Price Transparency: Standard Charges and Price Estimates

UC San Diego Health recognizes the importance of patients' access to information and is committed to helping patients better anticipate out-of-pocket costs for specific services.

Price Estimates for Shoppable Services

In accordance with the Centers for Medicare & Medicaid Services (CMS) Pricing Transparency Rule, effective January 1, 2021, the estimator link provided below contains the required 70 CMS-specified and 240 UCSD-selected shoppable services.

Important note: The estimated fees, based on services selected and benefits provided, will be a hospital estimate and not a guarantee of final billed charges. Professional fees, such as physician, radiologist, anesthesiologist, and pathologist fees are not included in the estimate. Your out-of-pocket costs will depend upon actual services that you receive. Your insurance coverage determines your co-payment, co-insurance percentage, and annual deductible. If you receive a $0 estimate or no estimate at all, it may be due to currently unavailable plan-specific benefit information, and you are encouraged to manually enter your specific benefit information. If you have questions about your current benefit information, please contact your insurance provider.

Right to Receive a Good Faith Estimate

UC San Diego Health is providing the following notification in accordance with Section 2799B‐6 of the Public Health Service Act.

Patients who are not enrolled in a health care plan or coverage, or a federal health care program, or not seeking to file a claim with their plan or coverage, have the ability, at the time of scheduling health care items and services or upon request, to receive a Good Faith Estimate of expected charges.

  • The estimate will be provided in writing at least one business day before your scheduled medical service or item.
  • The estimate may be the average charges for the items and services, and the actual charges may exceed the estimate.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. To learn more about the dispute process, please contact a UC San Diego Health customer service representative by:

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call our estimate line at 855‐657‐4550 and select option 1.

Standard Charges

Hospitals are also required to establish and make public a list of their standard charges (also called the charge description master, CDM, or chargemaster). The charge information displayed on this website is representative of either current hospital charges or average charges for items that are not priced until dispensed (pharmaceuticals, biologicals, supplies and implants).

Note: This data is stored in a machine-readable JSON file. To open, right-click and select "Save Link As." The download may take up to 10 minutes and can be opened using the Notepad ++ application. (Download link for Notepad ++) 

Background

In an effort to encourage price transparency by improving public accessibility of charge information, the federal Centers for Medicare & Medicaid Services (CMS) updated its guidelines, effective Jan. 1, 2019, to specifically require hospitals to make public a list of their standard charges via the internet in a machine-readable format, and to update this information at least annually, or more often as appropriate.

Information to Help Patients Use This Data

This data is intended to help you become a well-informed patient who actively participates in your medical care. This report is one tool; use it as a guide. In addition, you can ask questions about your diagnosis and proposed medical care; written information may be available. If the terms are too technical, ask what they mean. Clear information will help you more successfully follow your doctor’s advice.

Other information that will help put this data into context:

  • Physician charges are not included. Depending on the services provided, you may receive a separate bill from some providers within UC San Diego Health that have their own billing departments. Please direct any questions for these departments to the phone number provided on the billing statement.
  • Practice decisions vary from physician to physician, and collectively may explain some differences in charges and outcomes across facilities (if you utilize this information to compare to other healthcare facilities).
  • Severity of illness and intensity of care may vary. Patients within the same diagnostic related group (DRG) may need very different levels of service and staff attention, causing a variation in charges.
  • Current charges and outcomes may be different than those displayed here. The information presented is a snapshot of the data from the most recently available 12-month time period for the average charges by DRG, and UC San Diego Health is committed to refreshing the data annually, at the beginning of the calendar year, to reflect any charge increase based on inflation by suppliers and pharmaceutical companies.
  • Some reasons why charges may differ among facilities:
    • The equipment facilities use to provide services differs in age and frequency of use and may impact the charges of the hospital.
    • Salary scales may differ by region and are typically higher in urban areas than in rural areas.
    • Shortages of nurses and other medical personnel may affect regions differently. Where shortages are more severe, staffing costs, and therefore charges, may be higher.
    • Facilities differ in their approach to pricing based on operational costs. Some facilities try to spread the cost of all services and equipment among all patients. Others establish charges for specific services based on the cost to provide each specific service. Some facilities may provide certain services at a loss while other facility operations subsidize the losses. Any of these situations can result in significantly different charges among hospitals for a given type of service.
  • Charges shown are the facility’s standard service/supply charges. The charge reduction for the service/supplies the patient receives is based on your insurance company’s contract with UC San Diego Health.
  • For self-pay patients who do not qualify for financial assistance, we offer a discount equal to 45 percent of the charge for many qualifying services/supplies.
  • The file is based on Diagnosis Related Groups (DRGs). A DRG is a grouping of diagnoses which represent similar, but not the same, diseases, and the resources provided to care for patients with similar diseases. For example, there is more than one DRG for pneumonia; that is, a patient may group into a different pneumonia DRG depending on the type and severity of the pneumonia and the resources necessary to treat it.

Other Resources

For general questions about health care, refer to these sites:

Contact Us

We are here to help. For billing questions, call 855-827-3633, 9 a.m. – 6 p.m. weekdays, or email askus@ucsd.edu.

You can also visit Frequently Asked Questions for information about general billing issues, financial assistance and your billing statements.