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 rates.
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.
“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 is a comprehensive list of items and services provided by the hospital in 2020. The list includes the hospital’s 2020 standard charges for each inpatient and outpatient service or item (also known as a chargemaster); 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. This list of services/items and the corresponding amounts is based on 2020 claims data.
Codes and prices not included in file:
- Codes not billed in 2020
- 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 2020
- 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 at: https://www.cms.gov/hospital-price-transparency/consumers to better help you understand this data and how it can be used to compare prices for similar services at other hospitals.