What hospitals charge in Virginia and North Carolina

The Hospital Price Index covers every Medicare-participating hospital in Virginia and North Carolina that publishes a parseable machine-readable file with at least one of (gross charge, discounted cash price, negotiated rate). One hospital that publishes only minimum / maximum standard charges is included; all others publish the gross + cash variant.

Range = lowest and highest cash price across any procedure, any hospital. Avg cash = mean discounted cash price across all priced procedures.

The procedures most widely published across Virginia hospitals, with the price spread observed in this quarter's snapshot. Spread is the ratio of the highest published cash price to the lowest. An echocardiogram costs $60 at one Virginia hospital and $8,401 at another — a 140x spread for the same CPT code.

Lowest, highest, and avg are discounted cash prices published by each hospital. Spread = max ÷ min for the same CPT/HCPCS code. Hospitals = count of unique facilities publishing the procedure.

Average discounted cash price across each system's hospitals. Systems with fewer than two indexed hospitals are excluded.

Index = system avg ÷ lowest system avg. Procedure mix differs across systems — index is descriptive, not adjusted for case-mix or geography. Use the procedure-level table above for apples-to-apples comparison on a single CPT code.

Across 90,106 cash-and-payer rate pairs published by Virginia and North Carolina hospitals this quarter, 37,516 negotiated insurance rates (41.6%) are higher than the same hospital's published cash price for the same procedure. This is not a billing error or a benefit-design quirk — it is the published rate the insurer agreed to pay.

For-profit hospitals in this index publish higher prices than nonprofit hospitals for the same CPT code. Per-procedure ratios in Virginia range from 0.1x (where for-profits price near or below nonprofits) to 4.2x (where the gap is widest), with a median ratio of 1.6x. The ratio is highest on imaging studies and ER visits, lowest on commodity outpatient labs.

Per-procedure ratio = avg for-profit cash price ÷ avg nonprofit cash price for the same CPT code. We report per-procedure ratios rather than aggregate averages because procedure mix differs by ownership and aggregate ratios produce Simpson's-paradox artifacts.

Methodology

Universe. Every Medicare-participating hospital in Virginia and North Carolina with (a) a city populated in our records and (b) at least one published price in any of the four CMS standard-charge fields: gross charge, discounted cash price, minimum negotiated rate, maximum negotiated rate. Hospitals that publish only payer-specific rates without any standard-charge column are excluded. Hospitals that publish under variant B (min/max only) are included; one hospital in this index — VCU Medical Center — uses that variant.

Source data. Each hospital's machine-readable file (MRF), published under 45 CFR 180.50 of the federal Hospital Price Transparency Final Rule. Files were downloaded from each hospital's website. Parsed prices are stored in our database; the 2026-05-01 snapshot used for this index is preserved as an immutable artifact for reproducibility.

Price field. "Cash price" in this index refers to the CMS standard-charge field labeled discounted cash price — the rate a hospital lists for an individual paying without insurance. "Negotiated rate" refers to the per-payer rate the hospital lists in the same file. We do not estimate, model, or interpolate prices. Every figure is a number a hospital published.

Procedure matching. Comparisons use the same CPT or HCPCS code across hospitals. The procedures shown in Section 2 are the codes most widely published by Virginia hospitals this quarter, ranked by hospital coverage.

What this index does not include. Professional fees (radiologist, surgeon, anesthesiologist) — typically billed separately and not on the hospital's MRF. Out-of-pocket costs — those depend on a patient's plan, deductible status, and benefit design. Inpatient bundle pricing for hospitals that publish only line-item charges. Quality and safety data — covered separately on each hospital's profile page.

Limitations. Published MRF prices are not transacted prices. A hospital's MRF is the rate the hospital is required to publish for a given payer or cash patient — not necessarily the amount that ends up being collected after billing adjustments, contractual write-offs, or charity care. Cash and negotiated rates are descriptive of the published rate environment, not predictive of any individual patient's bill.

Cadence. The Hospital Price Index is published quarterly. Each edition uses an immutable snapshot of the underlying database; the prior edition stays at its dated URL. The next edition (2026 Q3) is expected the first business week of July 2026.

Reproducibility. The audit data underlying every number on this page is preserved at data/snapshots/2026Q2/audit/index_audit.json in our repository. The source database snapshot is preserved at data/snapshots/2026Q2/hospitalpriceintel-2026Q2.db.gz with sha256 checksum recorded in the manifest.

For full data sources and procedure-coverage detail, see /about.