Thomas Health System · Charleston, WV
65
Beds
394
Inpatient discharges a year
$42.5M
Net patient revenue a year
28
In-network payers
St Francis Hospital is a 65-bed proprietary hospital in Charleston, WV, affiliated with Thomas Health System. Below you'll find publicly disclosed negotiated rates and facility details, including 28 in-network payers and 165 disclosed rate categories.
The 24 services St Francis Hospital most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
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CT imaging
CPT 74177
$1,428 - $4,759
from 4 insurers · median $3,929
Common here, based on CMS Medicare volume
CT imaging
CPT 74176
$1,016 - $2,922
from 4 insurers · median $2,283
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$15,567 - $30,512
from 4 insurers · median $25,825
Typical for a hospital with this service line
Digestive procedures
CPT 49650
$26,858 - $43,019
from 4 insurers · median $37,716
Typical for a hospital with this service line
Orthopedics and pain
CPT 64721
$5,309 - $8,541
from 4 insurers · median $7,881
106 Medicare claims in Level 1 Nerve Procedures (CMS 2024)
CT imaging
CPT 70450
$423 - $1,728
from 4 insurers · median $1,095
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 66984
$4,623 - $7,934
from 4 insurers · median $5,405
93 Medicare claims in Level 1 Intraocular Procedures (CMS 2024)
Gynecology
CPT 58571
$18,997 - $37,421
from 4 insurers · median $24,277
Typical for a hospital with this service line
CT imaging
CPT 71275
$957 - $3,372
from 4 insurers · median $2,684
Common here, based on CMS Medicare volume
Mammography
CPT 77067
$330 - $606
from 4 insurers · median $565
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$304 - $714
from 4 insurers · median $449
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78452
$5,105 - $7,542
from 4 insurers · median $5,807
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$1,796 - $2,633
from 4 insurers · median $2,138
Common here, based on CMS Medicare volume
MRI imaging
CPT 70553
$1,373 - $5,388
from 4 insurers · median $4,213
Common here, based on CMS Medicare volume
Digestive procedures
CPT 47563
$6,063 - $30,319
from 4 insurers · median $27,477
Typical for a hospital with this service line
Digestive procedures
CPT 45378
$2,071 - $7,496
from 4 insurers · median $5,377
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$6,670 - $22,767
from 4 insurers · median $18,194
Typical for a hospital with this service line
Medicine & Surgery
CPT 29881
$7,527 - $14,133
from 4 insurers · median $12,381
14 Medicare claims in Level 3 Musculoskeletal Procedures (CMS 2024)
Ultrasound
CPT 76705
$405 - $1,252
from 4 insurers · median $839
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 55866
$32,369 - $46,960
from 4 insurers · median $39,523
Typical for a hospital with this service line
MRI imaging
CPT 72148
$871 - $3,304
from 4 insurers · median $2,294
Common here, based on CMS Medicare volume
Orthopedics and pain
CPT 29888
$16,392 - $34,251
from 4 insurers · median $31,298
Typical for a hospital with this service line
Medicine & Surgery
CPT 42820
$6,974 - $13,265
from 4 insurers · median $11,781
Typical for a hospital with this service line
MRI imaging
CPT 70551
$942 - $3,273
from 4 insurers · median $2,738
Common here, based on CMS Medicare volume
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 24 | 633% | 6 | 5 |
| Insurer B* | 24 | 574% | 19 | 0 |
| Insurer C* | 24 | 382% | 5 | 16 |
| Insurer D* | 24 | 380% | 13 | 1 |
How we chose these services: 3 appear in this hospital's own Medicare claims, 13 are common here based on CMS Medicare volume, and 8 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for St Francis Hospital, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Quality
No Medicare readmissions penalty
See quality ratingsDoctors and services
No Medicare-funded residents
Finances
$42.5M net patient revenue
The employer identification numbers (EINs) health plans and networks list for St Francis Hospital in the in-network rate files they publish, with the organization NPIs billed under each.
| Tax ID (EIN) | Plans and networks listing it | Organization NPIs |
|---|---|---|
| 61-1272692Charleston Hospital INC | 33Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Aspirus Health Plan, Asuris Northwest Health and 28 more | 1891732889 Charleston Hospital Inc.1316984487 Charleston Hospital Inc. |
| 55-0404900Herbert J Thomas Memorial Hospital Assoc | 24Aetna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Aspirus Health Plan, Asuris Northwest Health and 19 more | 1316925506 Herbert J. Thomas Memorial Hospital Association1104681014 Herbert J Thomas Memorial Hospital Association1275620809 Herbert J Thomas Memorial Hospital Associationand 11 more |
Source: PayerPrice analysis of insurers' Transparency in Coverage in-network files. An EIN can cover several hospitals and clinics in a health system, and insurers sometimes list other organizations' NPIs under it.
333 Laidley Street, Charleston, WV 25301
(304) 347-6500
How Medicare adjusts St Francis Hospital's inpatient payments for its readmissions, quality and cost results.
No penalty
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2026 IPPS final rule.
0.00% on Medicare payments
Value-based purchasing
Hospital Value-Based Purchasing bonus or reduction for quality and cost, as estimated in the FY 2026 IPPS final rule.
Source: CMS IPPS final rule Impact File (FY 2026).
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What St Francis Hospital reported to Medicare in its latest cost report, covering Oct 1, 2023 to Apr 30, 2024.
394
Inpatient discharges
Medicare 11%, Medicaid 6%
2,735
Inpatient days
32% of available bed days used
174
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 832068). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges St Francis Hospital reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 304 | 218 | 2,213 | 2,735 |
| Discharges | 44 | 25 | 325 | 394 |
| Average length of stay | 6.9 days | 8.7 days | 6.8 days | 6.9 days |
| Average daily census | 1.4 | 1.0 | 10.4 | 12.8 |
505
Medicare Advantage days
42 discharges
1,897
Medicaid managed care days
276 discharges
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 40 | 2,735 | 304 | 32% |
| Skilled nursing facility | 25 | 2,678 | 856 | 50% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
The comprehensive outpatient service groups (APCs) St Francis Hospital billed Medicare for most in 2024: 522 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 1 Nerve ProceduresAPC 5431 | 106 | 101 | $9,475 | $1,279 | $1,407 |
| Level 1 Intraocular ProceduresAPC 5491 | 93 | 58 | $9,880 | $1,570 | $1,752 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 81 | 80 | $55,714 | $13,780 | $15,763 |
| Level 2 Intraocular ProceduresAPC 5492 | 71 | 64 | $25,781 | $2,707 | $3,116 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 50 | 46 | $62,723 | $8,941 | $10,772 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 33 | 33 | $112,618 | $23,871 | $26,719 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 29 | 15 | $7,935 | $1,095 | $1,220 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 26 | 26 | $34,776 | $4,646 | $5,339 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 19 | 18 | $47,734 | $4,619 | $4,524 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 14 | 14 | $26,391 | $2,030 | $2,373 |
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.
Revenue, expenses and income St Francis Hospital reported to Medicare for Oct 1, 2023 to Apr 30, 2024. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $155.8M | 366.6% |
| Inpatient | $15.5M | 36.4% |
| Outpatient | $140.4M | 330.2% |
| Contractual allowances and discounts | -$113.3M | -266.6% |
| Net patient revenue | $42.5M | 100.0% |
| Operating expenses | -$26.7M | -62.8% |
| Operating income from patient care | $15.8M | 37.2% |
| Other income | $324,485 | 0.8% |
| Investment income | $846 | 0.0% |
| Other | $323,639 | 0.8% |
| Net income | $16.1M | 38.0% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $36.9M | 23.8% |
| Medicaid (including managed care) | $16.1M | 10.4% |
| Other payers and self-pay | $101.9M | 65.8% |
| Total charges | $154.8M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Traditional Medicare is the program charges on Worksheets D-3 and D Part V; Medicaid is from Worksheet S-10.
Computed from St Francis Hospital's latest cost report, which covers 213 days; income and expense figures are scaled to a year.
37.2%
Operating margin
Operating income from patient care / net patient revenue
37.7%
Total margin
Net income / net patient revenue plus other income
42.5%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
42% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$34.02
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
223.9%
Return on assets
Net income for a year / total assets
372.1%
Return on equity
Net income for a year / fund balance
1.74
Current ratio
Current assets / current liabilities
-1.59
Quick ratio
Cash, temporary investments and net receivables / current liabilities
86 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
-92 days
Days in patient receivables
Net patient receivables / daily net patient revenue
41 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
5.94
Asset turnover
Total revenue for a year / total assets
0.3 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What St Francis Hospital owned and owed at the end of its reporting period (Apr 2024), across all fund types: $12.3M in total assets and a $7.4M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $10.4M | 84.6% |
| Patient receivables, net | -$18.3M | -148.1% |
| Inventory | $1M | 8.4% |
| Total current assets | $8.6M | 69.4% |
| Property and equipment, net of depreciation | $3.8M | 30.6% |
| Total assets | $12.3M | 100.0% |
| Current liabilities | $4.9M | 39.8% |
| Total liabilities | $4.9M | 39.8% |
| Fund balance (net assets) | $7.4M | 60.2% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care St Francis Hospital provided without full payment, as reported on Worksheet S-10 of its cost report.
$148,276
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$2M
Bad debt
Patient bills written off as uncollectible, at charges
$1.9M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$631,662
Total unreimbursed and uncompensated care
2.4% of operating expenses
Medicaid, CHIP and indigent care shortfalls plus charity care and the cost of bad debt (Worksheet S-10 line 31)
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
St Francis Hospital's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Sep 2019 | Sep 2020 | Sep 2021 | Sep 2022 | Sep 2023 |
|---|---|---|---|---|---|
| Net patient revenue | $62.6M | $56M | $55.6M | $58.5M | $56.4M |
| Operating expenses | $62M | $38.3M | $36.6M | $40.6M | $40.3M |
| Operating margin | 0.9% | 31.6% | 34.1% | 30.5% | 28.5% |
| Net income | $58,050 | $21.6M | $26.6M | $20.9M | $17.1M |
| Total assets | $40M | $32.4M | $46.5M | $67.2M | $94.4M |
| Discharges | 642 | 695 | 684 | 816 | 730 |
| Inpatient days | 9,540 | 7,326 | 5,777 | 5,916 | 5,304 |
| Medicare Advantage days | 144 | 374 | 411 | 511 | |
| Beds | 64 | 65 | 65 | 65 | 65 |
| Employees (FTE) | 309 | 292 | 261 | 191 |
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center St Francis Hospital reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Impl. dev. charged to patients | $9.4M | $32.8M | 0.29 | ||
| Asc (non-distinct part) | $1.5M | $5.3M | $44.1M | 0.12 | 24,295 |
| Operating room | $646,673 | $3.7M | $17.4M | 0.21 | 23,800 |
| Pain management | $1.5M | $3.1M | $20.9M | 0.15 | 15,703 |
| Radiology-diagnostic | $425,820 | $1.4M | $6M | 0.24 | 11,078 |
| Laboratory | $220,644 | $1.4M | $5.8M | 0.24 | 6,325 |
| Wound care | $128,270 | $986,843 | $5.9M | 0.17 | 8,953 |
| Healthscope family practice | $207,953 | $868,498 | $623,288 | 1.39 | 6,878 |
| Drugs charged to patients | $730,687 | $3M | 0.25 | ||
| Physical therapy | $277,729 | $683,669 | $1.6M | 0.42 | 5,759 |
| Respiratory therapy | $188,025 | $358,780 | $837,837 | 0.43 | 1,457 |
| Ear nose & throat | $115,202 | $339,053 | $862,964 | 0.39 | |
| Ct scan | $79,266 | $322,922 | $3.9M | 0.08 | 803 |
| Observation beds (distinct part) | $144,703 | $285,586 | $273,978 | 1.04 | |
| Hyperbaric | $69,062 | $177,770 | $387,914 | 0.46 | 1,327 |
| Corneal transplant | $157,272 | $262,120 | 0.60 | ||
| Clinic | $34,640 | $146,652 | $45,462 | 3.23 | 2,250 |
| Electroencephalography | $32,620 | $174,536 | 0.19 | 286 | |
| Podiatry | $1,129 | $183,836 | 0.01 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $1.2M | $4M | $5.4M | 0.73 | 31,378 |
| Skilled nursing facility | $868,991 | $2.1M | $4.5M | 0.47 | 9,253 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $3,900 | $5.2M | 856 | $4.56 | 63,286 |
| Employee benefits department | $3.6M | ||||
| Maintenance & repairs | $2.8M | 28,982 | |||
| Cap rel costs-bldg & fixt | $1.5M | 318,624 | |||
| Pharmacy | $388,077 | $560,946 | 7,076 | $54.84 | 2,555 |
| Cap rel costs-mvble equip | $521,565 | ||||
| Medical records & library | $493,838 | 3,639 | |||
| Dietary | $422,342 | 9,587 | |||
| Housekeeping | $351,032 | 1,415 | |||
| Social service | $165,566 | 3,477 | |||
| Laundry & linen service | $111,917 | 627 | |||
| Central services & supply | $79,808 | $111,607 | 3,062 | $26.07 | 7,632 |
| Nursing administration | $2,618 | 2,876 | |||
| Cafeteria | -$179,239 |
Source: CMS cost report (HCRIS, Form 2552-10), report 832068, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
The factors Medicare uses to set what it pays St Francis Hospital for an inpatient stay.
1.31
Case mix index
Higher than 11% of hospitals paid under Medicare IPPS
Average Medicare DRG weight of its inpatient cases (FY 2026); higher means more complex, costlier care.
No Medicare-funded residents
Teaching status
Medicare-funded interns and residents per bed (FY 2026).
91.6%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2026).
44
Medicare inpatient stays
Medicare claims CMS based FY 2026 payment rates on.
Urban (metro area)
Location type
Geographic area CMS assigns before any wage index reclassification (FY 2026).
| IPPS fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| Case mix index | 1.58 | 1.59 | 1.42 | 1.11 | 1.08 | 1.31 |
| Wage index | 0.847 | 0.842 | 0.857 | 0.840 | 0.798 | 0.898 |
| Readmissions adjustment | -0.04% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% |
| Value-based purchasing adjustment | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% |
| Medicare inpatient stays | 15 | 15 | 32 | 27 | 55 | 44 |
Source: CMS IPPS final rule Impact File (FY 2026).
The officers and board members on St Francis Hospital's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
Charleston Hospital Inc files the Form 990 for the tax ID insurers list for St Francis Hospital, so these people may lead the wider organization rather than St Francis Hospital alone.
| Name | Title |
|---|---|
| Albert J Wright Jr | Wvuhs President/ceo |
| Dr Gregory Rosencrance | President |
| Timothy Skeldon | CFO |
| Leslie Lawson | VP Operations |
Board members: Andy Barker, Paul Breedlove, Very Rev Donald S Higgs VF, Daniel Rodgers MD.
Source: IRS Form 990 Part VII filed by Charleston Hospital Inc (EIN 61-1272692), via the IRS e-file data. A health system's return can cover several hospitals.
340B drug pricing program
Not participating
340B ID DSH510031, registered as a disproportionate share hospital. Authorizing official: Jason Gizzi, VP Of Finance/cfo.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
St francis hospital snf
CCN 515110, certified 1991, Medicare prospective payment
Source: Worksheet S-2 Part I of St Francis Hospital's latest Medicare cost report (HCRIS).
About St Francis Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at St Francis Hospital range from $1,373 to $5,388 across 4 insurers. Blue Cross Blue Shield's rate is $1,373. The median at nearby comparable hospitals is $1,827. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at St Francis Hospital range from $1,428 to $4,759 across 4 insurers. Blue Cross Blue Shield's rate is $1,428. The median at nearby comparable hospitals is $2,401. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Diagnostic colonoscopy (CPT 45378), published negotiated rates at St Francis Hospital range from $2,071 to $7,496 across 4 insurers. Aetna's rate is $2,071. The median at nearby comparable hospitals is $3,199. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at St Francis Hospital range from $330 to $606 across 4 insurers. Cigna's rate is $590. The median at nearby comparable hospitals is $271. What a patient pays depends on their plan's deductible, coinsurance and network status.
CMS reports no Medicare-funded interns or residents at St Francis Hospital for fiscal year 2026.
No. St Francis Hospital has no Hospital Readmissions Reduction Program penalty in fiscal year 2026.
St Francis Hospital's Medicare case mix index is 1.31 for fiscal year 2026, higher than 11% of hospitals paid under the inpatient prospective payment system.
St Francis Hospital reported 394 inpatient discharges and 2,735 inpatient days from Oct 1, 2023 to Apr 30, 2024.
St Francis Hospital reported 174 full-time-equivalent employees on payroll from Oct 1, 2023 to Apr 30, 2024.
St Francis Hospital reported $42.5M in net patient revenue on $155.8M of gross charges for Oct 1, 2023 to Apr 30, 2024, an operating margin of 37.2%, and net income of $16.1M.
St Francis Hospital reported $631,662 of unreimbursed and uncompensated care for Oct 1, 2023 to Apr 30, 2024, including $148,276 of charity care at cost.
Insurers' price transparency files list St Francis Hospital under employer identification number 61-1272692 (Charleston Hospital INC), and 1 other tax ID. 33 health plans and networks list 61-1272692 for it.
HRSA's 340B database lists St Francis Hospital (340B ID DSH510031) as no longer participating since 2024.
CMS lists 32 services at St Francis Hospital, including Acute Renal Dialysis, Anesthesia, Audiology, Cardiac Catheterization Lab, Cardiac Thoracic Surgery, Chemotherapy.
St Francis Hospital has 65 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. Facility type: Short Term Acute Care Hospital.
St Francis Hospital is located at 333 Laidley Street, Charleston, WV 25301. Its main phone number is (304) 347-6500.
St Francis Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 510031.
The National Provider Identifier (NPI) on file for St Francis Hospital is 1891732889.
St Francis Hospital is affiliated with Thomas Health System.
St Francis Hospital lists 28 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Avera Health Plans, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
165 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
For hospital finance and compliance teams
The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.
We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers