Charges are the list price set by the hospital before any discounts, write-offs, insurance adjustments, etc. are applied.
Charges by hospital are the charges of the top 20 inpatient diagnoses and outpatient procedures.
Counts by hospital are the counts of the top 20 inpatient diagnoses and outpatient procedures.
Charges and Counts by Hospital (years shown are publication year)
Pricing by service type
* Due to the pandemic, limited number of hospitals were able to submit the data.
Frequently Asked Questions About the Pricing Reports
Why does Vermont report charges for hospital and physician services?
Hospitals are required to report charges for "high volume health care services" according to Vermont law (18 V.S.A. § 9405b) with "...valid, reliable, useful, and efficient information," patients can make informed decisions about their healthcare.
What services are included in the charge lists?
There are three different lists: hospital charges for inpatient stays (DRG codes), hospital charges for outpatient procedures (CCS - Services and Procedures), and hospital and physician charges for common outpatient services (CPT codes). For inpatient stays and outpatient procedures, the list shows hospital charges for higher volume procedures they performed. For common outpatient services, the list is from a selection of charges developed by reviewing other states’ websites, employer claims data, and data from Vermont hospitals. Hospital and physician charges are shown for this list where applicable.
Why do charges for certain procedures vary across hospitals?
Charges could vary because of the unique circumstances related to each patient’s illness. Also, hospitals have a unique mix of patients served, as well as different types and quantities of services they provide. All of these factors affect the charge for a service.
Is the amount that’s listed for a procedure the actual amount that I will be charged and have to pay?
The amounts that are listed for hospital inpatient stays (DRGs) and hospital outpatient services and procedures (CCS) are the average full charge for a procedure. However, very few people actually pay full charges. The actual amount paid will depend upon many variables, including an individual’s insurance plan and the complexity of his/her procedure. The amounts that are listed for common outpatient services (CPT) are the actual price for that service as listed in the hospital chargemaster as of October 1 (some prices are established on January 1).
What is the chargemaster?
The chargemaster is a comprehensive and hospital-specific listing of each item and service that can be billed to a patient, insurance company, or other payer. Every item and service has a specific code and corresponding charge in the charge master. Since there are usually multiple healthcare services provided to a patient, the total invoice typically includes a list of multiple services for a given visit or admission. A patient’s bill is the sum total of this array of services. For example, selected medical events for a given patient may have one code or several codes included in the final invoice for patient care.
What if I have insurance? How does that affect the charge, and how much will I have to pay?
What you will pay depends upon your insurance plan. If you are insured, you will pay only the co-payment, co-insurance, and/or deductible required by your plan, regardless of the total gross charge. Your insurance company will pay a negotiated amount to the hospital that represents some portion of the charge – generally less than the full charge. In some cases, a negotiated discount may be applied to your deductible.
What do I have to pay if I don’t have insurance?
Some hospitals have discount policies for patients who have no insurance, under which the patient receives a discount off of the full charge, similar to the discounts negotiated by insurance companies. All hospitals have free care policies for low-income patients. You can call a hospital to learn about its policies and application process. Financial counselors are available at the hospitals to help answer specific questions and guide you through the process.
Are physician charges included in the prices shown?
Physician charges are included in the list of common CPT outpatient services where applicable. However, the amounts shown for inpatient stays and outpatient procedures do NOT include physician charges. Those charges only include hospital charges.
How do I find information on charges for procedures that are not listed in this report?
If you want to find charges on procedures that are not listed, call the hospital directly and talk to their consumer services representative or someone in the billing department. In nearly all cases, the hospital can provide an estimated charge, but will not be able to give you an absolute price. Individual circumstances can affect the final charges for care.
Should I make a decision based on the charges listed or are there other factors I should consider?
The gross charge is simply one factor in deciding where to go for healthcare. Other factors that should be considered are the location of your doctor, the services offered by a particular hospital, how many of the procedures the hospital has performed, the quality reporting by a hospital, waiting times for the procedure, etc. You also may want to ask questions of your healthcare provider for a better understanding of options for your personal situation.
Where does the pricing information come from for these different hospital services?
The source of the inpatient (DRG) and outpatient (CCS - Services and Procedures) pricing information is the Vermont Uniform Hospital Discharge Data Set. Billing information is compiled into a database and the charges are taken from the database under a set of agreed upon standards. Hospital and physician pricing for outpatient diagnostic services are based upon Common Procedural Terminology (CPT®) code charges that are contained in each hospital’s chargemaster. The hospitals provide these prices directly to the Vermont Department of Health.
