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 The Bill Rate Index does, 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 right column counts who filed that year. Headline figures use FY2025, the most recent year with a full set of them in.
Most recent filing each, the biggest users of agency staff first. Search for yours, or open it to see every year.
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 ratesPaste 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 stateEvery 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.
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.
Hospitals reporting no contract labor, 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.
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.