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.

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.