The Price Is Public. Nobody Can Read It.

The CMS Hospital Price Transparency rule, in force since 2021 and strengthened for 2026, is one of the most complete disclosure regimes in American healthcare: every hospital must publish, in a machine-readable file, its gross charge, discounted cash price, and every payer-specific negotiated rate for every service. Compliance, after early resistance, is now broad. And it almost doesn't matter, because the median file is hundreds of megabytes of JSON — one we measured is 843 MB, which is larger than the entire text of Wikipedia when it was published. No spreadsheet opens it. No browser renders it. The law delivered the data and the delivery format destroyed the information.

Take a brain MRI with contrast (CPT 70553). At Cedars-Sinai, the sticker price is $15,417 while the per-code negotiated rates insurers actually pay, in the same outpatient setting, run from $445 to $8,675 — a 19.5x spread on the same code, same setting, same building, before any cross-hospital comparison. CT abdomen with contrast at the same hospital: $17,058 sticker against a best negotiated rate of $222 — 77x. A wrist X-ray (CPT 73630) negotiates at $17.30 at UCLA and $469.94 at Providence Washington — 27x across town. Correction in this revision: our first pass reported spreads up to 101.8x, but those maxima traced to flat case rates published identically across hundreds of unrelated codes; Rev 1.1 excludes them, and every number in this section survives that filter. The chargemaster figure that dominates billing disputes is still routinely an order of magnitude above what the system actually transacts at.

Total knee replacement, CPT 27447, outpatient, negotiated rates: $6,121 at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. $47,391 at Ronald Reagan UCLA Medical Center in Los Angeles — 15 miles away. Both are real contracted rates from the hospitals' own files, published as flat case rates covering the full surgical episode — the form in which hospitals typically contract major surgery — rather than per-line negotiated prices. A patient with a high-deductible plan at the second hospital could owe more than six times the entire cash-package price of the first. Cross-hospital variation of this magnitude is the norm in our sample, not the exception: brain MRI negotiated rates span $311 (UCLA) to $4,402 (Providence Washington) across the five institutions.

The five files we parsed total 1.5 GB and 10.1 million rows. There are roughly 6,000 hospitals in the United States. Extrapolating the observed file sizes, the complete national price dataset is on the order of a few hundred gigabytes raw — and compresses to a queryable database well within a single consumer machine. This is the central finding of this report, beyond any specific spread: the engineering excuse for not knowing American hospital prices is over. Any journalist, benefits team, researcher — or patient — can hold the whole market in one database. The parser that proves it is open source, handles both required formats, and ingested the largest file in 34 seconds.