Figuring out how much health care costs is complicated. Often, many pieces come together to make up the costs, but we want to do the best we can to give you a good estimate of your costs. On January 1, 2019, University of New Mexico Hospitals (UNMH) and Sandoval Regional Medical Center (SRMC) will post official pricing lists on their website.
There are three pricing lists, a drug pricing list, the Charge Description Master (CDM), and the Diagnosis Related Group (DRG). The first pricing list, called a drug formulary, can help you get an estimate of the cost of your prescriptions. The CDM looks at outpatient procedure costs. The DRG looks at the cost of an inpatient hospital stay based on the patient’s diagnosis.
Drug Formulary with Average Wholesale Prices
You can download the UNMH and SRMC Drug Formulary with Average Wholesale Prices (AWP). This drug formulary is a list of the prescription drugs available in our pharmacies. The AWP is the national average price for a drug. The price patients pay depends upon their coverage plan.
Charge Description Master (CDM)
The Charge Description Master (CDM) can help you to figure out about how much you might pay for a procedure or a visit. We will update the file at least once a year. The CDM estimate of the cost of your health care includes some costs but not others.
The UNMH CDM includes files for the Comprehensive Cancer Center, Adult Behavioral Health and the Children’s Psychiatric Center.
Professional Fees and Facility Fees
If you are treated at UNMH or SMRC (in the Emergency Room or during clinic visits, and for some kinds of hospital stays), there are two separate sets of charges for your visit. There is a facility fee and a professional fee. The facility fee for a procedure is based on operating, staffing, and equipment costs. The professional fee is the charges for the medical providers’ services.
The CDM does include all UNMH and SRMC facility fees for outpatient procedures.
The CDM does not include any professional fees.
Manual Pricing Costs
Manufacturers or pharmaceutical companies set some prices. We call these costs “MPs.” (MP stands for “manually priced.”) Because we do not control the pricing, these costs are not included in the CDM. However, when they apply, they may be a part of a patient’s charges.
Changes in Costs Set by Third-Party Payers
The UNMH and SRMC CDM prices are not final prices because we often have to make changes. Changes can happen for several reasons. For example, we try to work with third-party payers to get discounts as often as we can. (Third party payers are groups outside of the hospital and the patient, like insurance companies). Government payers (like Medicare or Medicaid) may also set and change prices themselves.
Remember, you should not consider the price listed in the CDM file as an absolute final cost for your medical care. Here are some of the reasons.
- Professional fees are not included in the CDM.
- Manual pricing costs are not included in the CDM.
- Changes happen often when we are working with other groups who set prices and pay costs. The CDM may not show the changes right away.
Diagnosis Related Group (DRG)
The pricing system called Diagnosis Related Group (DRG) gives estimates for standard payments to hospitals. The estimates in the DRG are based on a different way of looking at costs than the CDM. The DRG is the estimated average all-inclusive cost for a patient to stay in the hospital based on their diagnosis. We will update the list at least once a year.
The DRG costs are only an estimate of charges. They are based upon the average amount charged in the past year. The actual amount may change. The actual charge depends on how complex the diagnosis is and whether or not there are complications.
In general, a DRG price does include all facility fees related to a hospital stay from the time of admission to discharge.
The DRG does not include professional fees.
For More Information
For information about Medicare Inpatient Provider Utilization and Payment Data, please use the following link:
For an estimate of what you might pay for a procedure at University of New Mexico Hospital (UNMH) please call (505) 925-0900.
For an estimate of what you might pay for a procedure at the Cancer Research and Treatment Center (CRTC), please call (505) 925-0336.
For an estimate of what you might pay for a procedure at Sandoval Regional Medical Center (SRMC) please call (505) 994-7157.