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Hospital Price Transparency

The information found here includes all of Valleywise Health’s pricing data for services at our hospital locations, in formats required by The Center for Medicare & Medicaid Services (CMS).

Do not delay or avoid hospital care based on cost or ability to pay. We want to help you make informed decisions about your care. To obtain cost estimates for common health care services, please access our easy-to-use Patient Estimator tool. Valleywise Health offers financial assistance programs and payment options. You may also contact our financial counselors for assistance by calling 833-855-9973. For the most accurate estimate of out-of-pocket costs, contact your insurance provider.

Patient Estimator

Our Patient Estimator tool provides standard charges for shoppable services that are commonly scheduled in advance and available at Valleywise Health hospital locations. Please note that this is a planning tool only. Final charges (the amount paid by your insurance and by you) can and will change based on a number of factors, including (but not limited to):

  • Insurance coverage
  • Insurance deductible
  • Insurance copay
  • Actual services and care provided
  • Rates are subject to change

A financial counselor can help explain these and other factors that will impact your final charges.

Patient Estimator Tool

About the Hospital Price Transparency Final Rule

The Centers for Medicare & Medicaid Services’ (CMS) Price Transparency Final Rule requires hospitals operating in the U.S. to establish, update and make public a list of its standard charges for the items and services it provides.

All hospitals are also required by this law to provide standard pricing of shoppable services under the Hospital Price Transparency Final Rule. This rule is intended to help consumers gain a better understanding of what charges they may expect for their care. For more information: Hospital Price Transparency

Terms to know

Healthcare terminology may be confusing, especially when you’re navigating insurance codes and billing information. Here are a few definitions you will see associated with the rule:

  • Standard charge: This is the standard price of items and services available through the hospital. Please keep in mind that the final cost of services and care will vary based on many factors, including the time of year service was received, insurance and if any complications arise during care.
  • Chargemaster: The chargemaster is the large file that includes the list of standard charges for all services and items.

Types of charges

You may see multiples charges listed for a service. It is important to understand why and what they are. The rule specifically defines four types of standard charges the hospital is required to provide in a consumer-friendly display. These include:

  • Discounted cash price: The charge applied to an individual who pays cash (or cash equivalent) for a specific item or service.
  • Payer-specific negotiated charge: The charge a hospital has negotiated with a third-party payer (such as an insurance company) for a specific item or service.
  • De-identified minimum negotiated charge: The lowest charge a hospital has negotiated with all third-party payers for an item or service.
  • De-identified maximum negotiated charge: The highest charge that a hospital has negotiated with all third-party payers for an item or service.

Machine-readable file

In addition to the estimation tool, Valleywise Health has also provided a machine-readable file that includes all codes and all payer contract rates for all services provided at our hospital locations. This is in accordance with the Hospital Price Transparency Final Rule.

Machine-Readable Files

Disclaimers for Machine Readable File

  1. Charges and base rates are not all inclusive and can include additional charges and payments for carve out drug and supplies.
  2. The base rate shown represents the allowable payer specific rate and in some instances, due to complications, stop loss or lesser of provisions for atypical claims or physician ordering patterns, utilization and other factors, the allowable amount for a particular claim can be significantly lower or higher
  3. The hospital and physician chargemasters as well as the NDC data represents the most current available as of the Machine-Readable run date
  4. Medicare OPPS, APRDRG & EAPG payment methods represent base rates that can be adjusted by other regional or hospital specific factors. Line item charges and subsequent payments can be subject to packaging. For example, items with a negotiated rate of 0
  5. Service Package under rate methodology within the hospital charge master, represents items that are displayed as an inpatient MS-DRG
  6. EAPG’s are cross walked to a HCPCS, if the EAPG weight is 0.00, the base rate is $0.
  7. Where there are rates displayed for salaried physicians, in some instances where the payer fee schedule is absent of a facility rate, the non-facility rate is what will be displayed.
  8. If the hospital has employed physicians, the MRF will display a separate CDM within the billing code type field with standard charges in accordance with CMS regulations.

Employer Sponsored Plan Price Transparency

Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Valleywise Health. To link to the Machine-Readable Files, please click here.