Key PointsQuestionAre potential financial penalties associated with hospital compliance with federal price transparency regulations?FindingsIn this cohort study of 4377 acute care hospitals, compliance with the 2021 Centers for Medicare & Medicaid Services Price Transparency Rule increased from 70.4% in 2021 to 87.7% in 2022. Increases in compliance were significantly positively correlated with penalty size, which changed from a flat rate to a function of hospital bed counts.MeaningHospital compliance with federal price transparency regulations is high and increasing; this study suggests that financial penalties may be a useful policy enforcement mechanism in health care.