Open · CC0 · Updated 2026-05-11

Hospital Ledger

Federal law has required every U.S. hospital to publish a machine-readable price file since 2021. We checked all 4,625.

Compliance
have a live MRF
Missing
no findable file
Under CMS enforcement
hospitals notified by CMS
Total CMS actions
since 2021

What the law required

Under 45 CFR § 180, since January 1, 2021 every U.S. hospital must publish a single machine-readable file (MRF) containing standard charges, payer-specific negotiated rates, discounted cash prices, and de-identified min/max negotiated charges. The file must be free, public, and easily accessible without registration, authentication, or PII.

Mark Cuban, in launching Cost Plus Drugs, has spent two years pushing for exactly this kind of price transparency. The law's already on the books. What's missing is the database.

This is that database. Every CMS-required hospital, cross-referenced with the live MRF URL (where it exists) and the CMS enforcement record (where the hospital failed to comply).

Top 25 worst offenders

CMS-required hospitals with the most enforcement actions and no findable MRF.

CCNHospitalCity, StateCMS actions

Worst states

By share of CMS-required hospitals with a live MRF.

StateTotalLive% live

By facility type

Rural Emergency Hospitals (the newest category) lag furthest.

Sources / methodology

The inputs, checks, and limits are listed here on the site, not just in the repo.

Open the current summary JSON
Primary sources
How this was built
  1. Start with all CMS-required hospitals.
  2. Join known MRF links from the seed datasets.
  3. Probe URLs live and follow redirects to verify which files actually respond.
  4. Rediscover missing files from hospital transparency pages when the seed is dead.
  5. Parse live CSV, JSON, XLSX, ZIP, and wrapper-page formats into one schema.
  6. Generate the on-site standardized price previews from those parsed files.
What the numbers mean
  • Compliant means a live machine-readable file was found and verified.
  • Missing means no live public MRF was found after automated discovery and probing.
  • Under CMS enforcement means the hospital appears in CMS's public enforcement record.
  • Standardized price preview appears when parsed rows were actually generated for that hospital.

Current limits: some hospitals are behind bot-defense or publish malformed files. Missing rows can mean non-compliance, anti-bot blocking, or broken vendor output.

🩺 Live prices — standardized, on-site

Parsed directly from each hospital's MRF into a unified schema. No external links — search prices by CPT or HCPCS code below.

Use it

Everything here is CC0 / public domain. No attribution required. Build whatever you want on top.