SelfPayRates

Hospital price and billing glossary

Hospital bills and price files use terms of their own. A discounted cash price is what a hospital charges a patient who pays directly; the gross charge is its full list price; a negotiated rate is what an insurer pays. Below are 28 terms you will meet on a bill, in a price file and on SelfPayRates, in plain words.

Updated 2026-10-01

Discounted cash price
The price a hospital charges a patient who pays for a service directly, without insurance. It is one of the standard charges every hospital must publish (45 CFR 180.50), and it is the Cash price column on SelfPayRates. Some hospitals leave it empty or set it equal to the gross charge.
Gross charge
The hospital's full list price for a service, before any discount, taken from its chargemaster. Few patients pay it; insurers pay negotiated rates and self-pay patients usually get the cash price. It is the List price column on SelfPayRates.
Chargemaster
The hospital's master list of every item and service it bills, with a gross charge for each. Each hospital sets its own, so list prices for the same code differ widely.
Negotiated rate
The price a hospital has agreed with an insurer for a service under a specific plan. Together, the insurer and the patient pay this amount for in-network care. SelfPayRates shows the range of negotiated rates a hospital publishes as Insurers pay.
Standard charge
The federal term for the prices a hospital must publish for each item and service: the gross charge, the discounted cash price, each payer-specific negotiated rate, and the lowest and highest negotiated rate.
Machine-readable file
The public price file in which a hospital publishes its standard charges, in a CMS template (CSV or JSON). It can run to millions of lines. Every price on SelfPayRates links to the file it came from.
Hospital price transparency rule
The federal regulation (45 CFR part 180), in force since January 1, 2021, that requires every US hospital to publish its standard charges in a machine-readable file and to show prices for common shoppable services. CMS enforces it.
CPT code
A five-character code from the American Medical Association's Current Procedural Terminology that names a procedure or service, such as 73721 for an MRI of a leg joint without contrast. The code, not the name, decides the price, so ask your doctor for it.
HCPCS code
A code from the Healthcare Common Procedure Coding System kept by CMS. Level II codes are a letter and four digits (G0121, J1885) and cover supplies, drugs and services that CPT does not.
Revenue code
A four-digit code on a hospital bill that says which department a charge belongs to, such as 0610 for MRI or 0450 for the emergency room. Codes 0960 to 0989 are professional fees.
Modifier
Two characters added to a code to change its meaning: 26 is the professional component (the doctor's reading), TC the technical component (the hospital's equipment and staff), RT and LT the right or left side, 50 both sides. A price with a modifier can be only part of the service.
Facility fee
The hospital's own charge for a service: the room, equipment, supplies and staff. Hospital price files list facility fees; the doctor usually bills separately.
Professional fee
The charge of the physician who performs or interprets a service, such as the radiologist who reads an MRI or the surgeon. It often comes as a separate bill. SelfPayRates leaves professional fees out of comparisons so that a doctor's fee does not look like a cheap hospital price.
Outpatient and inpatient
Outpatient care does not need a hospital admission; inpatient care follows a formal admission, usually overnight. Hospitals price the same code differently in the two settings, so SelfPayRates shows them separately.
Self-pay
Paying for care yourself, without insurance. It includes insured patients who choose not to use their insurance for a service. Self-pay patients have a right to a Good Faith Estimate.
Deductible
The amount you pay each year before your insurance starts to pay. Until it is met, an insured patient pays the insurer's negotiated rate, which can be higher than the hospital's cash price.
Good Faith Estimate
A written estimate of expected charges that hospitals and other providers must give uninsured and self-pay patients for scheduled care. How to get one.
No Surprises Act
The federal law in force since January 1, 2022 that created the Good Faith Estimate for self-pay patients and protects insured patients from most surprise out-of-network bills.
Patient-provider dispute resolution
The federal process for disputing a bill that is $400 or more above your Good Faith Estimate for any one provider or facility. You start it within 120 days of the bill and pay a $25 fee. How it works.
Financial Assistance Policy
The written policy, required of nonprofit hospitals by section 501(r) of the Internal Revenue Code, that says who gets free or discounted care and how to apply. You can apply up to 240 days after the first bill. Each hospital page on SelfPayRates says whether the hospital is nonprofit.
Amounts generally billed
AGB: what a nonprofit hospital generally bills patients who have insurance for a service. Patients who qualify under its Financial Assistance Policy cannot be charged more than AGB for emergency or other medically necessary care.
Charity care
Free or discounted care a hospital gives to patients who cannot pay, based on income. Nonprofit hospitals describe it in their Financial Assistance Policy; many public hospitals run their own programs.
Itemized bill
A bill that lists every charge separately, with its date, code, quantity and amount, instead of totals by department. Ask for one before paying a large bill. Letters you can copy.
Medicare rate
What Medicare pays for a service under its national fee schedules: the outpatient hospital schedule (OPPS), the lab schedule (CLFS) or the physician schedule. SelfPayRates shows it next to cash prices as a reference point; a cash price near the Medicare rate is low.
Median, P10 and P90
The median is the middle price: half of the hospitals charge less, half more. P10 is the price below which the cheapest tenth of hospitals fall, P90 the price above which the most expensive tenth fall. SelfPayRates uses them instead of the lowest and highest price, which are often data errors.
CCN
CMS Certification Number: the six-digit number Medicare assigns to a hospital. SelfPayRates uses it to match a price file to the CMS hospital register.
NPI
National Provider Identifier: the ten-digit number that identifies a provider or organization on claims. Hospitals list theirs in the price file.
Critical access hospital
A small rural hospital with 25 beds or fewer, usually far from other hospitals, that Medicare pays on a cost basis to keep care available in the area.

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