We have provided some definitions and information to help better understand the different topics.
Charge: The dollar amount assigned to a specific healthcare service before negotiating any discounts with payors. The charge is different from the price. Very few patients pay the charge regardless of their insurance status; and, therefore, this data is not meaningful to people.
Out-of-Pocket: A portion of the total price for healthcare services and treatment for which the patient is responsible. This includes copayments, coinsurance, and deductibles.
Price: The negotiated and contracted amount providers expect to be paid by payers (also called the “allowed amount”). Your out-of-pocket liability is based on this allowed amount. Note that the price for service will vary by insurance plan as these are separately negotiated.
What the Charge list is: The standard charge list is strictly related to the Charge for a service. Hospitals are typically paid based on contracted rates for the services they provide, so the charge will not reflect the amount paid by your insurance or the amount due from you. Your coverage, co-payments, and deductibles are specific to your insurance plan.
- The information contained in the file is current as of the last upload. Charge information is subject to change and the file will be updated as soon as possible.
- The file contains the charge amount, the charge code, and the charge description of the item or service as reflected in the hospital’s chargemaster.
- The charge list may not include fees for Professional Services (ex. Psychiatrists, Psychologists, Other Professional Providers).
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