How to read an itemized hospital bill

An itemized bill lists every charge separately, with a code for each one. It is the only version of a bill you can actually check. If you received a summary bill with a single total, call the billing department and ask for the itemized bill with procedure codes. Hospitals provide these on request, and you cannot compare prices without one.

The codes

• CPT and HCPCS codes (five characters, like 70551 or J1885) identify a single service: a scan, a lab test, an hour in the emergency department, a drug dose.
• MS-DRG and APR-DRG codes (three digits) bundle a whole stay - surgery, room, nursing and routine care - into one case rate. A surgical bill often has one DRG line and a handful of CPT lines.
• Revenue codes (three or four digits, like 0300 for laboratory) are department labels, not specific services. The same revenue code covers thousands of different charges, so revenue-code lines cannot be compared across hospitals; look for the CPT or HCPCS code next to them.

The three prices on every line

• Billed amount is the hospital's gross charge - its list price. Almost no payer pays it.
• Cash price is the discounted price the hospital publishes for self-pay patients. If you are uninsured, this is the number to negotiate toward.
• Typical insurance price is the median of the rates the hospital negotiated with the insurance plans in its file. If you are insured but have a large deductible, this is roughly the scale of what your plan allows.

What to do with a flag

Our bill checker flags five things. A billed amount above the hospital's own published list price is the strongest: the hospital is charging more than its own public price for that code, and a written request for correction is reasonable. A quantity above the CMS Medically Unlikely Edit means CMS considers that many units in one day unlikely for that code - sometimes it is a keying error, sometimes there is a clinical reason, and asking costs nothing. A possible duplicate is often a genuinely repeated service (two X-rays are two lines), so check the dates of service before questioning it. A bundling flag means CMS's NCCI edits treat one code on the bill as included in another when both are billed for the same date of service, so the included code may not be payable separately - worth a question, especially when no modifier is shown. A charge more than twice the typical published price is worth a phone call asking how the price was set.

Before you pay

• Ask for the cash price for the whole account, in writing, even if you are insured and mid-deductible.
• Ask about financial assistance (charity care). Nonprofit hospitals must have a written policy and must screen eligible patients; many bills are reduced or written off for people who simply apply.
• If you were uninsured and booked the care in advance, ask whether a good-faith estimate was required and how the final bill compares with it.
• Keep every letter and note the name and date of every call. Put disputes in writing, like the letter the checker generates, so there is a record.

This guide is general information, not medical, legal or financial advice. Prices on this site come from the machine-readable files hospitals publish under the federal Hospital Price Transparency rule (45 CFR Part 180).