Research Alert: November 21, 2025

Third Party Negotiated Hospital Pricing in Rural and Urban Hospitals Within 12 U.S. States

To comply with the Hospital Price Transparency Rule passed in 2019, hospitals are required to publicly post machine-readable files of five different “standard charges” associated with individual items or services: gross charges; payor-specific negotiated rates; de-identified minimum and maximum negotiated rates; and discounted cash prices (for self-pay patients). This report examined hospital pricing for common services and procedures in rural and urban hospitals.

Key Findings:

• Hospital prices vary widely across hospitals and within hospitals. Gross charges are like a “sticker price” – the full cost a hospital lists for a service – while negotiated charges are the discounted rate agreed upon with insurers. These negotiated rates often differ between insurers, even for the same service at the same hospital. Different hospitals may also set different gross charges and negotiated rates for similar services.
• For routine care, gross and negotiated charges were generally lower in rural hospitals included in this study than in urban. The negotiated charge for a level 3 ER visit (CPT 99283) was approximately $215 higher in urban compared to rural hospitals studied.
• Pricing for imaging procedures was similar in rural and urban hospitals studied, with urban hospitals reporting slightly lower negotiated charges for abdominal CT scans and lumbar MRI scans. Urban hospitals also had lower negotiated charges for Cesarean section and vaginal delivery than rural hospitals.
• Variation in negotiated charges across the rural versus urban hospitals studied was observed, but the direction of variation depended on the state and type of procedure being considered. Overall, the differences between rural and urban hospitals studied were relatively small compared to the variability of the data in general (i.e., between as well as within hospitals).

Additional Resources of Interest:

• More FORHP-funded research on Healthcare financing
• More information about the Rural and Underserved Health Research Center