A patient prices an MRI at your client's imaging center, then at the hospital. Both answer. Only one of those answers exists anywhere a second person can check — and CMS has opened a comment box on whether that should still count.

Every agency with an imaging client has built the same page. Two columns. Our price on the left, the hospital's on the right, and a line underneath about how much a person saves by driving eleven extra minutes.

I have built that page. The number in the left column is real — it comes out of the client's own system and somebody there will stand behind it. I want to talk about where the number in the right column comes from, because on July 7 CMS published a rule that spends three pages asking the same question, and the comment box closes August 31.

Since January 1, 2021, every hospital in the country has had to publish its prices two ways: a machine-readable file with everything in it, and a consumer-friendly display covering three hundred services. That is the rule everyone knows. The part almost nobody outside a hospital compliance office knows is the sentence directly underneath it.

A hospital that runs an estimator widget does not have to publish the consumer list at all. Not a file, not a table, not a page you can bookmark. A visitor types in a service, a number appears on their screen, and the requirement is met. One person, one number, once.

Which is fine, right up until you need that number for something. You cannot cite it. You cannot archive it. Two people can run the same query and get different answers, and neither of them is wrong, and there is no third document to go check. And CMS has noticed something worse than that.

Sit with the shape of that. The widget quotes a patient a cash price. The machine-readable file — the one CMS made hospitals attest is true, accurate and complete, with a named senior official responsible for the encoding — says no cash price exists for that service.

Both are the same hospital, on the same day, about the same scan. One of them has a person's name on it. The other has a loading spinner.

CMS is not accusing anyone. It is doing something more useful: it wrote down the contradiction and asked the public to explain it. And in the same section it asks the question that actually decides your client's next three years of pricing pages.

Two ways to satisfy the same rule, producing two completely different artifacts: one you can download and one you can only witness.

Kept honest, because the distinctions matter here. This is a request for information inside a proposed rule, not a proposal. CMS is not proposing to remove deemed compliance in this document — it says the responses will “inform future rulemaking.” 45 CFR 180.60(a)(2) is in force and a hospital running a qualifying estimator tool is compliant today. The cash-price contradiction is CMS relaying an observation from interested parties and asking for clarification; the agency does not say how often it happens, does not name a hospital, and neither do I — I have not audited any specific hospital's file or tool for this piece. CMS separately reports through its own compliance reviews that display and file charges “do not always match,” which is the broader version of the same problem. The three hundred / seventy figures and the deeming language are quoted from the current text of 45 CFR 180.60 as published by eCFR; everything else is quoted from the Federal Register document itself. Estimator tools also do something a file cannot — apply a specific person's insurance — and that is a real service, not a dodge. The argument here is about what is publicly comparable, not about whether the tools are useful. None of this is legal or compliance advice.

Sources (primary, verified today): Centers for Medicare & Medicaid Services, “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems … Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data,” proposed rule, 91 FR 41734 (July 7, 2026), file code CMS-1850-P, RIN 0938-AV83 — the request for information is section XXIII at 91 FR 41997–41999. federalregister.gov serves its full-text file behind a block, so the document was read from the govinfo PDF, extracted with pypdf; the August 31 deadline, file code and docket number were confirmed against the Federal Register JSON API. The deeming provision, the three hundred / seventy shoppable-services requirement and the discounted-cash-price data element are quoted from 45 CFR 180.60 as currently published by eCFR (title 45 issue date July 27, 2026). Background dates cited inside the rule and used here: the CY 2020 HPT final rule at 84 FR 65524 (November 27, 2019), the CY 2026 OPPS/ASC final rule at 90 FR 53448 (November 21, 2025), and Executive Order 14221 at 90 FR 11005 (February 25, 2025). No trade coverage supplied any fact in this edition.

If you build pricing pages for healthcare clients, there's a sentence in the federal price transparency rule you should read before you build another one.

Every hospital has had to publish prices two ways since January 2021: a machine-readable file, and a consumer-friendly display of 300 services.

Here is 45 CFR 180.60(a)(2), in force right now:

"A hospital is deemed by CMS to meet the requirements of this section if the hospital maintains an internet-based price estimator tool."

Run a widget, and you never have to publish the consumer list. Not a file. Not a table. Not a page anyone can bookmark. A visitor types in a service, a number appears on their screen, and the requirement is satisfied.

One person. One number. Once.

That matters to you the moment you need the number for something. You can't cite it. You can't archive it. Two people can run the same query and get different answers and there's no third document to check.

And CMS has noticed something sharper than that. From the request for information published July 7 (91 FR 41999):

"hospitals are able to provide information about discounted cash prices in their price estimator tool, even where there is no information about discounted cash prices encoded in the hospital's MRF. We are seeking clarification to better understand why a hospital would be able to provide information about a discounted cash price in the price estimator tool, yet attest in their MRF, by not encoding the information, that they have not established a discounted cash price for that item or service."

Same hospital. Same scan. Same day.

The widget quotes a patient a cash price. The file — the one CMS requires hospitals to attest is true, accurate and complete, with a named senior official responsible for the encoding — says no cash price was ever set.

One of those has a person's name on it. The other has a loading spinner.

CMS isn't accusing anyone. It did something more useful: wrote the contradiction down and asked the public to explain it. And then asked the question that decides the next three years of every price comparison you'll ever build:

"What positive or negative effects would consumers experience if the price estimator tool alone were no longer considered compliant?"

Two things I'd do this week.

First, stop pulling competitor prices out of estimator tools. Go to the machine-readable file. Since April 1, 2026, CMS has been enforcing a requirement that percentage-based and algorithm-based rates carry real dollar figures — median, 10th and 90th percentile allowed amounts, with the claim count behind them. A median allowed amount from an attested file is a citation. A screenshot of a widget is a screenshot.

Second, if you have a client who publishes a real cash price, understand what they actually have. Not a lower number — a verifiable one. A price a stranger can check is a different product from a price that appears once and disappears. Most independent imaging centers have never said that out loud, because they assumed everyone published the same way.

Comments close August 31. File code CMS-1850-P, docket CMS-2026-2344. That record is going to be hospital associations and the vendors who build the estimator tools, and both would like deemed compliance to survive. CMS is explicitly asking what consumers experience. An imaging center that competes on a published price could answer that in 400 words and be the only one in the file who did.

Honest caveats: this is a request for information, not a proposal. Nothing changes on August 31 except that the record closes. The deeming provision is in force and hospitals using it are compliant. The cash-price contradiction is CMS relaying what interested parties reported and asking for clarification — it doesn't say how often it happens and doesn't name anyone. And estimator tools do something a file can't, which is apply a specific person's insurance. That's a real service. The argument is about what's publicly comparable, not whether the tools are worth having.

Source: 91 FR 41734 (July 7, 2026), section XXIII at 41997. Read from the govinfo PDF. Not legal advice.

FIRST SOURCE · one verified original-source finding, composed for one reader · this edition: marketing — written for the agencies who build the comparison page, and have to source the other side of it