The Mount Sinai Hospital Price Transparency
The Mount Sinai Health System is committed to price transparency and to helping you understand your out-of-pocket costs. This page includes links to machine-readable files with all standard charges. They include gross charges, discounted cash prices, and payer-specific negotiated charges for the range of items and services provided by The Mount Sinai Hospital.
In compliance with Centers for Medicare and Medicaid Services regulations, The Mount Sinai Hospital’s machine-readable files include all standard charges. These include gross charges, discounted cash prices, and payer-specific negotiated charges for items and services we provide.
However, standard charges don’t easily translate into the price of your expected care. Costs vary based on a variety of factors, including:
- The exact combination of services received
- How much you have spent this year on health care (due to insurance deductibles and out-of-pocket maximums)
For the best estimate of your out-of-pocket costs, contact your insurance company.
If you don’t have health insurance, or are underinsured, you may qualify for financial assistance. You can speak with our patient financial advocates to learn more about our financial assistance program and other subsidized health insurance programs.
The Mount Sinai Hospital
Frequently Asked Questions
You may have additional concerns about how the chargemaster works. Below, we list some of the most common questions and their answers.
What is a hospital chargemaster?
The chargemaster is a list of gross charges for the services provided by the hospital. It includes medical procedures, lab tests, supplies, medications, and other goods and services. The chargemaster provides the gross prices, which are often higher than the price you will pay.
The rows in the chargemaster represent the services provided by the hospital; a single line-item charge may not represent a complete medical service. In general, multiple charge line items are necessary to represent all components of a service encounter (e.g. procedure(s), supplies, and drugs).
Please note that the figures listed in the chargemaster are not static. Prices and items change over time for a variety of reasons. The prices quoted in the chargemaster are valid as of the date noted. We regularly post price updates.
The other machine-readable file includes the hospital’s average charges by Medicare Severity Diagnosis Groups. This system classifies inpatient cases based on medical diagnoses and human body systems.
How can I read the machine-readable file? What types of charges are included?
Medicare defines several different types of charges that should be available for patients to see:
- Gross charge: Price of an item that is reflected on a hospital's chargemaster, without any discounts
- Discounted cash price: Cost to an individual who pays cash for a hospital item
- Payer-specific negotiated charge: Price that has been negotiated with a given third party payer
- Deidentified minimum negotiated charge: Lowest of the payer-specific negotiated charges, across all payers and plans, for a given code
- Deidentified maximum negotiated charge: Highest of the payer-specific negotiated charges, across all payers and plans, for a given code
Are gross charges the same for every patient?
Yes, gross charges are standard for every service whether or not you have insurance. The total charges on your patient bill will reflect the actual services that you receive. The charges on your bill may be different than the gross charges for a number of reasons including:
- Your length of stay
- The time it takes to complete your procedure
- Medications and products you receive
- Other health conditions you have that might make your care more complicated
In addition, your out-of-pocket expenses will depend on your specific insurance coverage and/or whether you are eligible for the hospital’s financial assistance policy.
Can I be charged for services that are not included in the chargemaster?
The hospital chargemaster reflects hospital services only. It does not contain any professional fees such as physician services. In addition, it may not include certain ancillary services, such as anesthesia for procedures. These costs are billed separately, based on the price at the time of service. Please contact your insurance company for estimated professional fees and to check if your physician is in-network for your health insurance plan.
Please note that some costs are subject to provider invoicing at the time of service. These can include certain costs associated with items such as blood products, implants, medications, and organ acquisition.
Why is the code I need not on this list?
Our machine-readable files are based on the services we provided at each of our facilities over the past 12 months. If The Mount Sinai Hospital has not provided a certain service over the previous year, it might not be on the list.
Why do charges for the same procedure or item vary by hospital?
Hospitals set their gross charges for services and items based on their costs, which vary among hospitals. For example, charges may vary based on issues such as:
- Hospital location
- Availability of specialized services such as trauma and transplant services
- Whether it is a teaching hospital
- Level of underpayment from the Medicare and Medicaid programs
- Services provided to the uninsured
Regardless, insurance companies and patients without insurance may pay a different fee than the gross price.
Why may items in the chargemaster have different prices but the same service code?
Some chargemaster codes can include a number of items. For instance, one code may include a number of different medical supplies, lab tests, or medications. Each individual supply, test, or drug might have its own price. There could be a number of reasons for this difference, including varying dosages.
If insurance companies and patients without health insurance don’t pay the chargemaster prices, what do they pay?
For the most part, neither insurance companies nor patients pay the gross charge amount. Insurance companies negotiate discounts based on these gross charges in their contracts with hospitals. Patients with health insurance are responsible for a certain portion of these insured discounted rates, including deductibles, copayments, and/or coinsurance, each of which can vary from one insurance plan to another. Patients without insurance can apply for support through the hospital to either receive insurance coverage (if eligible) or reduced costs through the hospital’s financial assistance policy.
Why is the price for a particular code higher or lower here than at other institutions?
Every health system maintains its own contracts with health insurance companies. Historically, health systems have not had any visibility into the pricing for which other health systems have contracted. For this reason, it is common for a health insurance company to negotiate higher or lower prices on specific services between different health systems. In addition, different health systems sometimes have very different underlying costs associated with providing care.
How will these rates change over time?
Generally these negotiated rates are established for a period of years, during which time there are typically no significant changes in terms. However, sometimes there will be small changes in reimbursement terms over time.
Your out-of-pocket obligation is based on your insurance plan. Please contact your insurer or employer to understand how these obligations might change year over year.
What do I do if I don’t have health insurance or am underinsured?
If you do not have health insurance, you can apply for support through the hospital to either receive insurance coverage (if eligible) or reduced costs through the hospital’s financial assistance policy. These programs will lower your costs.
Mount Sinai’s financial assistance program also contains contact information for each of the hospital’s Patient Financial Services Departments. These departments can give you a cost estimate and help you figure out if you are eligible for subsidized health insurance through programs such as Medicaid.
How can I get an estimate of my out-of-pocket expenses for a procedure?
Mount Sinai’s Online Patient Estimator Tool provides out-of-pocket cost estimates. The tool lists costs for over 300 shoppable services. For other services, or to verify your estimate, you should contact your insurance company. For these estimates, you will often need to provide the codes associated with your procedure or service; please contact your physician for the correct codes to share with your insurance company.
What if I have more questions?
If you have additional questions in relation to the chargemaster or the average charges, please email us at firstname.lastname@example.org. Don’t forget to provide your contact information. We will have the appropriate representative respond to your question.
If you have any additional questions, email us and we will do our best to respond promptly.