What is Pricing Transparency?
Under the Affordable Care Act and guidelines established by the United States Department of Health and Human Services, each hospital operating within the United States must make public on the internet in a machine-readable format a list of the hospital’s standard charges for items and services provided by the hospital. In addition, hospitals are required to provide a searchable consumer friendly display of the most common “shoppable services” that could be utilized for cost estimates to help consumers make more informed decisions.
The Centers for Medicare and Medicaid Services (CMS) requires that hospitals make available a Standard Charge File for consumers to review that includes the five different types of charges defined below. Our hospital Standard Charge file includes information from our charge master and payer negotiated agreements but they do not reflect a patient’s liability. If you have insurance coverage, we encourage you to contact your insurance provider to discuss patient payment obligations as defined under your insurance plan.
- Gross Charge: The full price listed on the hospital chargemaster. Gross charges can vary from hospital to hospital for the same procedure or service based on factors like hospital location, physician supply and medication preferences, the kinds of services the facility typically provides, and the expertise required to deliver the services.
- Discounted Cash Price: The price offered to patients who pay on their own without third-party insurance coverage.
- Payer-Specific Negotiated Charge: The charge a hospital has negotiated with a third-party payer for an item or service, which can vary based on your coverage and specific plan. You’ll sometimes see this referred to as the “allowed amount” on an insurer’s EOB.
- De-identified Minimum Negotiated Charge: The lowest charge a hospital has negotiated for an item or service across all insurers.
- De-identified Maximum Negotiated Charge: The highest charge a hospital has negotiated for an item or service across all insurers.
- The hospital charges listed do not include patient-specific insurance deductibles or copayments, potential self-pay, or financial assistance discounts and therefore are not a reflection of patient responsibility.
- The pricing is in effect as of the applicable period prior to the publication date; pricing is subject to change. Any changes to charges, rates, network participation, or other data elements on or after the publication date are not reflected.
- Actual reimbursement for services is dependent on many factors, such as the length of stay, the specific medical services provided, the medications and supplies provided with the service, and other variable factors that vary by payer and pricing methodology.
- Comparisons of rates within the file between payers or comparison of files between hospitals will not necessarily reflect accurate distinctions in prices due to variations in pricing methodology.
- Pricing does not include charges for all physician services or other ancillary professional services that may be rendered.
- Not all services listed in this file may be currently available at the hospital.
Shoppable Service Cost Estimates
Hospitals are required to provide a searchable consumer-friendly display of the most common “shoppable services” that can provide you with cost estimates for specific services to support you in making informed decisions about your care and its cost. CMS wants you to be able to price shop for a specific hospital service and schedule it at a time that is convenient for you.
We support all efforts to improve your health care shopping experience and to provide cost estimates for services that inform your decision making, but our innovative neighborhood hospital does not offer any shoppable services. Instead, our neighborhood hospital focuses on emergency services and inpatient services. We don’t offer hospital-based outpatient services you can schedule in advance. Instead, in our innovative care model, we create a healthcare HUB that brings many outpatient services to the same building without the hospital costs.
CMS defines a “shoppable service” as a hospital service that can be scheduled by you in advance. Shoppable services are typically those that are routinely provided in non-urgent situations that do not require immediate action or attention to you.
- Our hospitals only provide emergency care and inpatient services and do not offer any “shoppable” services that can be scheduled in advance.
- Because we only focus on the essential hospital services, our hospitals do not provide any opportunity for you to schedule a service at a time that is convenient for you.
- Our hospitals are open 24/7 to serve you for your emergency care and many inpatient needs, however we do not offer any shoppable services that can be scheduled in advance. Some of those “shoppable” services may be available in the same building though other services providers, unaffiliated with the hospital.
For more information about the services available in our hospital and limitations on our ability to provide shoppable services cost estimates to you at this time, please contact a service center representative at (888) 617-8548.
Standard Charge Description files can be downloaded by clicking the links below.
Standard Charge Description Files:
Pricing Transparency Updated: February 8, 2022
The Hospitals of Providence Neighborhood Hospitals makes no guarantees regarding the accuracy of the pricing information provided herein. The pricing information provided by this website is strictly an estimate of prices, and The Hospitals of Providence Neighborhood Hospitals cannot guarantee the accuracy of any estimates. All estimates are based on information provided by a prospective patient and do not include, among other things, any unforeseen complications, additional tests or procedures, and non-hospital related charges, any of which may increase the ultimate cost of the services provided. Any prospective patient should understand that a final bill for services rendered at The Hospitals of Providence Neighborhood Hospitals may differ substantially from the information provided by this website, and The Hospitals of Providence Neighborhood Hospitals shall not be liable for any inaccuracies.