Please consider the following when using this file:
- We strongly encourage patients shopping for services to use the Shoppable Services Price Estimate tool or contact their health insurance provider to determine applicable benefit limits and out-of-pocket costs. Patients could also call the hospital directly to discuss estimates specific to amounts potentially owed (e.g., deductibles, copayments, and coinsurance balances).
- This file does not account for all financial assistance or uninsured/underinsured discounts that are available to eligible patients and does not facilitate the calculation of other patient responsibility amounts, which vary by patient and visit type.
- Payers might not reimburse for each service or item using the same methodology, which inhibits comparison between payers for those services and items without applying rate structures related to specific patient stays. Rates provided do not account for outlier reimbursement, carve-out services and items, add-ons, and rate structures related to specific patient stays (e.g., length of stay). Based on negotiated contractual agreements, payers might also adjust the reimbursement listed in this file based on value-based or quality-based assessments.
- This file does not include charges for services not provided by the hospital or charges billed for non-hospital services, such as the provider's professional fees. Only prices for negotiated services and items are included in this file. Anything left blank is either not reimbursed or not separately reimbursed by the applicable payer.
- Gross charges are not provided for non-chargemaster items (e.g., DRGs) because there is no fixed gross charge amount. Patients with the same DRG might have significantly different charges based on severity of illness, services rendered, and other complicating clinical factors. Since our cash price is based on a percentage of gross charges, it cannot be provided for these items because it does not exist.
- While negotiated rates are provided for chargemaster items, many are not separately reimbursable when billed in association with a procedure paid at an all-inclusive rate, even when a charge amount is listed. This is common for supplies and drugs that are packaged in reimbursement, which make up a significant amount of the overall chargemaster line items.
- Charges, minimums, and maximums are provided for payers with negotiated rates. Typically, negotiated rates for managed Medicare/Medicaid payers are benchmarked against government payer reimbursement, which might be less than commercial reimbursement. Therefore, these rates should not be compared.
- In some situations, contract terms establish reimbursement based on a specific methodology or billing code, even when multiple methodologies or billing codes might apply. For example, an inpatient nursery stay for a newborn baby is often reimbursed by revenue code, not MS-DRG/APR-DRG, even though negotiated DRG rates exist for that service.
- In some cases, reimbursement might be capped to a maximum of billed charges regardless of the negotiated rates. Additionally, charges measured in increments (e.g., hours, milliliters) might be reimbursed based on a fixed amount that’s not directly proportional to the quantity billed.
- Rates and applicable payers are subject to change. As new contracts are negotiated and rates are updated, this file is regularly updated and maintained. This data is current based on the date indicated in the file.
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