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Average Medicare Charges for Hospital Outpatient Services, 2019

Average Medicare charges (average prices) for selected hospital outpatient services are listed here for calendar year 2019. Types of services include biopsy, breast surgery, musculoskeletal (e.g. bunions, knee cartilage, broken bone added together) procedures, ENT, cochlear implant, pacemaker charges, upper GI procedures, endoscopy, and more. File includes charges, what Medicare allowed, and what Medicare paid, and how many Medicare beneficiaries used that service. File shows charges to Medicare patients by physician name, state average and national average prices. Extremely difficult to use, even if somewhat familiar with using Excel files. High level price summary for about 60 categories in APC. More detail (such as bunions and bone spurs) is found in the HCPCS file, a couple of thousand procedures are listed there. In 2019, this file shows that the most common type of Comprehensive Observation Services (given to over 1 million Medicare patients) had an average charge over $17,600, with Medicare allowing $2,335 on average; Medicare paid an average of $1,854. A Level 3 Pacemaker was about $44,000 in charges, with Medicare allowing less than $8,500 (and paying $7,276 on average). A Level 2 Upper GI had an average charge in 2019 of $10,161. Medicare allowed under $1,500, and it paid $1,150 on average. Good information, very user-unfriendly. From CMS updated August 2021.

Colorado Average Cost for Office Visit, ER Visit, Outpatient Tests and Hospital Stay

Find out the average charge and average amounts allowed (cost) for an office visit, ER visit, outpatient tests and hospital stays in Colorado. More than 60 types of hospitalizations and almost 90 outpatient types are listed. Web site shows average price and amount paid in 2020 for each major insurance company. Compare the 9 regions such as Denver, Boulder, Ft. Collins, East CO, etc. Average cost for a 15-minute office visit (code 99213) was $101 in CO in 2020, compared to an average charge of $199. A new patient visit (99203) cost $176 for 30 minutes; the average charge was $288.  The most common type of ER (emergency room department) visit cost $1,293 (allowed) compared to $2,432 in charges. The ER visit code was 99283. The next two most common ER visit types cost $2,202 and $3,586 on average; their charges averaged almost $4,800 and $6,600 respectively. Most likely there were additional tests and imaging charges that were added to the bill.

Almost 13,000 Medicare Advantage cataract and lens procedures were done in 2020 (code 66984). While the average cataract removal charge was over $4,400, the allowed amount was $1,053. The Medicare member was responsible to pay $105 to $227, depending on insurance company. For other insurance, the member might have to pay $943 for a cataract removal. View prices and average costs for colonoscopy and ambulatory knee arthroscopy surgery. Inpatient costs include maternity and newborn charges, C-Section delivery, psychiatric admission, alcohol treatment, rehab, depression, diabetes and many more hospital stays. Consumers may wish to add medical inflation of at least 4.4% for 2022. Provided by the State of Colorado.

Cosmetic (Plastic) Surgery Prices – Physician Fees, 2021 (pdf) Editor's Pick

Cosmetic surgery (plastic surgery) average prices show physician fees for 2021. The average cost went up 6% for a surgical procedure. This compares to 1.23% medical cost inflation. Average cost (2021) shown near the end of this document: e.g. $6,764 for tummy tuck, $4,235 for breast augmentation, $4,864 for breast lift (mastopexy), liposuction $2,736, eyelid surgery (blepharoplasty) at $3,963, up 33%; breast reduction $5,806, nose surgery (rhinoplasty) $5,443, facelift at $9,127, neurotoxins at $409, dermal fillers at $766, and nonsurgical fat reduction $1,735. Prices do not include facility fee nor anesthesia cost. ASAPS physicians performed 320 surgical procedures, on average, in 2021. In total, (plastic) surgical procedures increased 54%. Liposuctions increased 66% in 2021. Face and neck procedures were up 55% in 2021, believed in part, due to the “Zoom Effect”. See Quick Facts in older reports for how long cosmetic surgery or botox procedures or spider vein treatments take, average surgeon’s fees, how long before you’re back to work, etc. Find the average surgeon’s fees in this annual book of national statistics by The Aesthetic Society (also called the American Society for Aesthetic Plastic Surgery, or ASAPS). ASAPS active members are Board-certified in Plastic Surgery.

Illinois Hospital and Ambulatory Surgery Center Ratings and Prices (IDPH)

Illinois hospital and ambulatory surgery center ratings and prices, from IDPH. Compare IL hospitals on patient satisfaction ratings; heart attack, heart failure, pneumonia, surgical infection prevention, knee arthroscopy, cardiac surgery, safety measures, infection rates, some survival information, more. See volume and 2019-2020 median charges (closest you’ll get to average cost) for selected types of inpatients (e.g. birth, c-section, appendectomy, COPD, gall bladder), and outpatients at ambulatory surgery centers (such as arthroscopy priced at $42,000 average in IL), bunionectomy (which had a statewide list price at $23, 374), hernia repair ($24,600), colonoscopy ($7,400), lens, lumpectomy, tonsillectomy (almost $15,000). Prices may be found under the SERVICES tab after you select the hospital or facility. May get a full report for one hospital or ambulatory surgery center at a time, or one measure at a time for multiple facilities side-by-side, with state averages. Hospital Report Card by IL Dept. of Public Health (IDPH) for all IL cities incl. Chicago area, Peoria, Rockford, Springfield, Champaign. Updated with 2018-2020 prices, 2019 and 2020 quality data, and 2019 patient satisfaction scores. Add medical inflation costs of at least 7%.

Iowa – Average Price for Ambulatory Surgery 2021

Compare 2021 average prices for ambulatory outpatient surgery at Iowa hospitals. Costs do not include surgeon fee or other professional charges. Check one procedure at a time. Average charge billed last year for Upper GI endoscopy was between $7,000 and $8,000 (rounded to the nearest thousand dollars). Colonoscopy average cost was between $5,000 and $8,000 excluding physician fees. Simple cataract $8,000 to $9,000. Tonsillectomy with adenoid removal, over age 11 was $10,000. One ear tube cost $12,000. Average charge for shoulder surgery $23k to $25,000. Laparoscopic gall bladder removal averaged $20k in hospital charges. Inguinal hernia repair (laparoscopic) averaged $28,000. Knee ACL repair averaged $34,000 in Iowa. Bunion correction surgery was $22,000 in average charges. An outpatient vasectomy was $7,000. Hysterectomy average charges were $26,000. Individual hospitals shown if they have enough volume. However, volumes are not shown. More ambulatory surgery procedures are listed. From the IA Hospital Association; reasonably easy to use. Updated 2022.

Maine Costs for Surgery, x-ray, imaging, lab tests (MHDO)

Compare costs in Maine for surgery, x-ray, imaging and lab tests across hospitals and medical groups. MHDO Maine Health Data Organization’s website shows average amount paid (median “cost”) by commercial insurance for surgery such as hip or knee replacement, shoulder arthroscopy, carpal tunnel, gallbladder removal; skin growth removal; lab tests such as strep, blood tests, urine. Imaging tests such as mammogram, x-ray, CT, MRI, ultrasound. Diagnostic procedures such as colonoscopy. Good news is that both physician and hospital charges for surgery are shown to give you an idea of total cost (and discounts); CPT codes listed. Costs for surgery, office visits and tests are from 2020-2021 claims, excluding Medicare and Medicaid. Search by city or zip code radius. From maine.gov; updated 2022.

Nevada Hospital Inpatient, ER and Ambulatory Surgery 2021 Average Charges Editor's Pick

Find average hospital, ER, and ambulatory surgery charges in Nevada for 2021. Each hospital is listed by name. Nevada Compare Care shows average hospital charges (prices) for every NV inpatient DRG (Diagnosis Related Group), and overall average ER or ambulatory surgery charge. Overall Nevada 2021 inpatient charge was a whopping $109,256 per stay, or $19,505 per day. Average charges increased 13% over last year; with a slightly higher case mix index. Sample DRGs: Psychoses (average $21,914, down 1%), Normal Newborn ($5,923, up 4%), uncomplicated vaginal delivery ($30,447, up 11%), Septicemia ($161,023 for DRG 871), Major joint replacement (hip or knee) at $152,973, Cesarean Section ($48,477 without complications).

Average 2021 NV emergency room visit charge was $11,105 statewide (up 7%). The number of ER visits in Nevada rose to almost 1 million from 925,000 visits the prior year. Average ER charges ranged from $2,389 average at Banner Churchill Hospital, to $17,404 average at Centennial Hills hospital. Statewide average Ambulatory Surgery Center charge was $8,955 (up 2%), but no breakout by procedure type is shown. Endoscopy Center average charges are included. Outpatient surgery at a hospital averaged $52,265 in charges, up by 21%. Standard Reports also show case volume by facility. No information about how much was actually paid. NV reports are a joint effort between Center for Health Information Analysis (CHIA) and the Division of Health Care Financing and Policy (DHCFP). Updated May 2022.

Texas – Average Cost for Outpatient Procedures – 2019

Find the 2019 average cost (average charge) for outpatient procedures in Texas. The Top 50 by Average Charges Per Procedure shows an average price of nearly $76,000 for a Level II arthroplasty (joint replacement or resurfacing) in 2019; however, Dallas County costs were closer to $68,000. Pacemakers also cost about that amount. Outpatient angioplasty cost over $83,000. Some chemotherapy procedures were as high as $120,000. A cochlear implant cost over $112,000 on average. Only the most expensive outpatient procedures are listed, not necessarily the most common high-volume procedures. Add at least 5.22% to estimate 2021 prices. Texas Health Data, from Texas Health Care Information Collection (THCIC).

Vermont – Hospital Outpatient Surgery Prices, 2022

How much does outpatient surgery cost in Vermont? To find 2022 prices (the most recent available), see Section called Pricing of Common Services at Community Hospitals.

Tables 2A and 3P let you compare average gross charge (the closest you will get to average cost) for most common ambulatory surgery procedures at 14 general hospitals in VT. Table 3P (Other) Prices is more current, to September 2022, and it includes the physician charge. Hip replacement averaged $38,895 in VT. Knee replacement average cost was over $39,000; knee arthroscopy averaged $14,541. Outpatient gallbladder removal was $17,128 on average. A prostate biopsy was about $4,000. Hernia repair averaged $18,297. A tonsillectomy with adenoid removal in a child under age 12 was $12,618. Cataract prices, carpal tunnel release and more than 20 outpatient procedures are shown. Prices varied by hospital.

Table 2A shows prices for some procedures, 12 months through September 30, 2020 (two to three years old). Here you can find prices for ear tubes (myringotomy), outpatient hysterectomy, bunion removal, lumpectomy and other procedures. This table DOES NOT include the surgeon or other physician fees. Medical inflation has been about 4.7% over the past 2 years, and 9% over 3 years. As with all of Vermont’s reports, the font size is about as small as you can get.

Virginia Healthcare Prices – ER Visit, Ambulatory Surgery, Test, Hospital Stay Costs

Find Virginia Healthcare Prices for ER visits, ambulatory surgery, tests and hospital stays. This site shows average price ALLOWED (commercial insurance prices) in 2018 for almost 40 common healthcare services in VA. Includes a mix of outpatient, clinic, hospital stays and other services such as an ambulance (median $550) or an emergency helicopter ride ($19,466 which includes average base cost of $14,402 plus mileage). Examples: hospitalizations (maternity), outpatient xray/imaging, CT and MRI tests; colonoscopy, mammogram; inpatient or ambulatory surgery (e.g. hernia, gall bladder, knee replacement, tonsillectomy, kidney stones); and ER or well-child visits (median $126). Shows median and range of costs and provides a breakout by type of cost: facility, surgeon, anesthesiologist, etc. Also shows average price by setting: clinic vs. hospital vs. ambulatory surgical center; and region of Virginia. The median amount allowed for an ER visit (medium, code 99283) was $1,091. The 2020 report shows allowed amounts for each service that you or your insurance plan ACTUALLY PAID in 2018. More relevant than most pricing information, but lags in timeliness. Add at least 12% medical inflation rate to estimate 2022 costs. Virginia Healthcare Pricing Transparency, from Virginia Health Information (VHI), updated June 2020. No new updates as of August, 2022.

Wisconsin – Ambulatory Surgery Facility Charges, 2020

How much does outpatient surgery cost in WI?  Compare Wisconsin ambulatory surgery facility charges (prices) for 2020 for each hospital and freestanding ambulatory surgery center. Find average 2020 charges for 20 common ambulatory surgery procedures, such as Colonoscopy (5 codes), Endoscopy, Biopsy, Spinal Injection, Cataract & Lens ($7,675 average), Total knee replacement (arthroplasty) average price $39,538; outpatient Knee surgery/arthroscopy ($12,397), Carpal Tunnel ($7,247) and more. For colonoscopy, a less-frequent Colorectal Cancer Screening, or colonoscopy for a patient that is NOT high risk (code G0121) had an average charge of $3,728 in 2020. However, the two most common colonoscopy procedures had an average charge of about $6,000. Number of procedures for each hospital and surgical center are shown for top 20 only. Go to the Overview report for a longer list of 40 procedures including gall bladder removal (laparoscopic cholecystectomy at $19,649 average statewide cost, ear tubes, and tonsillectomy. Prices do NOT include surgeon and physician fees, which may cost thousands of dollars and could double prices shown. Consumers should add medical inflation to estimate 2021 facility prices. Health Care Data Report 2020 by WHA Information Center, published August 2021.

Wisconsin PricePoint – Outpatient & Ambulatory Surgery Cost

Find average cost for outpatient and ambulatory surgery in 2021, from Wisconsin PricePoint. Compare outpatient and ambulatory surgery volume and charges for colonoscopy, cataracts, eardrum surgery, shoulder or knee surgery, carpal tunnel surgery, removal of tonsils & adenoids, appendectomy, breast biopsy, endoscopy, gallbladder (cholecystectomy), upper GI, heart catheterization and more. Compare hospitals and surgical centers. Typical (median) price in county and statewide Wisconsin median prices shown, but no dates are provided on the consumer site. Must use the healthcare professionals site to see the dates and the number of procedures done at each hospital; 2021 prices are shown. Prices exclude surgeon and other doctors’ fees which may double the numbers you see here

Ambulatory Surgery Average Charges in U.S. Hospitals, 2007

Find average charge for about 80 outpatient ambulatory surgery procedures done in hospitals in 2007 (excluding surgeon’s or other physician fees.) Consumers will need to adjust the 2007 prices for medical inflation, to estimate 2021 costs.  Add at least 50% for a rough estimate. Overall average was $6,100, compared to nearly $40,000 for inpatient surgery. In today’s 2021 medical dollars, that would be $9,100 and nearly $60,000. Average colonoscopy & biopsy price in 2007 was $2,369; upper GI endoscopy $3,131; cataract & lens was $4,870; tonsillectomy $5,286; knee cartilage $7,357; hernia repair $8,187; outpatient gallbladder removal (cholecystectomy) $10,838; breast biopsy $3,863; lumpectomy $7,458; ear tube surgery (myringotomy) $3,547; D&C $6,366; arthroscopy $8,970; incontinence procedures $9,929; varicose veins $,8459; bunionectomy $7,699; wrist fracture $7,807; $4,770 for circumcision. AHRQ Statistical Brief #86 published February 2010 unfortunately still has not been updated by the federal government. No longer Editor’s Pick

Medicare Ambulatory Surgery Allowed Costs – 25 Commonly Performed Procedures

Medicare Ambulatory Surgery Allowed Costs are shown for 25 commonly performed procedures.  This file shows 25 procedure payments by Medicare and what they considered the Allowed Amount. It also shows average amounts Medicare paid to Ambulatory Surgery Center (ASC) facilities for selected outpatient surgery such as spinal injection (example: CPT code 62311 Medicare allowed $377, and paid $297), knee arthroscopy (CPT 29881 $1631 allowed), prostate needle biopsy (CPT code 55700 $670 average allowable cost; $530 average cost paid), simple cataract removal & lens insertion ($1,679 allowed; Medicare paid $1,339), bunion correction ($1,825 allowed), crushing kidney stones ($2,330 allowed), large bowel endoscopy ($586 allowed, plus $671 for removal of polyps), and more. Includes physician fees and payment to the ASC. Confusing file unless you know CPT codes and can use Excel files. Actual prices or charges are not shown. Old 2012 data published Sept. 2013. No updates available. Consumers may wish to add a minimum medical inflation factor of at least 27% to estimate 2021 prices.

Other Helpful Listings

Ambulatory Surgery in U.S. Hospitals, 2003: HCUP Fact Book No. 9

Facts and figures on ambulatory surgery in US hospitals, from the 2003 HCUP Fact Book No. 9. Shows outpatient surgery volumes, average prices, gender, comparisons to inpatient surgery, and more in 2003. The Appendix shows the average charge per visit for each type of ambulatory surgery. Average charge in 2003 was $5,600, which is approximately equal to $9,900 in 2021 dollars (medical inflation only). However, technology has also changed, so the average prices listed are for reference only. Read sections online. Published January 2007. Amazingly, the federal government never updated this publication, despite the public’s desire to know more about ambulatory surgery costs!

Cochlear Implant – Codes you may need to ask about prices

Find the codes for cochlear implants in order to ask about prices. Johns Hopkins provides a list of codes that can help consumers ask their insurance companies about how much Cochlear Implants cost. Total costs are unknown for 2022. Past estimates have ranged from $30,000 to $100,000 (AARP). By asking your insurance company and your hospital to look up the procedure codes, you might be able to get a specific cost estimate for this outpatient procedure.

Oregon – compare hospital and outpatient surgery costs (2020)

Compare hospital and outpatient surgery costs in Oregon. The most recent data are from 2020 costs. However, only the difficult-to-use Excel files full of data are available from the government OHA – Oregon Health Authority. Click on HOSPITAL PAYMENT REPORTS. Look for the statewide numbers to see median commercial payment across the state. Hospitals with the larger volumes for any given procedure, also show their median cost for both 2020 and 2019. In the past, a set of reports (instead of just the data file) showed the median amount PAID by commercial insurance companies. Costs paid, are after any discounts off charges (prices) have been taken. The file may have more than one line for what appears to be the same procedure. For example, two median costs are shown for Hernia repair – the outpatient surgery cost was close to $11,000 while the inpatient cost was nearly $27,000. Read closely. The user-unfriendly data file was updated June 2022.

If you choose the older Reports (2017 or 2018), select OUTPATIENT SURGERIES Report for same-day procedures such as breast biopsy ($3,302 median paid in 2017), carpal tunnel ($4.313), colonoscopy ($2,383), ambulatory gallbladder surgery ($11,697), hernia repair ($8,605 median paid), knee or shoulder arthroscopy, tonsillectomy ($6,380), tympanostomy (ear tubes $4,680), upper endoscopy, and more. Select INPATIENT Procedures Report to compare hospitals on costs for appendectomy, coronary bypass, kidney removal, inpatient gallbladder surgery or hernia repair, inpatient hip replacement, hysterectomy, angioplasty and more. Select PREGNANCY report to find 2017 maternity costs paid (about $8,400 for normal delivery, $14,838 for uncomplicated c-section and $2,200 for newborns). Compare hospital payments for IMAGING such as CT, MRI, Nuclear Medicine tests, ECG, x-ray, bone density studies. Compare amounts paid for RADIATION AND (outpatient) CHEMOTHERAPY infusions or injections. The reports are easier to read, cover a large set of services, and show each hospital’s payment, along with what was paid the year before. Unfortunately, the information in the reports is 5 to 6 years old. When estimating, consider medical inflation which has been about 14% from 2017 to 2022. Hospital costs may have gone up much more than that. Average amount paid for one type of hernia repair surgery, for example, rose more than 9% per year in the past 3 years – to nearly $11,000.

Vermont – Outpatient Surgery counts and average price statewide

Find out how many outpatient surgeries (selected types) were done at each Vermont hospital, and the average price statewide. Shows counts (volume, to calculate market share) and average gross charge for period of Oct 2019 to Sept. 2020. Average cost does not include physician charges. Volumes include arthrocentesis, cataract surgery, endoscopy, cholecystectomy (gall bladder surgery), colonoscopy, ear tubes (myringotomy), tonsillectomy, bunionectomy, circumcision, breast biopsy, outpatient vascular catheterization, hernia repair and more. Part of the VT State Act 53 Hospital Community Report series, Table 2B published in June 2022.

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