Costs of Hospital Billable Services
Costs for hospital services and procedures vary among healthcare providers based on several factors including whether they are an academic medical center, a teaching hospital, a community service provider and other factors.
The chargemaster and diagnostic related group list are provided to you by MelroseWakefield Healthcare and are applicable to services provided at MelroseWakefield Hospital, Lawrence Memorial Hospital, and outpatient departments.
Request a Price Estimate
Are you having a procedure at one of our hospitals and wondering what it may cost? As a courtesy to our patients, we can provide price estimates for outpatient services.*
You may also call us for a price estimate call us at 781-338-7447. To best serve you, please have the following information ready: the patient’s name. a phone number to return your call, the 5 digit CPT procedure code (which can be obtained from the doctor’s office that is ordering the test).
*Please note that the estimates provided are based on the information known at the time of the request. All final charges are dependent on the decisions made by your health care team during your visit. We do not provide estimates for inpatient hospital stays or physician services.
A hospital chargemaster is a comprehensive list of all the billable services and items provided by a hospital. The chargemaster captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges. Because hospitals operate 24 hours a day, seven days a week, a chargemaster can contain thousands of services and related charges.
Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company, Medicare, or MassHealth. In most circumstances, the chargemaster rates are not reflective of the actual payment to the hospital. These payers then apply their reimbursement terms or contracted rates to the services that are billed. If a patient co-payment, co-insurance, or deductible is owed, these too are most often not based on chargemaster amounts but rather the payment terms determined by the insurer or government program.
Costs vary among health care providers based on several factors including whether they are an academic medical center, a teaching hospitals, a community service provider and other factors.
MelroseWakefield Healthcare provides specific cost estimates for patients.
You can find more information on our financial assistance policies or may make an appointment with our financial counselors at 781-338-7111.
Frequently Asked Questions
Frequently asked questions and answers to help you understand how to use the chargemaster and price estimate tool.
What is the “CDM Code”?
CDM code is short for charge description master code. This value is a unique identifier for items in the chargemaster.
How are the descriptions determined?
Generally, descriptions in the chargemaster are based on the Current Procedural Terminology (CPT) short descriptions that are written by the American Medical Association, the entity that owns CPT.
What if I need financial assistance or counseling?
Financial counselors are available to help you navigate and understand your financial options. In some cases, patients may be eligible for free or reduced cost of health care services through various state public assistance programs as well as the hospital financial assistance programs. Such programs are intended to assist low-income patients taking into account each individual’s ability to contribute to the cost of his or her care.
For those individuals that are uninsured or underinsured, the hospital will, when requested, help them with applying for either coverage through public assistance programs or hospital financial assistance programs that may cover all or some of their unpaid hospital bills. Find more information about our financial assistance policy or schedule an appointment with one of our financial counselors at 781-338-7111.
What is not included in the chargemaster list?
The chargemaster may not include charges for services provided by the doctors who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care.
The following provides a list of providers who may send a separate bill for any services provided in the hospital:
- your personal doctor, if he/she sees you in the hospital
- the surgeon who performs your procedure
- the anesthesiologist who works with the surgeon
- the emergency medicine physician who sees you in an emergency
- the urgent care physician who sees you in urgent care
- the radiologist who reads your X-rays or other imaging
- other doctors who may be consulted by your doctor during your time in the hospital
Are the charges or diagnostic related group the same for every patient?
The list of charges is the same for all patients. For inpatient stays, some insurance companies or payers roll charges into a diagnostic related group (DRG). The DRG can vary depending on the insurance company or payer. We have shared DRGs for Medicare.
However, the total charges or DRG for an individual patient often vary from one patient to another for a number of reasons, including but not limited to:
- how long it takes to perform the service or how long it takes you to recover in the hospital
- whether the service or procedure you receive is more or less difficult than expected
- what kinds of medication you require
- whether you experience complications and need additional treatment
- other health conditions you may have that may affect your care
Chargemaster amounts are almost never billed to a patient or received as payment by a hospital.
Where can I find more information about hospital costs?
If you would like more information about what your care might cost you or our financial assistance policy, you may make an appointment with our financial counselors at 781-338-7111. For assistance with a price estimate, please call 781-338-7447.
Your health plan can also help you to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles and your expected out-of-pocket responsibility.