Price Transparency: Price Estimate and Downloadable List


 

Price Estimates Back to Top


For individuals with insurance or self-pay the Centers for Medicare and Medicaid Services has identified 70 CMS required Shoppables and requires hospitals to add 230 more shoppable services. If pricing for a shoppable service is not included on the shoppable page, the service is not available from the hospital. Standard charges for all services including the 70 plus 230 or more Shoppables are displayed on a downloadable list and a minimum of 70 Shoppables are displayed as  price estimates. Additional 230+ Shoppables and standard charges are available via the price estimator tool.

Price Estimate

Downloadable CMS MRF and Shoppables Lists Back to Top


Standard charges for all services including the CMS machine-readable file (MRF) and the 70 plus 230 or more Shoppables are displayed on a downloadable list. A minimum of 70 Shoppables are displayed as price estimates. Additional 230+ Shoppables and standard charges are available via the price estimator tool.

Holy Cross Hospital:


Price Transparency - Standard Charges 

CMS Machine-Readable File (MRF) 

Average Charges - English Average Charges - Spanish

Holy Cross Germantown Hospital:


Price Transparency - Standard Charges 

CMS Machine-Readable File (MRF) 

Average Charges - English Average Charges - Spanish

 

Price Estimate for Services Back to Top


Holy Cross Health supports price transparency and believes it is important for you to know what out-of-pocket costs you will incur for services provided at one of our facilities. We have established three easy ways for you to obtain estimate of your costs – call, email or click. By calling 301-754-7194 for Holy Cross Hospital and 301-557-6195 for Holy Cross Germantown Hospital or emailing sshsfincounseling@holycrosshealth.org, we can give you an estimate of your out-of-pocket costs for a medical service or procedure.

We review:

  • Your health insurance card
  • Physician information
  • The type of procedure you are considering
  • The Holy Cross Health hospital where the procedure will be performed

Use our Price Estimate Request form and we will send you an estimate of the charge for medical services or procedures. This only reviews the specific service or procedure and provides you with an average estimate of the charge and does NOT assess your insurance or out-of-pocket costs.

No Surprises Act – Good Faith Estimate Back to Top


Uninsured and self-pay patients may request a good faith estimate. Learn more

 

COVID-19 Diagnostic Test Pricing Back to Top


During these unprecedented times, it is important for you to know the costs for COVID-19 diagnostic testing. Holy Cross Health's COVID-19 laboratory test cash price is $51.31 or $100 depending on the type of test, as mandated statewide by the Maryland Health Services Cost Review Commission. Each test conducted will be billed. Patients are not required to pay for COVID-19 laboratory tests. The cash price is the price that will be charged to third-party payers. The amount charged is also subject to adjustment if the test is performed by a government agency.

 

Price Disclosure and Lists Back to Top


The Centers for Medicare and Medicaid Services have identified 70 shoppable services. If pricing for a shoppable service is not included on the shoppable page, the service is not available from the hospital.

By clicking to download this price transparency information you agree you have read and understand the following:

  1. Updates. The information contained in the file(s) is current as of the last upload. This information is subject to periodic changes and the file(s) will be updated and posted as soon as practically possible.
  2. Charges. In Maryland, charges—also called "rates"—for hospital services, such as room and board, radiology, laboratory, and other inpatient and outpatient services are regulated by the Maryland Health Services Cost Review Commission (HSCRC), a state regulatory agency. The HSCRC sets average hospital rates in January and July every year. Though the state sets hospital rates as of a certain date, hospital charges are allowed to fluctuate during the course of the year, and detailed charges for certain items may be different than the average approved rate that covers a larger group of services. That means charges on individual hospital bills may be different than the charges posted here. This is both allowable and normal as hospitals adjust charges frequently to comply with other regulations. Rates are set on average, and the underlying service charges may vary because they are components of the average. PLEASE NOTE THESE CHARGES do not include fees from your physician, surgeon, anesthesiologist or other professional services billed by your physician(s) AND OTHER PROFESSIONAL PROVIDERS. Typically, you will be billed separately for these professional services.
  3. File Contents. The file(s) contain the gross charge, charge description, associated accounting/billing code (such as HCPCS, CPT, NDC, DRG, or other payer identifier) of the item or service as reflected in the hospital's charge description master or other internal sources for similar data and or charges from common services packages (collectively referred to as CDM). The file includes five standard charge types required by the rule – either established and/or allocated – gross charge, discounted cash price, de-identified minimum contracted rate, de-identified maximum contracted rate, and derived contracted rate. Although the CMS rule requires “negotiated” charges be included as a standard charge type in the file, Maryland hospitals do not negotiate reimbursement rates with payers for hospital services. Per HSCRC regulations, payers are required to pay charges billed for hospital services, less a state-mandated discount, when applicable. The data reflected in the file for Holy Cross Health reflects calculated payment rates. (Please also refer to Section titled ‘File Layout Information’ below).
  4. Adjustments. Following the CMS guidelines, the information posted represents the hospital’s current gross charges as reflected in the CDM. However, it is important to understand that the information represented in the CDM is the starting point in many cases and can undergo additional adjustments through the billing process, therefore, please be aware:
    1. Charges for certain items or services are based on per unit, such as – including but not limited to – surgeries, anesthesia, and recovery which can be based on the unit of time and complexity; medications, drugs which can be based on weight-based dosage, age or packaging; etc.
    2. b. The file may also contain CDM items for non-charges (such as payments, allowances, transactions, etc.)
  5. MS-DRG Information.Note on MS-DRG related information: Prior calendar year inpatient discharges are grouped using the current year CMS MS-DRG. The current Medicare year's geographic mean length of stay (LOS) and description is used. The current year is used if the same MS-DRG is present in two Medicare periods. Charges are calculated and displayed by DRG by taking the total charges divided by the total case volume per DRG. Charges are listed for acute inpatients and newborn accounts. The charges to patients with all insurances and payers were included in calculating the charges per DRG. Charges to Rehabilitation and Long-Term Care accounts have been excluded. Also excluded are charges related to error MS-DRGs 0, 998, 999. Individual cases where LOS is greater than the Geographic Mean LOS times 1.5 are excluded. Low volume DRGs where number of cases were < 10 and high dollar outliers are also excluded.
  6. File Layout Information. The information provided herein is as required by The Centers for Medicare & Medicaid Services’ Price Transparency Final Rule and is not a guarantee of final billed charges, which may vary from these estimates for many reasons including the individual patient’s unique medical condition, complications, unknown circumstances, other diagnoses and recommended treatments. Moreover, these estimates may not include professional fees such as physician, radiologist, anesthesiologist, and pathologist fees. The insurance benefit information (where applicable) is based on information provided by insurers which may not be current on the date of a scheduled procedure, and benefits and eligibility are subject to change and are not a guarantee of payment:
    • Chargemaster – Tab to display chargemaster (normally a 4-5 column extract) includes gross charges
    • Standard Charges – Tab to display Standard Charges. Includes all five charge types required by the rule – either established and/or allocated – gross charge, discounted cash price, payer-specific negotiated charge, de-identified minimum negotiated charge, de-identified maximum negotiated charge – when available
    • Shoppable Services – Tab to display Shoppable Services. Includes the 70 mandated by CMS and at least 230 additional services selected by the hospital except for when a hospital doesn’t provide the required number of services. All five charge types required by the rule – either established and/or allocated – gross charge, discounted cash price, payer-specific calculated charge, de-identified minimum calculated charge, de-identified maximum calculated charge
    • Additional tabs:
      • Description – Consumer-friendly description of service, item or pharmaceutical
      • Code – Can contain CPT/HCPCS, MS-DRG or APR-DRG Code (note: all APR-DRG’s are displayed as 3 numbers to distinguish from other codes and end in X to signify severity)
      • Type – Outpatient (CPT/HCPCS) or Inpatient (MS-DRG or APR-DRG)
      • Gross Charge – Charge for an item or service
      • Discounted cash price – The discounted cash price information is subject to hospital-specific policy guidelines for financial assistance discounting. Patients can determine their eligibility and associated discount by contacting the hospital
      • De-identified min calculated rate The minimum derived calculated rate across all payers (All payers)
      • De-identified max calculated rate  The maximum derived calculated contracted rate across all payers (All payers)
      • Derived calculated rate – The median derived calculated rate across all payers (All payers)

Cautions: The file(s) can be voluminous, and download may take excessive time depending on your internet speed. Please consider the environment before deciding to print. By clicking to download this information you agree you have read and understand the above.

The Centers for Medicare and Medicaid Services have identified 70 shoppable services. If pricing for a shoppable service is not included on the shoppable page, the service is not available from the hospital.