Price Transparency: Price Estimator & Standard Charges

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Important information about price comparisons and estimates

Ballad Health values transparency in healthcare, and ensuring patients have the tools to manage the cost of healthcare. Unlike many other competing providers of outpatient services in the region served by Ballad Health, it is the policy of Ballad Health to not only provide pricing transparently where possible, but to also provide significant discounts – or even writing off the entire cost of services provided – for patients who are low income and who qualify for these programs.

In 2019, Ballad Health provided healthcare services costing more than $60 million, the cost of which was written off as charity care for low-income patients, and over the last five years that total exceeded $300 million. Additionally, Ballad Health incurs costs of several million dollars annually for the provision of 24-hour per day coverage for emergency diagnostics and services – costs which are not incurred by many other competing providers of outpatient services in the region and which are not reimbursed directly to Ballad Health.

The pricing agreements between insurers and Ballad Health are complex and attempt to reflect the actual cost to the hospitals of the delivery of healthcare services. Many of the costs associated with hospital services are not shared by competing providers of outpatient services, and thus the pricing negotiated with the insurers may vary widely from pricing with non-hospital outpatient services.

Price estimator tool

The Ballad Health price estimator tool is intended to provide you with a good faith estimate of your out-of-pocket costs.

These estimates include hospital items and services associated with a procedure such as medical services, room and board, and supplies. This estimate is a best effort based on the information we have available at the time of the request.

This estimate is not a guarantee of what you will be charged. The final charges may vary depending upon the actual services you receive, equipment and medications necessary for treatment and other variables which are not possible to know in advance of the hospitalization or service. The estimate may vary based on your medical benefits or eligibility for the hospital’s program for discounts or free care.

Launch the Price Estimator

For additional information about our price estimate tool and how it works, please read our frequently asked questions (FAQs) below or call us at (423) 431-1776.

Ballad Health standard charges

These machine-readable files provide a listing of all charges each hospital facility may bill for inpatient and outpatient services. The files also include payer-specific negotiated payment rates and the minimum and maximum payment rate for each item. Some items are bundled with other services and may not identify a specific payment rate.

The actual cost of your service will vary based on factors specific to your case, such as your length of stay in the hospital or the complexity of your medical condition.

Download the Standard Charges machine-readable files by facility using the following links. Please call (423) 431-1776 should you have questions.

Ballad Health contracted providers

This document lists Ballad Health's contracted providers. Patients will be billed for additional charges, including out-of-network charges, if the patient is provided medical services by a healthcare provider that is not in-network. In particular, the patient should ask the facility if he or she will be provided any medical services by anesthesiologists, radiologists, emergency room physicians or pathologists who are not in the patient’s network. It is your responsibility to verify with your insurance if any of the below contracted providers are not in-network.

Ballad Health Contracted Providers

Frequently asked questions

Our Price Estimate Tool provides estimates for 300 shoppable services. These are services that can be scheduled in advance such as joint replacements, mammogram screenings and physical therapy.

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.