Price Transparency: Price Estimate and Downloadable List
For individuals with insurance or self-pay the Centers for Medicare and Medicaid Services has identified 70 CMS required Shoppables and requires hospitals to add 230 more shoppable services. If pricing for a shoppable service is not included as an Estimate option, the service is not available from the hospital. The 70 required Shoppables and the additional 230+ Shoppables and standard charges are available via the price estimator tool.
Downloadable CMS MRF
Standard charges for all services are included in the CMS machine-readable file (MRF) on a downloadable list.
Mishawaka Medical Center
Plymouth Medical Center
Quick Links:
COVID Testing | Request Price Estimate | Helpful Definitions | Price Disclosure & Lists | No Surprises Act
Trinity Health Public Policy and Federal Advocacy is committed to working with consumers, payers and policymakers on developing the best solutions for achieving price transparency goals. Our active participation in CMS rule-making process reflects a strong interest in public policies that support better health, better care and lower costs to ensure affordable, high quality, and people-centered care for all.
We support price transparency and believe it is important for you to know what out-of-pocket costs you will incur for services provided at Saint Joseph Health System. We have established three easy ways for you to obtain estimate of your costs – call, online or download.
COVID-19 Testing
During these unprecedented times, it is important for you to know the cost of COVID diagnostic testing. The COVID-19 test cash price is $53 – $375, depending on the type of test. The test conducted will be billed. Patients are not required to pay for COVID-19 tests. The cash price will be charged to third party payers if a contracted price has not been negotiated. The amount charged also is subject to adjustment if state law mandates pricing or the test is performed by a government agency.
Price Estimate for Services
SJHS supports price transparency and believes it is important for you to know what out-of-pocket costs you will incur for services provided at one of our facilities. We have established two easy ways for you to obtain estimate of your costs – simply call us at either 574.335.1360 or 574.335.4500 to get an estimate of your out-of-pocket costs for a medical service or procedure.
We review:
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The specific service or procedure you will receive
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The physician providing the service
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Your insurance, including what you have already paid toward your deductible
Use our Price Estimate Request form and we will send you an estimate of the charge for medical services or procedures. This only reviews the specific service or procedure and provides you with an average estimate of the charge and does NOT assess your insurance or out-of-pocket costs.
No Surprises Act – Good Faith Estimate
Uninsured and self-pay patients may request a good faith estimate. Learn more
Price disclosure and lists
- Updates. The information contained in the file(s) is current as of the last upload. This information is subject to periodic changes and the file(s) will be updated and posted as soon as practically possible
- Charges. It is important to understand the distinction between two different types of charges prevalent in the healthcare industry. The first is “gross charge” that relates to the established prices that are billed to all patients regardless of insurance or health care coverage. The second is “negotiated charge” or prices the insurance companies and payers have agreed to pay for services (also known as the “contracted rate”). A patient with insurance or coverage typically is responsible for a portion of the negotiated charge which will vary based on benefits that are provided by the insurance companies and payers. The portion of the charge that a patient will pay a hospital for services is called the “out-of-pocket” expense (often as a copay or deductible amount or co-insurance)
- File Contents. The file(s) contain the gross charge, charge description, associated accounting/billing code (such as HCPCS, CPT, NDC, DRG, or other payer identifier) of the item or service as reflected in the hospital's charge description master or other internal sources for similar data and or charges from common services packages (collectively referred to as CDM). The file includes five standard charge types required by the rule – either established and/or allocated – gross charge, discounted cash price, payer-specific negotiated charge, de-identified minimum negotiated charge, de-identified maximum negotiated charge. (Please also refer to Section 7 ‘File Layout Information’ below)
- Additional Fees. The gross charge represents the dollar amount assigned to specific medical services before application of any negotiated discounts to third-party payers. The actual hospital charges will vary based on the type of care provided, treatments, individual health conditions and other factors. If you need an estimate of your out-of-pocket cost, please call or submit a request online as described elsewhere on this website. PLEASE NOTE THESE CHARGES do not include fees from your physician, surgeon, anesthesiologist or other professional services billed by your physician(s) AND OTHER PROFESSIONAL PROVIDERS. Typically, you will be billed separately for these professional services. Most displayed charges herein do include hospital services such as room and bed charges, including operating rooms, recovery rooms and treatment rooms. Other charges such as medication charges, food service charges, anesthesia charges also are typically included with the surgical procedure or MS-DRG charge levels. However, in certain circumstances, they may be displayed separately in charge files or on hospital bills
- Adjustments. Following the CMS guidelines, the information posted represents the hospital’s current gross charges as reflected in the CDM. However, it is important to understand that the information represented in the CDM is the starting point in many cases and can undergo additional adjustments through the billing process, therefore, please be aware:
- The gross charge shown is the original charge for the item or service prior to any adjustments that result from applying modifiers in certain situations
- The CDM is used in multiple hospital departments and may have different charges for the same item or service and such instances will repeat in the file. For a single chargemaster item, the charge is consistent; however, there may be slight variation in charges for services with similar descriptions for various reasons
- Gross charges for certain items or services are based on per unit, such as – including but not limited to – surgeries, anesthesia, and recovery which can be based on the unit of time and complexity; and medications, drugs which can be based on weight, dosage, age or packaging; etc.
- Certain items and or services have a zero-dollar price in the CDM for a variety of reasons – contracted billing services that drop charges externally, no cost supplies, investigational device or medication exemption items in clinical trials and studies, replacement for a recalled or defective device, explode codes and other system limitations. Such items and services will appear with a zero-dollar charge and this charge is not reflective of the actual charge. In addition, items and or services are sometimes assigned a one penny price to reflect, for example, a state or federally provided medication or drug, contrast items, therapy status codes used for CMS reporting, etc. The charge that will appear on the bill may vary from the charges in the posted file(s)
- The file may also contain CDM items for non-charges (such as payments, allowances, transactions, etc.)
- The gross charge shown is the original charge for the item or service prior to any adjustments that result from applying modifiers in certain situations
- MS-DRG Information. Note on MS-DRG related information: Prior calendar year inpatient discharges are grouped using the current year CMS MS-DRG. The current Medicare year's geographic mean length of stay (LOS) and description is used. The current year is used if the same MS-DRG is present in two Medicare periods. Charges are calculated and displayed by DRG by taking the total charges divided by the total case volume per DRG. Charges are listed for acute inpatients and newborn accounts. The charges to patients with all insurances and payers were included in calculating the charges per DRG. Charges to Rehabilitation and Long-Term Care accounts have been excluded. Also excluded are charges related to error MS-DRGs 0, 998, 999. Individual cases where LOS is greater than the Geographic Mean LOS times 1.5 are excluded. Low volume DRGs where number of cases were < 10 and high dollar outliers are also excluded
- File Layout Information. The information provided herein is as required by The Centers for Medicare & Medicaid Services’ Price Transparency Final Rule and is not a guarantee of final billed charges, which may vary from these estimates for many reasons including the individual patient’s unique medical condition, complications, unknown circumstances, other diagnoses and recommended treatments. Moreover, these estimates may not include professional fees such as physician, radiologist, anesthesiologist, and pathologist fees. The insurance benefit information (where applicable) is based on information provided by insurers which may not be current on the date of a scheduled procedure, and benefits and eligibility are subject to change and are not a guarantee of payment:
Description – Consumer friendly description of service, item or pharmaceutical Code – Can contain CPT/HCPCS, MS-DRG or APR-DRG Code (note: all APR-DRG’s are displayed as 3 numbers to distinguish from other codes and end in X to signify severity)
Type – Outpatient (CPT/HCPCS) or Inpatient (MS-DRG or APR-DRG)
Gross Charge – Charge for an item or service
Discounted cash price – The discounted cash price information is subject to hospital-specific policy guidelines for financial assistance discounting. Patients can determine their eligibility and associated discount by contacting the hospital
De-identified min contracted rate – The minimum derived contracted rate across all payors (All payers)
De-identified max contracted rate - The maximum derived contracted rate across all payors (All payers)
Derived contracted rate - The median derived contracted rate across all payors (All payers)
Cautions: The file(s) can be voluminous, and download may take excessive time depending on your internet speed. Please consider the environment before deciding to print. By clicking to download this information you agree you have read and understand the above. here.... By clicking to download this information, you agree you have read and understand the above. Click below to download the medical center's current standard charges.
The Centers for Medicare and Medicaid Services have identified 70 shoppable services. If pricing for a shoppable service is not included on the shoppable page, the service is not available from the hospital.