The Bill Rate Index What the hour costs, and who keeps it
2,907 hospitals · Medicare cost reports · FY2021 to FY2025

An agency hour cost 165% more than a staff hour in 2021. It now costs 85% more.

Hospitals file both numbers with the federal government every year, on the same line of the same form. Nobody had put them side by side, so here they are, for every hospital in America, going back five years.

The premium is what the agency is paid. Almost none of it reaches the nurse.

The median American hospital, by year

Filings on the right. Headline figures use FY2025, the most recent year with a full set of them in.

The wage The premium
Widest gap on record
The wageThe premium
Median employed hour $43.42 What the hospital pays its own clinical staff, wages only.
Median contract hour $84.29 What the same hospital pays for staff furnished under contract.
The gap today 85% 3,410 hospitals across 52 states and territories, most recent filing each.

Every hospital that filed the numbers

Most recent filing each, widest gap first. Search for yours, or open it to see every year.

 

Showing the first 50. Search or pick a state to narrow it.

Nursing homes are worse

The same federal question, asked on a different form, of 11,897 skilled nursing facilities. Their gap is 99%, and their own staff earn a little over half what hospital staff do.

Nursing home rates

Where does your own contract sit?

Paste what your recruiter sent you. It works out the real hourly value, separates taxed pay from stipends, and sets it beside what your hospital reported paying. Nothing leaves your browser.

Check your split Browse by state

Where these numbers come from

Every hospital paid by Medicare files Form CMS-2552-10. On Worksheet S-3 Part II, line 1 is salaries paid to employees and line 11 is direct patient care furnished under contract. Both carry hours and an hourly rate the hospital works out itself.

The premium here is the contract rate measured against the employed rate, same hospital, same year.

What it is not

It is the gap in hourly cost to the hospital, not the agency's margin. The contract rate also carries the agency's payroll taxes, insurance and overhead, and the employed rate excludes the hospital's own benefits.

What was left out

Hospitals reporting no contract labour, no usable wage data, or rates outside any plausible range. So are years with under 100 contract hours or 1,000 employed hours, where an average is noise.

A second source agrees

Illinois makes nurse agencies report what they charged the facility and what they paid the worker, by county. It lands in the same territory. The county table is here.