Last updated in April 2023. As pricing may change periodically, patients are encouraged to contact email@example.com to obtain estimates using the most current information.
Thank you for your interest in understanding more about hospital charges. Contained in this file you will find information that complies with the pricing transparency requirements for machine-readable files prescribed by the Centers for Medicare & Medicaid Services (CMS). In those requirements, hospitals must provide several different types of charging elements.
In general, it is useful to create a distinction between two different types of charges that exist in the healthcare industry. The first is "gross charge" which relates to the established prices that are billed to all patients regardless of insurance coverage. The second is the "negotiated charge" that relates to prices insurance companies have agreed to pay for services. All patients will receive the same "gross charge" for items and services at the hospital, however, the "negotiated charge" will vary based on agreements that exist with insurance companies.
If a patient is insured, they will typically be responsible for a portion of the negotiated charge. The portion of the charge that an uninsured or insured patient will pay a hospital for services is referred to as an "out-of-pocket" expense. An insured patient's out-of-pocket expense will be dependent on the type of coverage the patient has with the insurance company. Uninsured patients should contact a hospital representative to assist with options for payment. Individual patient responsibility and pricing estimates can be discussed by contacting firstname.lastname@example.org.
Other important notes about the machine-readable files:
- The term “Variable” is used in the file to denote that a rate may have been negotiated for this item, service, or service package, but the terms of reimbursement prevent the generation of a single fixed rate for this item, service, or service package. Similarly, it is also used to denote inpatient DRG*-based charges, signifying that charges will vary for a given DRG. For a more precise estimate, please contact the Hospital Financial Liaison (contact information listed above).
- The term “Not separately reimbursable” is used for inpatient expected reimbursement in instances where a payor does not reimburse on a DRG basis.
- The term “Cash Package Pricing” indicates cash pricing for selected services. Please visit our Cash Pricing page to learn more.
- The term “self-pay” signifies discounted facility charges equal to 55% of billed charges.
- Multiple services may be included within each procedure represented by a CPT**; we are only displaying the negotiated rate for the fixed primary CPT.
*DRG refers to Diagnosis Related Group, which is a methodology for inpatient reimbursement
**CPT refers to Current Procedure Terminology, which is a methodology for outpatient reimbursement