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Price Transparency Standard Charges

Federal Price Transparency Requirements 

 

For Patients: If you are looking for an estimate of costs of an item or service, please use our Price Estimator Tool or contact one of our Financial Counselors at 508-334-9300

The following information is provided as required by the federal Price Transparency Rule, but it should not be relied upon for purposes of predicting the actual cost of care for the reasons described below.

The intent of price transparency is to provide information to help patients make decisions about the cost of their health care. Starting January 1, 2021, the federal government requires each hospital operating in the United States to provide clear, accessible pricing information online about the items and services they provide in two specific ways:

1.    A list of shoppable services or a price estimator tool

2.    A comprehensive, machine-readable file of all “Standard Charges” for items and services they provide, and the rates negotiated with every insurance company it contracts with and self-pay

This price information contained in these large files is NOT an estimate of the costs that you are responsible for paying. These files are not intended for patients and do not reflect your out-of-pocket costs. If you are a patient, you can request a cost estimate by contacting Financial Counseling at 508-334-9300 or use our online tool to view a cost estimate of common health care services.

HealthAliiance-Clinton Hospital DRG Standard Charges

HealthAlliance-Clinton Hospital CPT Standard Charges

 

“Standard Charges” File Disclaimers

UMass Memorial Health Care is committed to providing patients with meaningful information about their cost of care.  The information provided on this page includes the hospital’s standard charges for each Outpatient service or item (also known as a chargemaster) as of 12-28-2021, list of all Inpatient services provided in Calendar Year 2021, the average negotiated rate paid by each insurance company (payer) for that code, the minimum and maximum payment received from payers, and the discounted cash price for each billing code.  

Codes and prices not included in file:

  • Codes that are not negotiated and included in another rate
  • Codes used for administrative purposes only
  • Items and services provided by physicians and other clinicians not employed by the hospital

While we are committed to providing patients with meaningful cost data, the information in this file is not useful for comparative purposes due to many factors including but not limited to:

  • Payer-specific rates represent average payment received in 2021 for DRG Standard charges
  • Payments are based on payer-specific payment methodologies and diagnostic groupers which vary by payer
  • Payments are subject to application of insurance benefits which vary by patient  
  • Severity of illness or injury
  • How long it takes to perform the service  
  • How long it takes you to recover in the hospital
  • Whether the service or procedure received is more or less difficult than expected
  • Any medications required
  • Any complications and additional treatment
  • Other health conditions you may have that may affect your care.
  • Location of service provided 
  • Claim processing bundling logic

We encourage you to contact your health insurance company for your specific price and cost-sharing information.

For more information on the Federal Price Transparency Rule, you can visit the CMS website to better help you understand this data and how it can be used to compare prices for similar services at other hospitals.

 

Additional Consumer Protections for Medical Costs

Beginning January 1, 2022, new regulations take effect giving patients more protections regarding certain medical costs. Learn more about these surprise billing and balance billing protections.

 

Last Updated (06/10/2022)