At UCSF Health, we're committed to helping patients and their families make informed health care decisions. This commitment includes providing information and resources related to the potential cost of treatment at UCSF Benioff Children's Hospitals.
In addition, federal law* requires medical centers to publish online a list of standard charges for hospital items and services, and update it at least once a year. You can click below to view our current lists in JSON format. This list is effective January 1, 2021.
UCSF Benioff Children's Hospitals standard charges
This document lists the gross charge for all services and items that could potentially be billed to our patients, insurers and guarantors. This list represents line-item charges for many different elements of the care we provide, such as surgical procedures, hospital rooms, special facilities such as operating rooms, supplies, devices, procedures, tests and medications.
We have also provided our self-pay pricing along with any fixed payer-specific negotiated charges. Please note that UCSF provides many complex services, which are reimbursed at a variable rate. This means that the reimbursement is dependent on many factors: the length of stay, medications and supplies provided with the service, and other variable factors.
The charges hospitals are required to post on this list may not reflect what you will actually pay. Your child's doctor and care team will determine what services and treatments are necessary. Your individual out-of-pocket costs will be impacted by insurance plan coverage, co-pays and deductibles, if applicable, as well as by the services provided and other variables that affect costs. For those reasons, this list should not be used to estimate the actual final cost you will incur.
We want you to understand your potential out-of-pocket costs before your visit, and we have a team of financial advisors available to help you with this. To speak with an advisor about a personalized out-of-pocket financial responsibility estimate specific to your child's care, call the Patient Estimate Program at the toll-free number below. For questions about our price lists, email [email protected].
Inpatient diagnosis-related groups (San Francisco)
Federal regulations* also require some hospitals to publish a list of average hospital charges for varying inpatient hospital stays by medical condition, known as diagnosis-related groups (DRGs). These charges represent the combined elements of the average hospital stay for patients with that particular medical condition. However, as with the line-item charges noted above, they are not the actual fees an individual patient would pay. Below is a list of UCSF Medical Center and UCSF Benioff Children's Hospital San Francisco's inpatient average DRG charges for fiscal year 2019.
Frequently Asked Questions
- What is the new CMS regulation, and what does it require?
In October 2018, the Centers for Medicare and Medicaid Services established a new requirement that hospitals post a list of standard charges for hospital items and services by Jan. 1, 2019, as well as diagnosis-related group (DRG) average charges, on the internet. The rule requires hospitals to list their charges, which are different from the amounts that either patients or insurers actually pay.
In November 2019, CMS added a requirement that hospitals post a machine readable file containing gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. This requirement went into effect on January 1, 2021.
- Has UCSF Health complied with the regulations?
Yes, we have complied with this new regulation by posting a machine readable file above. In addition to the steps CMS has required us to take, we are committed to helping patients and their families make informed decisions about every aspect of their care, including the out-of-pocket costs. We have a team of financial advisors available to help you with this. To speak with an advisor about a personalized out-of-pocket financial responsibility estimate specific to your visit and care, call the Patient Estimate Program at the number below or visit our Billing & Insurance page for more information.
- Haven't you been transparent about pricing in the past?
Yes. In fact, UCSF Health has been posting these prices online with the State of California Office of Statewide Health Planning and Development for years, in accordance with the State of California Payers Bill of Rights of 2003. The site updates pricing information each June for all hospitals in California. In addition, price information is readily available at our facilities.
- Is this what I will actually be charged if I come to UCSF Health?
The prices that hospitals are required to publish may not reflect the price you will pay. As an individual patient, your responsibility would depend on your insurance plan, coverage, deductibles, co-insurance and other factors.
- Why are the DRG charges so much higher than "standard charges"?
The List of Standard Charges, also known as the charge master list, reflects line-item charges for individual items, such as operating rooms, bone marrow procedures, etc. By contrast, the DRG is an average of the total charges for patients with a specific diagnosis, including all the line items that are involved in providing care. The average DRG total charges would be impacted by the acuity of an average patient's condition, his or her length of stay in the hospital, tests and medications, and other charges involved in his or her care.
Note that this is not what any patient would actually pay. Not only are these the average total charges for all patients with a particular medical condition, but an individual patient's out-of-pocket responsibility would be influenced by insurance coverage, deductibles, co-insurance and other factors.
- Why do different hospitals charge different prices for the care they provide?
There are no specific requirements or consistent guidelines for how hospitals determine their charges. As a result, one hospital might combine the charges of some line items, while another may spell out each charge individually. Neither approach is right or wrong, and both comply with the federal rule; they are simply different ways of representing the charge for a therapy or procedure.
In addition, some hospitals, including UCSF Medical Center and UCSF Benioff Children's Hospitals, serve as tertiary and quaternary referral hospitals, so other hospitals send patients who require more specialized care to us. As a result, the total charges for our patients normally include more extensive care, meaning potentially more line items and higher average charges.
- These lists are extremely confusing. How do we make sense of them?
Yes, this is extremely confusing. At UCSF Health, we have a team of financial assistance counselors to help current and prospective patients understand their potential out-of-pocket costs. Our team makes every attempt to personalize these quotes to enable patients to make informed decisions and understand their potential financial liability, both before and after their care. We also offer financial assistance and discounts for patients who have no insurance or, for patients who qualify, help them enroll in available and appropriate Medicare and Medi-Cal programs.
To speak with a staff member about a personalized out-of-pocket estimate specific to your visit and care, call the Patient Estimate Program toll-free at (844) 678-6831 or visit our Billing & Insurance page for more information.
For questions about our standard charges posted above, please email us at [email protected].
* This information is made available for inspection in compliance with the Centers for Medicare & Medicaid Services (CMS) rule CMS-1694-F and CMS-1717-P.
Billing & Insurance
After health insurance processes a claim, you may need to pay a portion out of pocket. Learn about billing, payment options, assistance and more.
We accept numerous health insurance plans at our pediatric hospitals in San Francisco and Oakland. Find out if your plan is one of them.
Financial assistance is available to eligible families for emergency and medically necessary pediatric care. Read about requirements and how to apply.
Health Insurance Glossary
Our glossary explains health insurance terms related to your child's care in language that's easy to understand. Get info about HIPAA, referrals and more.