Hospital Pricing
Our hospital pricing document outlines the charges for services at Cincinnati Children’s. Download a pdf copy of the price disclosure required under Ohio law.
The Center for Medicare and Medicaid Services (CMS) requires providers to publish the pricing or provide patient estimates for 300 shoppable services that will provide patients with their estimated out-of-pocket expenses. These 300 services include outpatient visits, diagnostic testing, radiology, labs and certain outpatient procedures that represent some of the services named by CMS and others that were considered shoppable by Cincinnati Children's Hospital Medical Center because they are high volume services provided by our organization. Click here to obtain an estimate for one of these 300 shoppable services.
In addition, you may click here to download a copy of our standard charges for items and services for hospital patients required under the Affordable Care Act. This contains current prices in Cincinnati Children’s chargemaster plus reimbursement by payer for clinical services as required by federal rules that were effective January 1, 2021. Note that the payment of these fees listed are dependent upon third party payor coverage policies under the terms of their contracts with Cincinnati Children's.
Cincinnati Children’s chargemaster is a list of billable services charged by the hospital for services rendered at the main location at 3333 Burnet Ave. as well as our neighborhood hospital locations. Pharmaceuticals, supplies and other items for which there is no payer-specific negotiated charge are not included in this file and are paid by third-party payers in addition to the negotiated charges listed in the file.
Inpatient negotiated charges for Medicaid Managed Care Payers including: Aetna Better Health of Kentucky, Aetna Better Health (OhioRISE), AmeriHealth Caritas, Anthem Indiana, Anthem Kentucky, Anthem Ohio, Buckeye Community Health Plan, CareSource Indiana, CareSource Ohio, Humana Kentucky, Humana Healthy Horizons , MDwise, Inc., Molina HealthCare, , Passport by Molina of Kentucky, United HealthCare Community Plan of Kentucky, United HealthCare Community Plan of Ohio, and WellCare of Kentucky are based on Diagnostic Related Groups (DRG) - a hospital classification system that determines a flat rate payment for an entire inpatient admission – also known as a case-rate. The specific services, items, etc., in the file are not paid on an individual basis but are included in the case rate for the admission. Components used in the DRG classification are patient’s principal diagnosis or condition requiring the hospital admission. Additional payments may be added for outlier cases. As a result there is no specific negotiated charge that can be listed in the file since it varies by each patient.
Outpatient negotiated charges for Ohio Medicaid Managed Care Payers including: Aetna Better Health (OhioRISE), AmeriHealth Caritas, Buckeye Community Health Plan, CareSource Ohio, Humana Healthy Horizons, Molina HealthCare, Anthem Ohio, and United HealthCare Community Plan of Ohio are based on Enhanced Ambulatory Patient Groups (EAPG) - a classification system based on the principal diagnosis and procedure codes submitted for a date of service. The specific services, items, etc. in the file may not be paid on an individual basis but may be included in payment groupings for services rendered during the outpatient date of service. The EAPG system is designed to classify services into groups that utilize similar resources and have similar costs. As a result there is no specific negotiated charge that can be listed in the file since it varies by each patient.
Outpatient negotiated charges for Indiana Medicaid Managed Care Payers including: Anthem Indiana, CareSource Indiana, and MDwise, Inc. are based on an outpatient prospective payment system for outpatient surgeries and a fee schedule based revenue center codes for other services. The specific services, items, etc. in the file may not be paid on an individual basis but may be included in payment groupings for services rendered during the outpatient date of service. Payments for time-based charges are reimbursed at a flat rate per day, not per incremental time unit. As a result, there is no specific negotiated charge that can be listed in the file since it varies by each patient.
Inpatient and outpatient negotiated charges based on grouping and markup methods over the costs of supply items and pharmaceuticals at the time of service are excluded as there is no specific negotiated charge that can be listed in the file since it varies by each patient.
Effective January 1, 2021, Cincinnati Children’s launched a population health network named HealthVine aimed at improving care for Medicaid-covered children who reside in our primary and secondary service areas. Currently HealthVine has a contract with CareSource covering children who reside in eight counties in Southwest Ohio. Under this arrangement, Cincinnati Children’s assumes accountability for care management and utilization management for these children. Cincinnati Children’s is reimbursed for hospital services under a capitated model which results in a Per Member Per Month (PMPM) payment in lieu of a specific negotiated charge for each service.
Anesthesia payment is made of 3 components: base units per procedure, time units (1 unit per 15 minutes) and additional units for patient age or physical condition may be considered. The total of these units are multiplied by a conversion factor (shown above) so that there is no specific negotiated charge that can be listed in the file since it varies by each patient.
As required by Kentucky Administrative Regulation 311A.032, fees for ambulance services can be found here.
Hospital prices do not reflect what patients pay for services. This is determined by your insurance coverage that includes out-of-pocket requirements and contracted rates and discounts based on agreements between payers and Cincinnati Children’s.
To obtain an estimate of the price you would pay for a service, you may contact our Customer Service Department at 1-877-430-8495 or 1-513-636-4427. You can also create an estimate using our new Guest Estimate feature. Prior to calling for a price estimate, you will need the following information:
- Description of services or the CPT procedure codes, which may be obtained from your referring physician
- Name of your insurance plan
