Payer-Specific Negotiated Charge

The payer-specific negotiated charge is the dollar amount a hospital has agreed to accept from one named insurance plan for one service. It is the most useful line in a hospital's transparency file because it is not an average and not a range. It says: this hospital, this CPT code, this carrier, this plan, this many dollars. Hospitals have been required to publish it since 2021, and since 2024 they must state it as a dollar figure rather than a formula or a percentage.

This is the number that ends the guessing. A total knee at one Austin-area hospital might list $27,400 for one carrier's Blue Choice PPO and $41,900 for a different carrier's PPO. Across town another hospital lists $19,800 and $33,200 for the same two plans. Those four numbers are the real contract rates, and they are public. Before the rule, an employer paying for that surgery through a self-funded plan could not see the contracted rate until the claim arrived, and a member had no way to compare hospitals at all. Now a member who knows their plan name can look up the facility rate at every hospital in the area. The one caution: the file lists the hospital's charge. The surgeon and the anesthesia group are separate contracts, published in the carrier's own transparency file rather than the hospital's.

The takeaway: find the exact plan name on your insurance card and look for it in the hospital's file. That line is your facility price. If two hospitals in your network differ by $20,000 for the same code, and they often do, that is money you can choose to keep.