Price Transparency: Price Estimator & Standard Charges

Hospital administration of a medication could be considered a shoppable service if it can be scheduled in advance. Examples include administration of flu shots or medication infusions for chronic conditions such as cancer treatments.

A good-faith estimate is a projection of cost based on the information given at the time of the estimate. It is not a guarantee of final cost, and could be higher or lower depending on several factors such as insurance coverage, a change in services required at the time of service, and additional fees.

There are two ways to obtain an estimate. One is obtaining the estimate yourself online. If you have the Ballad Health app and MyChart, you can log in to your account and choose Estimate My Bill. You may also obtain an estimate from our Ballad Health website or through your MyChart account by choosing Get an Estimate.

Estimates include hospital items and services associated with a procedure cost, such as supplies, procedures, room and board and facility fees. At the time of registration for your scheduled visit, our team will provide an estimate based on the CPT Code(s) provided by your healthcare professional and your medical coverage.

Current Procedural Terminology (CPT) codes are an important part of the medical billing process and are a universal way to identify medical procedures. Each procedure is given its own unique five-digit code that health insurance companies use to identify what type of care was provided. If you are unsure about what code to use for your estimate, check with your provider.

Generally, costs that are not included in the estimate are office visits before or after your procedure or other professional fees for physician services (i.e. surgeon, radiologist, anesthesiologist, pathologist, etc.). These are usually billed separately by the provider.

Under the Affordable Care Act, most insurance plans cover what are called “preventive services.” These include screenings for mammograms, cholesterol, lung cancer, and other preventive services your plan considers to be in-network. Currently, our estimate tool may show an out-of-pocket cost for covered preventive services, resulting in an inaccurate estimate. Please call (423) 431‑1776 to get the most accurate estimate for preventive services.

The tool provides a good-faith estimate of your out-of-pocket healthcare need, but you should not rely on this estimate as a guarantee of your final cost. We try our best to give you an accurate assessment of charges, but estimates may be higher or lower than your final cost depending on many factors.

Actual expenses may vary from patient to patient depending upon your physician’s treatment choices, your particular healthcare needs or whether you qualify for discounts or financial assistance. Your final bill could also change if your provider determines you need additional services during a procedure that weren’t included in your pre-service estimate. Likewise, costs may vary based on the information you enter into the estimate tool or your medical benefits and eligibility. Please check with your insurance provider if you need help understanding your benefits or the service you’ve chosen.

When requesting an estimate, make sure you have your current health insurance on file. Estimates may change as a result of your medical benefits and eligibility. For example, the cost of care could differ from your estimate if your insurance provider considers the service out-of-network or not medically necessary. Your final cost could also change if you have met all or part of your deductible or maximum out-of-pocket expenses at the time of treatment.

In a health insurance plan, your deductible is the amount of money you need to spend out of pocket for most eligible medical services or medications before your health insurance starts covering your healthcare costs. With a $3,000 deductible, for example, you pay the first $3,000 of covered services yourself.

Your out-of-pocket maximum is the most you'll have to pay for covered healthcare services in a year if you have health insurance. Deductibles, copayments, and coinsurance count toward your out-of-pocket maximum. However, monthly premiums do not.

For questions regarding your estimate, please call(423) 431‑1776.

The machine readable file provides a listing of all items and services, including DRG’s and service packages, along with payor rates and cash pay pricing. The basic standard charges file provides a listing of all items and services along with the current fee charged in an easy to search format.

For questions regarding your bill, please call (423) 408‑7400.

The Transparency in Coverage Final Rule requires group health plans provide machine-readable files for commercial price information. Group health plans must make certain that healthcare price information is publicly available in downloadable machine-readable files beginning July 1, 2022. Machine-readable files are available to be sure Ballad Health's group health plan is compliant with the requirement to include in-network negotiated rates and historical payments to out-of-network providers and their billed charges. You can access the files by clicking this link.