Colorectal Cancer (Additional Resources)
Primary Listings
Age Lowered to 45 for Colorectal Cancer Screening (AARP and USPSTF)
Blog article by AARP explains the new lower age recommendation – age 45 – for colorectal cancer screening. The full recommendation by the USPSTF (United States Preventive Services Task Force) is also linked here. Published May 18, 2021.
Colonoscopy: What it is, What to Expect
Overview of Colonoscopy, what it is and what to expect. Written by the American Gastroenterological Association (AGA). Includes preparing for the procedure, what to expect during and after the test, its relationship to colon cancer and colon polyps, polypectomy and more. Updated 2021.
Utah – How Much Does a Colonoscopy Cost?
How much does a colonoscopy cost in Utah? A Utah Department of Health report shows a median amount allowed by commercial insurance companies of $1,761 for a colonoscopy done between July 2019 and June 2020. Clinics allowed amounts were lower compared to Ambulatory Surgery settings. These were in turn lower than in Hospital Outpatient settings. Costs went up about $200 with each more sophisticated setting.
- The median office/clinic allowed amount for a colonoscopy was $1,428.
- The median amount in an ambulatory surgery center was $1,636.
- The hospital outpatient colonoscopy median was $1,818.
The report compares prices and median allowed payments for 61 locations: 9 clinics, 12 ambulatory surgery centers, and 40 hospital outpatient locations.
The lowest allowed amount at a location that had at least 500 procedures (on commercially insured patients) was Ridgeline Surgicenter in Ogden. The Ridgeline median charge of $7,209 compares to the allowed median of just $1,405. The 15 locations that did at least 500 procedures performed 80% of all the commercial insurance colonoscopies in Utah. Of the large centers, Bountiful Surgery Center and Wasatch Endoscopy Center had median charges near $8,000 for a colonoscopy. Granite Peaks Gastroenterology had the smallest gap between charges and allowed amounts. They accepted $1,446 as the median payment amount, on median charges of just $2,661.
The Utah report shows the wide gap between prices and allowed amounts that actually get paid. Nine colonoscopy locations had an average charge over $7,000. The report found median charges could be as high as $8,134, at Utah Surgery Center. But this ambulatory surgery center accepted on average, an allowed price of $1,900. That is effectively a 77% discount off charges. Ambulatory surgery centers tended to charge more than hospitals, then offer larger discounts. Insurance companies appeared to have a maximum allowed charge (up to $3,730), despite the billing price. Discounts vary by insurance plan. The most expensive location paid by commercial insurance was San Juan Health Services District hospital, which did just 17 commercial insurance procedures. Their median allowed amount was $3,279. Of the large centers, University Hospitals and Clinics (2,417 procedures) had the highest median allowed cost of $2,253. Sixteen locations across the state had allowed costs higher than University Hospital.
CPT codes 45385, 45380 and 45378 were used in the study, along with associated anesthesia, surgeon or GI physician, pathology, and procedure costs. These codes covered over 95% of all colonoscopies on commercial patients. Additional details such as volume, and actual numbers for each provider are in Utah’s OpenData Catalog linked in the report. Medicare patients and quality indicators were not included in the study. Published by the Office of Healthcare Statistics, March 2021.
Cost of 3 Cancers: Lung, Breast and Colorectal Cancer
Learn about long-term out of pocket costs of three cancers: lung cancer, colon cancer and breast cancer. See how costs could accumulate for over time. Using 2010 to 2014 data (essentially before the Affordable Care Act), costs were examined over time. Pages 9-10 are interesting because the charts show total cumulative cost over almost 4 years, an how much of that cost, the patient was responsible for. Patient’s 4-year cost was over $11,000 for lung cancer (of $282,000); $8,442 (of $165,000) for colorectal cancer; and $7,500 out of pocket (of $101,000 total cost) for breast cancer. Study by Milliman Research, April 2017. Note, this report is getting quite old.
Other Helpful Listings
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.
Maryland HMO & Health Insurance Plan Ratings 2020-2022
Find the latest Maryland HMO and PPO Health Insurance Plan Ratings. The only plan to get a full 5-star rating was Kaiser Permanente HMO. Compare KP with Aetna HMO and PPO, CareFirst BlueChoice and GHMSI, Cigna, MAMSI PPO, MD-IPA, Optimum Choice and United Healthcare HMO and PPO. Member satisfaction (CAHPS), getting appointments, flu shots, and many clinical measures of care such as Diabetes, breast cancer screening, behavioral health, well child care are some of the measures. Quality scores are 80% of the overall performance rating. Check Consumer Ratings, Clinical Ratings and Provider Network Ratings that make up the total score. Most scores reflect what happened in 2021. They were published in October 2022. Maryland Health Plan guide is by the Maryland Health Care Commission.
Medicare Coverage for Colonoscopy or other Colon Cancer Screens
Learn what Medicare covers for colonoscopy or other screens for colon cancer. Annual fecal occult blood tests (FOBTs) are free under Medicare. Other more expensive colon cancer screening tests such as colonoscopy and sigmoidoscopy are covered periodically, without cost to the patient if your doctor accepts Medicare assignment as full payment. Medicare also covers at-home multi-target stool DNA lab test (e.g. Cologuard) once every 3 years for certain people ages 50 to 85. Cologuard Find out Medicare’s details. Unfortunately, Medicare does not provide cost estimates for the public at this site
Montana Hospital Outpatient Surgery and Test Costs
Find out how much outpatient surgery and imaging tests cost in Montana in 2019-2020. Compare MT hospital charges for ambulatory surgery and diagnostic tests such as colonoscopy (median charge $2,611 for a diagnostic colonoscopy code 45378), sigmoidoscopy, breast biopsy, cardiac stress tests, cardiac catheterization. All prices EXCLUDE surgeon fees and other physician costs. PricePoint system shows facility prices in the past, for common surgical procedures such as tonsillectomy (median $6,004 with adenoid removal, under age 12, code 42820), cataracts, ear tubes, knee cartilage, bunions, child’s appendix removal, carpal tunnel, gallbladder removal, skin lesions, upper GI endoscopy; x ray, CT, MRI (e.g. spine MRI without dye had a median price of $1,692, code 72148) and other radiology imaging prices listed. Costs are from July 2019-June 2020. Consumers may wish to add medical inflation to estimate 2023 prices. No updates available as of April 2023.
Rhode Island – Top Ratings for Health Insurance Plans (NCQA)
Find top NCQA ratings for health insurance plans in Rhode Island. No plans earned the top 5.0 rating from NCQA this year. 2022-2023 Ratings. Based on Quality, Member Satisfaction and accreditation results. Five health plans earned 4.5 stars. Updated October 2022.
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, 2021
How much does outpatient surgery cost in WI? Compare Wisconsin ambulatory surgery facility charges (prices) for 2021 for each hospital and freestanding ambulatory surgery center. Find average 2021 charges for 20 common ambulatory surgery procedures, such as Colonoscopy (5 codes), Endoscopy, Angiography, Spinal Injection, Cataract & Lens ($7,916 average), Dental Surgery procedure (average $8,012), Total knee replacement (arthroplasty) average price $41,321 (up 4.5%); outpatient Knee surgery/arthroscopy $13,130 (up 5.9%), Carpal Tunnel $7,738 (up 6.8%) 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 $3,876 (up 4%) in 2021. However, the two most common colonoscopy procedures had an average charge of about $6,300. 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 $21,370 (up 8.8%) average statewide cost], ear tubes, and hernia repair. 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 2022 facility prices. Health Care Data Report 2021 by WHA Information Center, published 2022.
Wisconsin CheckPoint – Hospital Ratings and Patient Opinions Editor's Pick
Wisconsin CheckPoint helps you compare hospital quality performance and patient opinion ratings for 127 hospitals in WI. Topics: Birth and C-Section delivery, infections, readmissions; deaths (mortality) data, patient satisfaction, patient safety. Many conditions are rated, such as heart attack, heart failure, CABG and PTCA; pneumonia, surgical post-op infections, hip and knee surgery, vascular, colon surgery and hysterectomy; COPD, pneumonia; patient safety problems such as falls and pressure ulcers.
Also see how many patients would definitely recommend the hospital. (Ratings are listed under Patient Experience.) Compare hospitals on how many patients “understood their care when they left hospital”. Statewide, only 56% said they understood their care during 12 months ending Sept. 30, 2021, down 2 points from 2019. Eighteen (18) hospitals had fewer than half their patients understanding their care when they left the hospital: Marshfield Medical Center (hospitals in Marshfield, Neillsville, Beaver Dam, Rice Lake and Weston); Beloit Health System, Ascension hospitals (St. Francis and Columbia St. Mary’s Hospital in Milwaukee, All Saints Racine, Ozaukee, Mequon), Reedsburg Medical Center, Mayo Clinic Oakridge in Osseo, HSHS St. Nicholas in Sheboygan, Aspirus hospitals (Medford Portage and Rhinelander), Froedert in Kenosha and ThedaCare in New London. Statewide, 29 hospitals significantly under-performed (one-star) on this measure compared to the state average.
Congratulations goes to Memorial Hospital of Lafayette County in Darlington, for achieving 100% healthcare staff influenza vaccination during the 2021-2022 season. At the other end of the spectrum, Hudson Hospital & Clinic came in at an abysmal and embarrassing 41% staff vaccination rate. Ten other hospitals may have been in that low range also, since they chose not to publicly report.
Rankings are shown by stars (one, two, or 3 stars), and consumers can switch to numbers by clicking ‘Show Rates”. Many individual measures reflect 2021-2022 scores. Long-term trends lines are shown for each hospital, measure by measure, and the number of cases for that illness or surgery. Wisconsin Hospital Association makes quarterly updates. WHA receives Editor’s Pick for going beyond CMS measures, for showing all hospitals side-by-side, consumer ease in getting a free overall quality report for one hospital, staying current, and showing comparisons to the benchmark best in the state. Updated 2022.
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
Health Conditions, Glossary and Specialty Reports
