Understanding your hospital costs
The CY 2020 Outpatient Prospective Payment System (OPPS) Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates: Price Transparency Requirements for Hospitals to Make Standard Charges Public (CMS-1717-F2) final rule (Hospital Price Transparency final rule) was published in the Federal Register on November 27, 2019. In accordance with this rule, as of January 1, 2021, hospitals are required to provide clear, accessible pricing information about the items and services they provide in two ways:
In accordance with this rule, as of January 1, 2021, hospitals are required to provide clear, accessible pricing information about the items and services they provide in two ways:
- Display of shoppable services in a consumer-friendly format.
- Comprehensive machine-readable file with all items and services.
CMS recognizes the ability to price shop across settings, and calculate and compare out-of-pocket costs, requires data from both providers and payers.
We hope that the pricing information we have made available helps you make more informed decisions about your health.
The hospital must provide the following in a machine-readable file format:
- The gross charge is the charge for an individual item or service reflected on a hospital’s chargemaster, absent any discounts.
- The discounted cash price is the charge that applies to an individual who pays cash, or cash equivalent, for a hospital item or service.
- The payer-specific negotiated charge is the charge that a hospital has negotiated with a third-party payer for an item or service.
- The de-identified minimum negotiated charge is the lowest charge that a hospital has negotiated with all third-party payers for an item or service.
- The de-identified maximum negotiated charge is the highest charge that a hospital has negotiated with all third-party payers for an item or service.
LMH Health is required to update this information at least annually. The information contained in the file may not reflect LMH Health’s current prices, current negotiated rates, or current services.
- The prices included in this machine-readable format may not reflect any quality incentives or accountable care organization arrangements that LMH Health may have with the individual payers.
- The prices will not reflect any coinsurance, copays, deductibles, or out-of-pocket maximums that affect the patient’s final bill.
- Due to the complexities of the contracts with individual payers, location and type of service may alter the methodology of payment.
- The prices included do not include those costs associated with other providers, which are often billed separately. These charges may include services performed by emergency room physicians, pathologists, radiologists, or anesthesiologists.
- These prices are not intended for media use.
We have provided an accurate machine-readable file considering the limitations of these complexities.
By downloading the file, I acknowledge I have read the above information. Click the link below to download the file:
These prices were updated January 1, 2022.
Comprehensive Health Plans
The Transparency in Coverage final rule (CMS-9915F) which requires group health plans and health insurance issuers, including self-funded plans are required to make available to the public, including stakeholders such as consumers, researchers, employers, and third-party developers, three separate machine-readable files that include detailed pricing information was published in the Federal Register on October 29, 2020. In accordance with this rule, as of July 1, 2022 these files must be posted on the group health plan or health insurance issuer’s public website. The first file will show negotiated rates for all covered items and services between the plan or issuer and in-network providers. The second file will show both the historical payments to, and billed charges from, out-of-network providers. Historical payments must have a minimum of twenty entries in order to protect consumer privacy. UnitedHealthcare, UMR, and HealthSCOPE Benefits creates and publishes the required machine readable files on behalf of LMH Health. View the machine-readable files. View the machine-readable files