparency is improving. Usable prices are not.
A review of 2,000 hospitals finds stronger technical compliance, but most hospitals still do not give patients clear, dollar-and-cents prices they can compare before care.
Real progress, More Work Ahead
Compliance more than doubled.
CMS standardization and clearer technical guidance moved many hospitals into compliance. This is the largest jump in compliance to date. Continued pressure and expanded rules will take compliance to actual prices.
+28.3 percentage points
Why this matters
A compliant file can still leave a patient without a price.
The rule permits algorithms and percentages when a negotiated rate cannot be expressed as a dollar amount. But many entries omitted information needed to calculate the price or were too complex for a reasonable user to apply.
Clear, usable prices that can be compared across hospitals remain the goal.
A revealing system-level contrast
Rule compliance and useful pricing are not the same score.
The path forward
Make prices calculable, comparable, and enforceable.
The report calls for clearer standards and stronger enforcement—especially where algorithms, payer names, and percentages obscure what patients will pay.
Read the recommendations ↗- 01
>Clarify “all necessary information”
Tell hospitals what must accompany algorithms and percentages so the public can derive a dollar amount.
- 02
>Standardize algorithm types
Limit and define machine-readable algorithm formats and required supporting information.
- 03
>Standardize payer and plan names
Create a public naming list so patients can identify plans and compare hospitals.
- 04
>Keep improving file access
Bring CMS technical guidance into its specifications and tighten cash-price encoding.
- 05
>Remove ambiguous disclosure language
Require every applicable standard-charge type—not merely one.
- 06
>Enforce quickly and transparently
Publish the compliance process and the reasons for enforcement actions.
- 07
>Audit discounted cash prices
Prioritize hospitals whose estimators show cash discounts missing from their files.
How the review was conducted
A broad, independently validated review of public hospital data nationwide.
- 2,000
- hospital websites reviewed, examining hospitals
in all 50 states, and emphasizing the nation’s largest systems - Apr. 29–May 3
- 2026 review period for publicly available websites and files
- Independent
- review and validation by FireLight Health LLC using a substantial sample
The findings reflect PatientRightsAdvocate.org’s good-faith analysis and opinions and are not legal advice.
Report resource center
Go directly to the evidence you need.
Open the complete report or jump to its findings, methodology, recommendations, and hospital-level appendices.
Full report
The complete 102-page report, findings, examples, hospital lists, and source links.
Download PDF ↓ PAGE 03Summary of findings
The main compliance, usability, format, and access findings at a glance.
Open section ↗ PAGE 04Methodology
How hospitals were selected, reviewed, assessed, and independently validated.
Open section ↗ PAGE 07Health-system results
Compare full compliance and pricing sufficiency across the largest systems.
Open section ↗ PAGE 11Recommendations
Seven recommendations for guidance, standardization, and enforcement.
Open section ↗ PAGE 15Hospital appendices
Examples, validator failures, high performers, and all hospitals reviewed.
Open section ↗The bottom line
Patients need prices, not algorithms and percentages.
True transparency means real, upfront dollar-and-cents prices that patients, employers, and unions can compare before care.
Get the report ↓