How we price
What our plan-rate numbers are, where they come from, and what they can't tell you.
Where the numbers come from
Federal price-transparency rules require health plans to publish every rate they have negotiated with every provider. The files are enormous — hundreds of gigabytes a month across the plans sold in Texas — and almost nobody reads them. We do. These are the actual negotiated rates health plans publish under federal price-transparency rules. We clean them before showing them: we remove filler entries that aren't real negotiated prices, prices attached to providers who don't plausibly perform the service, and values that fail plausibility screens.
What we remove, and why
Published files are not clean. We take out three kinds of entry before anything reaches you:
- Filler. Rows that are not real negotiated prices — placeholder amounts, enumerated fee schedules standing in for a contract, percentage values that are not dollars at all.
- Implausible pairings. A rate attached to a provider who does not plausibly perform that service. A dermatology practice listed against a cardiac procedure is a filing artifact, not a price you could go and pay.
- Values that fail a plausibility screen. Amounts far outside what the service costs anywhere, which are almost always data errors rather than bargains.
We exclude rather than disclaim. Where a rate cannot be trusted we do not show it with a warning attached — a caveat next to a number does not stop anyone reading the number, and you have no way to weigh "this might be wrong". If it did not pass, it is not here.
What this data is not
- Not comprehensive. Some plans publish incomplete or unusable files, and some services cannot be verified. An absence here is not evidence that nobody near you offers something.
- Not your out-of-pocket cost. These are the amounts your plan and the provider agreed. What you actually pay depends on your deductible, copay and coinsurance.
- Not a quote. Always confirm the code and the cost with your provider before your visit.
- Professional and outpatient services. Hospital-stay prices are not comparable from this data, and dental, vision and durable medical equipment are absent.
Why your plan might not be listed
Don't see your plan? We only include plans whose published price data passed our quality checks. A plan is included only when its network's published rates can actually be tied to real, locatable providers. A plan can publish millions of rates and still fail that test — and listing it would mean offering you a lookup that returns nothing, with no explanation of why.
How current it is
Plans republish monthly and we refresh against them. Every result carries the date of the files it was drawn from, so you can see how fresh the answer is rather than having to trust that it is.