Hospital Price Transparency

Hospital Price Transparency

This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.

header-title-decorationHospital Price Transparency

Current regulations require hospitals to publish certain information about standard charges. Those hospitals are required to provide the information in two ways:

    1. A comprehensive machine-readable file for all items and services
    2. A consumer-friendly display for 500 shoppable services

The following resources are our effort to comply with those regulations. We hope they help patients and families make more informed decision about their care.  That said, the cost of care differs from individual to individual. Therefore, none of the rate information provided here reflects the cost of service provided to any specific individual.

Because the information here is general, we encourage patients to find out more about their own costs before getting care. Patients with insurance coverage should contact their insurance plans directly—as private coverage typically require co-payments or co-insurance—none of which are provided here. Furthermore, the regulation does not require that we disclose fee-for-service rates associated with Medicare or Medi-Cal.

Health Services’ rates are set up differently than those in many other health systems. Generally, we charge bundled (per day or per visit) rates, rather than use per item or service rates as other hospitals do. Because there is not a one-to-one correlation between an item or service and a rate, some of our posted rates are estimates based on a standard course of treatment within our system. In addition, because we are a county safety net system, some of our rates are available only to people who are residents of Los Angeles, uninsured or meet specific program criteria.

Here are some other things to know about the posted rates:

  • Many of the rates we disclose are negotiated with third party payors and are specific to region, hospital, service line or population.
  • Others come from our Board of Supervisors’ approved Charge Data Master—a collection of charges for certain products, procedures, and services sometimes called a “chargemaster.”
  • In many instances our rates vary by care setting; the same service provided in a more intensive health care setting (for example an emergency room) may cost more than the same service provided somewhere else (like a health clinic).
  • Rates may differ for different patients for a number of reasons such as the seriousness of the disease or condition, the patient’s type of health insurance or coverage, and whether the patient has an ability to pay for her or his care.
  • As mentioned above, Health Services usually charges payors per day, per visit, or for bundles of services rather than by item or by service. The rates provided here are estimates and we do not practice itemized billing on an individual basis.
  • None of the information we provide here constitutes an offer of items or services at any price.

For these and other reasons, price comparisons between Health Services’ rates and those of other health systems may be challenging.  Therefore, before scheduling any procedure or drawing any conclusions about what your service may cost, please contact the following:

Los Angeles General Medical Center: (323) 409-6361

Harbor/UCLA Medical Center: (424) 306-7000

Olive View/UCLA Medical Center: (747) 210-3082

Rancho Los Amigos National Rehab. Center: (562) 385-7320

 

Machine Readable Files

cms-hpt.txt

The downloadable Machine Readable files below include the following for services rendered by Health Services’ hospitals.  For the reasons expressed above, these rates do not necessarily reflect the amount a patient may ultimately pay:

  • the gross charge for each service
  • the hospital negotiated base rate
  • the maximum and minimum payment rate
  • Financial Assistance Programs and Charity Care Policy

Los Angeles General Medical Center

Harbor-UCLA Medical Center

Olive View-UCLA Medical Center

Rancho Los Amigos National Rehabilitation Center

 

Consumer Shoppable Services

The consumer shoppable rates include the following information for 500 services commonly provided by Health Services’ hospitals, including seventy services specified by Centers for Medicare and Medicaid Services:

  • the hospital negotiated base rate
  • the maximum and minimum payment rate
  • Financial Assistance Programs and Charity Care Policy

For the reasons expressed above, these rates also do not necessarily reflect the amount a patient may ultimately pay.

 

Los Angeles General Medical Center

Payor Contract – Shoppable Inpatient Services By Per Diem for Anthem Blue Cross, Blue Shield Promise, L.A. Care, Molina, and Health Net

Medicaid Payor Contracts – Shoppable Inpatient Services By APR-DRG for Kaiser

Medicaid Payor Contracts – Shoppable Outpatient Facility and Professional Services By Procedure for Anthem Blue Cross, Blue Shield Promise, Health Net, Kaiser, L.A. Care, and Molina

Medicare Payor Contracts – Shoppable Inpatient Services By MS-DRG for Blue Shield Triwest, Kaiser, Molina, and L.A. Care

Medicare Payor Contracts – Shoppable Outpatient Services By Procedure for Blue Shield Triwest, Kaiser, Molina, L.A. Care

Commercial Payor Contracts – Shoppable Outpatient Services By Service Area for Kaiser

Commercial Payor Contracts – Shoppable Services By Service Area for Anthem Blue Cross

Commercial Payor Contracts – Shoppable Outpatient Lab Services By Service Area for Anthem Blue Cross

Medicare and Commercial Payor contracts – Shoppable Professional Services by Procedure for Blue Shield Triwest and Anthem Blue Cross

 

Harbor-UCLA Medical Center

Payor Contract – Shoppable Inpatient Services By Per Diem for Anthem Blue Cross, Blue Shield Promise, L.A. Care, Molina, and Health Net

Medicaid Payor Contracts – Shoppable Inpatient Services By APR-DRG for Kaiser

Medicaid Payor Contracts – Shoppable Outpatient Facility and Professional Services By Procedure for Anthem Blue Cross, Blue Shield Promise, Health Net, Kaiser, L.A. Care, and Molina

Medicare Payor Contracts – Shoppable Inpatient Services By MS-DRG for Blue Shield Triwest, Kaiser, Molina, and L.A. Care

Medicare Payor Contracts – Shoppable Outpatient Services By Procedure for Blue Shield Triwest, Kaiser, Molina, L.A. Care

Commercial Payor Contracts – Shoppable Outpatient Services By Service Area for Kaiser

Commercial Payor Contracts – Shoppable Services By Service Area for Anthem Blue Cross

Commercial Payor Contracts – Shoppable Outpatient Lab Services By Service Area for Anthem Blue Cross

Medicare and Commercial Payor contracts – Shoppable Professional Services by Procedure for Blue Shield Triwest and Anthem Blue Cross

 

Olive View-UCLA Medical Center

Payor Contract – Shoppable Inpatient Services By Per Diem for Anthem Blue Cross, Blue Shield Promise, L.A. Care, Molina, and Health Net

Medicaid Payor Contracts – Shoppable Inpatient Services By APR-DRG for Kaiser

Medicaid Payor Contracts – Shoppable Outpatient Facility and Professional Services By Procedure for Anthem Blue Cross, Blue Shield Promise, Health Net, Kaiser, L.A. Care, and Molina

Medicare Payor Contracts – Shoppable Inpatient Services By MS-DRG for Blue Shield Triwest, Kaiser, Molina, and L.A. Care

Medicare Payor Contracts – Shoppable Outpatient Services By Procedure for Blue Shield Triwest, Kaiser, Molina, L.A. Care

Commercial Payor Contracts – Shoppable Outpatient Services By Service Area for Kaiser

Commercial Payor Contracts – Shoppable Services By Service Area for Anthem Blue Cross

Commercial Payor Contracts – Shoppable Outpatient Lab Services By Service Area for Anthem Blue Cross

Medicare and Commercial Payor contracts – Shoppable Professional Services by Procedure for Blue Shield Triwest and Anthem Blue Cross

 

Rancho Los Amigos National Rehabilitation Center

Payor Contract – Shoppable Inpatient Services By Per Diem for Anthem Blue Cross, Blue Shield Promise, L.A. Care, Molina, and Health Net

Medicaid Payor Contracts – Shoppable Inpatient Services By APR-DRG for Kaiser and L.A. Care

Medicaid Payor Contracts – Shoppable Outpatient Facility and Professional Services By Procedure for Anthem Blue Cross, Blue Shield Promise, Health Net, Kaiser, and Molina

Medicaid Payor Contracts – Shoppable Outpatient Services By Procedure for L.A. Care

Medicare Payor Contracts – Shoppable Services By Service Area for Health Net

Medicare Payor Contracts – Shoppable Inpatient Services By MS-DRG for Blue Shield Triwest, Kaiser, Molina, and L.A. Care

Medicare Payor Contracts – Shoppable Outpatient Services By Procedure for Blue Shield Triwest, Kaiser, Molina, L.A. Care

Commercial Payor Contracts – Shoppable Services By Service Area for HealthNet

Commercial Payor Contracts – Shoppable Services By Service Area for Kaiser

Commercial Payor Contracts – Shoppable Services By Service Area for Anthem Blue Cross

Commercial Payor Contracts – Shoppable Outpatient Lab Services By Service Area for Anthem Blue Cross

Medicare and Commercial Payor contracts – Shoppable Professional Services by Procedure for Blue Shield Triwest and Anthem Blue Cross

 

Key Resources

  1. CMS FAQ for Hospital Price Transparency
  2. CMS Hospital Price Transparency final rule published 11/16/2023 Hospital Price Transparency | CMS
  3. New Hospital Price Transparency Enforcement Updates | CMS Final Rule Fact Sheet (issued Apr 26, 2023)
  4. Medi-Cal Fee Schedule- professional and outpatient: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/rates
  5. Medi-Cal Fee Schedule inpatient: DRG-Pricing-Resources-for-SFY-2023-24 (ca.gov)
  6. Medicare Physician Fee Schedule: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx