The Control State

Under the federal Hospital Price Transparency rule, Maryland's hospitals are required to publish a list price, known in the rule as the gross charge, for every item and service they provide. This report measures what they actually publish. The threshold is 260% of Medicare, the line Indiana wrote into law for employer contracts, measured with the same instrument as Reports No. 1 through 8.

Of 56,268 list prices that could be matched to a 2026 Medicare rate, 33,912 sit above the line. That is 60.3%, the lowest share in the series, below Michigan at 62.8% and New York at 69.2%, and 34 points below Florida. At 200% of Medicare the share is 72.1%. Move the line up to 300% of Medicare and 54.7% of prices are still above it. The median Maryland list price is 3.45 times Medicare. Excluding extreme prices moves the figure to 60.5%; removing every price above 100 times Medicare moves it to 59.3%; excluding UPMC Western Maryland's 397 benchmarkable rows published at $1.00 moves it to 60.7%; excluding the specialty orthopedic hospital, the trauma center, or the one hospital whose file lists several prices for most procedures with nothing to distinguish them, moves it by half a point or less.

Maryland is the series' control state. For decades, every payer, Medicare included, has paid Maryland hospitals on rates set by the state's Health Services Cost Review Commission, hospital by hospital and service by service, for inpatient, hospital outpatient and emergency care. The files are consistent with it. At most hospitals the median cash price is 98% of the list price, matching the 2% discount Maryland regulation gives any patient or payer who pays at discharge. At the University of Maryland, MedStar, GBMC, Meritus and Frederick hospitals, the lowest negotiated rate sits at the same 98%.

Maryland is measured on 39 hospital price files from 16 systems, covering 38 of the state's 43 acute-care hospitals; see Methodology. Its count of benchmarkable prices is the smallest in the series. Per hospital file, the count is close to Florida's. Price counts reflect the current measurement table and may differ slightly from counts in earlier reports as hospital files are reloaded. Headline shares are unchanged unless a dated correction note says otherwise.

Every hospital in Maryland is regulated by the same commission. Their list prices are not alike. By system, the share above the line runs from 71.8% at MedStar Health's seven Maryland hospitals to 27.5% at GBMC:

By region, assigned by county, the share runs from 70.2% on the Eastern Shore and Upper Bay to 47.4% in Western Maryland, a 22.8-point gap. Much of that gap follows the systems in each region rather than the region itself. Western Maryland's 47.4% rises to 59.4% without UPMC. The Capital region's 53.0% rises to 66.7% without Holy Cross and Frederick, the two lowest-priced systems there. The state's two largest systems price at similar levels in most regions where they operate: MedStar at 73% to 74% in Baltimore and the Capital region, the University of Maryland system at 66% to 67% in Baltimore, the Capital region and Southern Maryland. As in Florida, the finding is the system, not the region.

In 2026, Medicare's national rate for a CT scan of the head without contrast (CPT 70450) is $106.81. Thirty-eight of the 39 hospital files in this report publish it. Each hospital's price here is its highest full-service list price for the code:

Twenty of the 38 hospitals price this scan below Medicare. These are not stray lines. Each is the highest price the hospital lists for the full scan, none sits in a price band covering ten or more procedures, and twelve are priced for this scan alone. Two, at $104.00 and $105.63, fall less than $3 short of Medicare's $106.81.

In Report No. 8, the cheapest Florida hospital listed the same scan at $1,215. That is more than every Maryland hospital's price, including Union's. The Florida median was $5,124, 48 times Medicare. In New York, in Report No. 7, the lowest hospital's price was $611.

Prices are each hospital's highest full-service list price for the code, excluding component-only lines (professional or technical only) and $1.00 placeholders. Union Hospital's CT price, the state's ceiling, is shared with four other codes. In the exhibits, a hospital is named only where it sets the state's floor or ceiling.

In the earlier states, most hospitals published the rates they negotiated with each insurer for each diagnosis-related group. In Maryland, 41 of the 43 acute-care hospitals publish no dollar price for an inpatient stay at all. Five, the four Johns Hopkins hospitals and Union Hospital, publish inpatient terms only as a percentage of charges, with no dollar figure. Thirty-six publish no inpatient rows of any kind. That is consistent with how Maryland hospitals are paid. The commission sets rates by service, not by stay.

Two hospitals publish dollar prices for inpatient stays, too few to measure Maryland's inpatient prices as a whole. Holy Cross Hospital in Silver Spring publishes one payer, a Medicare Advantage plan, at a median of 1.43 times Medicare. Elsewhere in this series, the lowest negotiated rate per stay, typically a Medicare Advantage plan's, sits at a median of 1.08 times across 15 New York hospitals in Report No. 7, between 1.06 and 1.73 times at 51 Florida hospitals in Report No. 8, and 1.12 times for SCAN, a California Medicare Advantage plan. Holy Cross's plan falls inside Florida's range and above New York's median and SCAN's. Atlantic General Hospital in Berlin publishes one figure per stay, serving as both its list price and its negotiated rate, at a median of 1.63 times. In Maryland, the Medicare figure behind these multiples is a reference point, not a real payment, because Maryland hospitals are not paid under Medicare's inpatient payment system.

Every hospital in this report has attested under federal rule that its price file is accurate and complete. The files were read as published. In Maryland, the largest finding is what the files leave out. Five hospitals publish no billable code a patient could match to a procedure, though the other hospitals under the same commission do.

• Five hospitals, no billable codes. Saint Agnes, Sinai, Northwest, Carroll and Levindale publish only their own internal charge codes, with no CPT, HCPCS or DRG code on any row. They count among the state's 43 hospitals and contribute no prices to this report. Sinai's separate shoppable services file shows the codes exist: it lists 315 procedures with their CPT codes and five with their DRG codes. Its machine-readable file carries none of them.
• A real cash price. In Florida, most hospitals published no cash price; in New York, the largest system's cash price copied the list price. In Maryland, the cash price is published and differs from the list price by the regulated 2% at most hospitals. At the four Johns Hopkins hospitals and Union Hospital it equals the list price on every row.
• Other price lists inside a hospital's file. Johns Hopkins' files carry price schedules that are not the hospital's own, some labeled for another facility and some for outside clients. Read without separating them, a Johns Hopkins Hospital CT scan would have appeared at $2,250 rather than its own $148.72. Only each hospital's own schedules are measured here.
• Codes that are not codes. GBMC fills the code field with "N/A" on 33,701 rows, 89% of its file. Atlantic General drops the leading zeros from its anesthesia codes. TidalHealth publishes its chest X-rays under codes retired in 2017. Rows without a valid code are not measured; Atlantic General's anesthesia codes were restored where the code could be read with certainty.
• Banded prices. Across the 39 files, 1,718 blocks of ten or more distinct procedures share one identical list price, 125 of them spanning three or more sections of the CPT code set. A two-view chest X-ray, one of the most common imaging studies, sits inside a shared radiology price at 34 of the 37 hospitals that publish it. UPMC Western Maryland lists 483 procedures at $1.00, across five sections of the code set. Atlantic General lists 209 procedures from six sections at $75.00.

Everywhere else in this series, the difference between a hospital's list price and what an insurer pays is set by private contract, and stays hidden until the file is read. In Maryland, the commission sets the rate every payer pays, and the files look like it. At most hospitals, the cash price and the lowest negotiated rate sit within 2% of the list price. The published price and the negotiated price are nearly the same.

That makes Maryland the series' control. In a state where one commission sets rates for every payer, its hospitals publish the lowest share of list prices above 260% of Medicare in nine states. The files show what one rate for every payer looks like. They cannot show why the same hospitals price a head CT below Medicare and an abdominal ultrasound at nearly seven times it.