Find price information and standard charges for shoppable services, as required by federal law.
We’re committed to helping you understand potential charges for the care your child will be receiving.
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At Phoenix Children’s, we believe getting and paying for healthcare should be the last thing on your mind when your child needs specialized care. To make it easier, we’ve provided helpful information here about what you might expect to pay for certain healthcare services, in accordance with the Hospital Price Transparency Final Rule.
Our estimation tool provides standard charges for shoppable services that are commonly scheduled in advance and available at Phoenix Children’s. 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 Phoenix Children’s financial counselor can help explain these and other factors that will impact your final charges.
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.
Searching for shoppable services
A shoppable service is a service that can be scheduled in advance. As defined by the federal government, shoppable services are those that are routinely provided in non-urgent situations that do not require immediate action or attention to the patient, thus allowing the patient to price shop and schedule a service at a time that is convenient for them.
Additionally, the Price Transparency Final Rule states that charges for shoppable services should be displayed as a grouping of related services. This means that the charge for the shoppable service (primary service) is displayed along with charges for ancillary items and services the hospital typically provides along with the primary shoppable service. For example, the estimate may include charges frequently associated with the requested procedure such as laboratory or facility fees. This helps consumers see the cost of the service in the same way they experience the service.
While shoppable services are those that can be scheduled in advance, they are not services that are always scheduled in advance. For example, certain imaging or laboratory tests can be scheduled in advance in non-emergency situations, but would not be in an emergency situation. A hospital may include these services in its list of shoppable services, even though they are not shoppable in all situations.
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.
- Charge: This is the final amount billed to your insurance for an item or service.
- Chargemaster: The chargemaster is the large file that includes the list of standard charges for all services and items.
Types of charges
Recognizing you may see multiples charges listed for a service, it is important you 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.
In addition to the estimation tool, Phoenix Children’s has also provided a machine-readable file that includes all codes and all payer contract rates for all services. This is in accordance with the Hospital Price Transparency Final Rule.
Requirements under the rule
The Hospital Price Transparency Final Rule requires that Phoenix Children’s select shoppable services that are commonly provided to the general public. If Phoenix Children’s does not provide one or more shoppable services, we will indicate this with “N/A” or a clear statement that the service is not provided. Phoenix Children’s is not required to make public Medicare and Medicaid fee-for-service (FES) reimbursement rates because such data is publicly available.
Phoenix Children’s also has flexibility in formatting shoppable services standard charges. However, the information must be updated each year to ensure it reflects any recent changes. Phoenix Children’s will clearly indicate the last date pricing information was reviewed and updated, as required by the law.
The information provided through our shoppable services list is an estimate and is not a guarantee of the final billing charges. Your actual bill may vary from the estimate based on the patient’s medical condition, unknown circumstances or complications, final diagnosis and recommended treatment ordered by your physician, among other things. Your estimate is based on a current procedural terminology (CPT) code, which can also affect your final bill if the incorrect code is inadvertently used by you in the pricing tool or if recommended treatment changes. Rates are subject to change. You should not rely on the information provided in your estimate to determine the actual amounts owed by you and your insurance company.
Professional fees, such as physician, radiologist, anesthesiologist and pathologist may not be all-inclusive in this estimate. This is an estimate only and not a guarantee of payment. Final payment may differ.