Understanding the Price Transparency Machine-Readable File

When you access the machine-readable file, you will find three tabs of information. Below is an explanation of what each of these items mean.

The chargemaster, often referred to as a hospital chargemaster, is an extensive list detailing the costs associated with all inpatient and outpatient services or items provided by a hospital. This includes everything from tests and exams to surgical procedures and room charges. Given the vast array of services offered by hospitals around the clock, a chargemaster is an exhaustive document containing thousands of service entries along with their corresponding charges. While the amounts listed in the chargemaster are what hospitals bill insurance companies, Medicare, or Medicaid, these insurers typically apply their own contracted or fee schedule rates to determine the actual payment amounts.

Cost Ranges

Hospital charges can vary widely based on the type of service or procedure. For example, a standard blood test may range from $10 to $100, while more complex surgical procedures can cost anywhere from $5,000 to $50,000 or more. Room charges also vary depending on the type of room and level of care required, with general room charges often starting at several hundred dollars per day.

Local Tips

Understanding your local hospital's billing practices can save you money. Contact the hospital's billing department to ask about financial assistance programs or payment plans if you are facing high costs. Additionally, some hospitals may offer discounts for uninsured patients or for paying the bill promptly.

FAQs

What is a chargemaster?

A chargemaster is a comprehensive list of billable services and items provided by a hospital, each with its associated charge.

How do insurers determine the amount they pay?

Insurers apply their contracted rates or fee schedules to the amounts listed in the chargemaster, which often results in lower payment amounts than the initial charges.

Can patients access the chargemaster?

Yes, hospitals are required to make their chargemasters available to the public, often through their website or upon request.

Chargemaster
This is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.

The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted or fee schedule rates to the services that are billed.

All Service Items
The All Service Items price list is based on information we have gathered from our claims and insurance payment files. This is machine-readable information containing required data elements under the CMS rule and is not necessarily intended for direct patient consumption. This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons including the seriousness of your medical condition, the actual time the procedure takes, and the services and supplies that you receive. If you have insurance, your benefits will ultimately determine the amount you owe (including deductibles, co-pay, co-insurance, and out-of-pocket maximums).

Shoppable Items
The high degree of variation in charging practices and differences in reimbursement methodologies between insurance payers make it difficult for patients to get the intended full-benefit of “pricing transparency.” Medicare wanted to give patients another way to compare prices, so the requirement asked hospitals to make prices available for shoppable services or items in a patient-friendly format.

Medicare defines “shoppable services” as services that typically can be scheduled by a patient in advance on a non-urgent basis. Medicare has identified 70 shoppable services that all hospitals should include and has asked hospitals to choose at least 230 additional shoppable services that they perform most frequently.