About Our Data

Written by Jayant Panwar | Last reviewed: Q1 2026

Where This Pricing Data Comes From

In 2022, a federal law called the Transparency in Coverage rule required every major health insurer to publicly publish the exact prices they have agreed to pay hospitals and doctors for every covered service. Insurers publish these files quarterly. Momentary Lab scrapes, processes, and organizes this data so patients can read and use it.

What "Negotiated Rate" Means

The negotiated rate is the price an insurer has contractually agreed to pay a specific provider for a specific procedure. Think of it as the bulk discount an insurer negotiates in exchange for directing patients to that provider. This is what most insured patients' bills are based on, not the higher list price hospitals publish separately.

Physician Fee and Facility Fee Are Listed Separately

When you have a procedure, you typically receive two separate bills: one from the doctor or surgeon (the professional fee) and one from the hospital or surgery center (the facility or institutional fee). Both appear as separate line items on your Explanation of Benefits.

What This Data Does Not Tell You

These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Here is what providers in your area are contracted to accept from insurers. Your personal share depends on your deductible and coinsurance — call your insurer's member line with the CPT code for your procedure to get your exact estimate or talk to our AI to get your answers.

How Current Is This Data?

Insurers are required to update these files quarterly. Momentary Lab scrapes and refreshes its data on the same schedule. Each page shows the quarter and year the data was last updated.

Patient Glossary

Negotiated Rate
The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number.
List Price (Chargemaster)
The hospital's published price before any insurance discount. Almost nobody pays this. Starting point for insurer negotiations.
Professional Fee
The physician or surgeon's portion of the bill. Billed separately from the facility fee.
Facility Fee
The hospital or surgery center's portion of the bill. Billed separately from the professional fee. Both appear on your EOB.
Explanation of Benefits (EOB)
Document your insurer sends after a claim. Shows list price, discount, what insurance paid, and what you owe. Not a bill, but your bill will match the 'patient responsibility' line.
Deductible
Amount you pay out of pocket each year before insurance starts sharing costs.
Coinsurance
Percentage of the negotiated rate you pay after your deductible is met. 20% coinsurance means you pay 20%, insurer pays 80%.
Out-of-Pocket Maximum
Most you pay in a plan year. After this, insurer covers 100% of covered costs.
CPT Code
5-digit code identifying a specific medical service. Ask your doctor for it — allows your insurer to give you an accurate estimate before scheduling.
In-Network vs. Out-of-Network
In-network providers have a contract with your insurer and accept the negotiated rate. Out-of-network providers do not.
Good Faith Estimate
Written cost estimate providers must give uninsured/self-pay patients before a scheduled non-emergency service, under the No Surprises Act.
Transparency in Coverage (TiC)
Federal rule effective July 2022 requiring insurers to publish negotiated rates for every covered service with every in-network provider.
Ambulatory Surgery Center (ASC)
Freestanding outpatient surgery facility. Typically accepts 40-60% lower negotiated rates than hospital outpatient departments.
High-Deductible Health Plan (HDHP)
Plan with higher deductible and lower premiums. Patients pay full negotiated rate until deductible is met.
Health Savings Account (HSA)
Tax-advantaged account for HDHP enrollees. Funds pay qualified medical expenses pre-tax.
Billing Class
TiC data separates rates into professional (physician fees) and institutional (facility fees). Both shown separately on Momentary Lab pages.

Rates sourced from insurer Transparency in Coverage machine-readable files (Q1 2026). Negotiated rates are contracted prices between insurers and individual providers and do not represent guaranteed patient out-of-pocket costs. Actual costs depend on insurance plan terms, deductible status, coinsurance rate, and specific services received.

View healthcare costsACA marketplace insurance data