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Hospital Clinic Visit Charges and Medicare Payments 2016

Find the average price in calendar year 2016 for various types of hospital outpatient charges to Medicare patients. File should show charges by physician name, state average and national average prices. Extremely difficult to use, even if somewhat familiar with using Excel files.  From CMS updated 2019.

American Hospital Directory – Outpatient Charges and Volumes (ahd.com) Editor's Pick

Charges and average costs for the 20 outpatient Ambulatory Payment Classifications (APCs) representing the highest Medicare outpatient payment to each hospital (excluding critical access hospitals). List varies by hospital. May include: cost for colonoscopy, laparoscopy, CT, MRI, clinic and emergency (ED or ER) visits, x-ray tests, upper GI, lower GI endoscopy, arthroscopy, cataract with lens, angiography, echocardiography, hernia repair, infusion therapy, nerve injection, observation services, outpatient cardiac catheterization, ultrasound. Scroll to bottom of the hospital page to Outpatient Utilization Statistics. Some rural critical access hospitals may not show any outpatient test and visit prices. Also shown: inpatient market share by local zip code; net income. Link is to the Free Hospital Information

California – Average Inpatient and Outpatient Hospital Prices, 2018

Find prices for CA hospitals including Kaiser and Shriners. Inpatient prices are listed in the complicated Charge Master, which shows the charge for every pill, lab test and hospital room rate. MRI and CT tests should be included. More useful are the outpatient files (look for Common25 in the filename), which list the average cost (charge) for top 25 types of outpatient procedures or surgery with CPT code). Hospital Outpatient reports may show prices for Emergency Dept. ER visits, lab tests, CT, MRI, Mammo, x-ray, ultrasound, PT visit, Arthroscopy, colonoscopy, hernia repair, gall bladder removal, etc., depending on their highest volume. Files are in Excel file format. Prices are from June 2018. Consumers can see one hospital at a time.  Provided through California OSHPD.

Florida Outpatient Surgery Prices & Visit Volume (2018 data) Editor's Pick

Compare hospitals and ambulatory surgery volumes and range of charges (average cost is not shown) for common adult and pediatric outpatient surgery procedures, by hospital or surgical center name. Includes arthroscopy, cataracts, laser eye procedures, cardiac catheterization, pacemaker, upper GI & lower GI endoscopy, colonoscopy, hernia repair, hysteroscopy, tonsil removal, lithotripsy, skin biopsy, bunion removal, pediatric circumcision and more. You might be surprised to find outpatient hernia repair prices averaged $10,413 to $26.585, but individual hospitals ranged from $945 (Florida Medical Clinic in Tampa) to a high charge over $72,000 at Palms of Pasadena in St. Petersburg (ages 18 to 64, Level 1). Cataract procedures at the highest volume center (University of Miami Hospital Bascom Palmer Eye Institute) listed charges from nearly $17,000 to over $19,000. The second largest center, St. Luke’s Surgical Center in Tarpon Springs, did cataract procedures for $1400 (ages 18-64). Might be worth asking about price before you schedule the surgery. Links to inspection reports. FloridaHealthFinder.gov 2017-2018 data. Editor’s Pick.

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

Compare IL hospitals on heart attack, heart failure, pneumonia, surgical infection prevention, knee arthroscopy, cardiac surgery, safety measures, infection rates, some survival information, patient satisfaction, more. See volume and 2016 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 bunionectomy, hernia repair, colonoscopy, lens, lumpectomy, tonsillectomy). Prices may be found under the SERVICES tab. May get a full report for one hospital at a time, or one measure at a time for multiple hospitals 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 2018, using 2016 data

Iowa – Average Price for Ambulatory Surgery 2018

Compare average prices for ambulatory outpatient surgery at IA hospitals, before adding surgeon fee or other professional charges. 2018 prices. Check one procedure at a time. Average charge billed last year for Upper GI endoscopy was between $6000 and $6900; Diagnostic Colonoscopy averaged $4,941 excluding physician fees; simple cataract $7442 to $8201; Tonsillectomy over age 11 $10,896; one ear tube $10,265; shoulder surgery $20k to $23,000; laparoscopic gall bladder removal averaged $17k in hospital charges; inguinal hernia repair (laparoscopic) averaged over $21,000. Individual hospitals shown if they have enough volume. From Iowa Hospital Association

Louisiana Hospital Ratings and Prices – LA Hospital Inform

Find range of charges (low price and high price) for Medicare patients at Louisiana hospitals, both inpatient and outpatient. Hospital-specific inpatient charges do not include childbirth or C-section, since it’s Medicare only. Find hip or knee surgery prices, gall bladder removal, psychiatric admission, rehab, heart problems, stent, stomach problems, stroke, GI hemorrhage, kidney failure, COPD, pneumonia, diabetes, bowel surgery, more; outpatient Medicare prices include ER visits, heart tests such as cardiac cath, EKG, heart imaging, valve repair; CAT scan or CT angiography, GI endoscopy, more. Quality scores and volumes (which cover all patients), are similar to those at HospitalCompare, but may be less current (2017). LA Hospital Inform is sponsored by the Louisiana Hospital Association; Price ranges from 2017 (outpatient and inpatient)

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

Maine Health Data Organization’s website shows average charges (median prices) for surgery such as hip or knee replacement, shoulder arthroscopy, carpal tunnel, gall bladder removal; skin growth removal; lab tests such as strep, blood tests, urine. Imaging tests such as mammogram, x-ray, CT, MRI, ultrasound. 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. Surgical prices date from 2016-2017. Office visit and test prices are from 2017 charges. From maine.gov

Minnesota – Hospital Price Check (Inpatient & Outpatient)

Hospital-specific prices (charges) for all inpatient hospitalizations (described in medical terms) and top 25 same-day surgery procedures in MN. Find average and median inpatient cost (before discounts) and volume for newborns and child birth delivery, pneumonia, chest pain, COPD, hip or knee replacement, appendectomy, cellulitis, hysterectomy, rehab, other surgeries & many more. Outpatient prices for biopsies, cataracts, colonoscopy, ear tubes, gallbladder (cholecystectomy), hernia repair, arthroscopy, tonsillectomy, upper GI endoscopy, hysteroscopy, carpal tunnel and other same-day surgery. Compare 3 hospitals, one procedure at a time; excludes doctor charges; by Minnesota Hospital Association, 2017 prices and volumes of cases

Montana Hospital Outpatient Surgery and Test Costs

Compare MT hospital charges for ambulatory surgery and diagnostic tests such as colonoscopy, 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, cataracts, ear tubes, knee cartilage, bunions (median $5483, $2000 more for big toe), child’s appendix removal, carpal tunnel, skin lesions, upper GI endoscopy; x ray, CT, MRI and other radiology imaging prices listed; 2015 costs

New Hampshire Physician Visit, Outpatient Hospital and Dental Prices – Compare (free)

Compare physician office visit prices, dental prices, hospital outpatient tests, PT visits and some surgery prices, as well as some ER prices (estimated at 2017-2018 prices plus 5% inflation) in NH. Choose procedure or test (e.g. lab, Radiology such as x-ray, MRI, CT or ultrasound). Select insurance, or uninsured to compare charges with your deductible. Tonsillectomy, colonoscopy and about 20 different surgeries are in Outpatient, which are bundled to include surgeon and anesthesia costs. Price transparency project developed by the New Hampshire Insurance dept. Excellent website, easy to navigate

Ohio Hospital Price List (Sample) – Inpatient, ER, Lab, X-ray Charges

Here’s an Ohio hospital example of a 14-hospital system called OhioHealth showing their current prices for all services at 12 of their hospitals.  Examples of items in the chargemaster include daily hospital room charge, ICU charges, labor, delivery, c-section and newborn prices, price for an ER visit (depends on Level of the emergency department), operating room charges, PT, OT, cardiology and pulmonary charges, prices for x-rays, CTs, MRI, ultrasound, DEXA scan, and many lab tests. Examples are CBC, BUN, Arterial blood gas, lipid panel, troponin, cultures, glucose, hemoglobin A1C, pap smear, creatinine. Because a hospital’s price list might be hundreds of pages long, with thousands of line items, it can be difficult to find what you’re looking for.  The documents are not fully searchable. (For example, the category for Emergency Services requires scrolling to find it.) In addition, selected average charges are provided by each hospital for certain DRGs, without describing what time frame was covered in the calculation.  Average charges list varies by hospital. Caution: Physician professional fees may not be included (even in the Emergency Department).  Check each hospital’s website separately. Covers Riverside Methodist, Grant Medical Center, Doctors Hospital, Dublin Methodist and Grove City; Grady Memorial Hospital, Hardin, Marion General, Mansfield, Shelby, O’Bleness, and Berger Hospitals.

Utah Outpatient Ambulatory Surgery Charges, 2017 – by facility

Utah theoretically provides Average charges for the top 20 outpatient procedures & ambulatory surgery at each Utah hospital and freestanding ambulatory surgery center. They state that both 2017 and 2014 charges are available. Scroll to the bottom of the page to see Outpatient reports. However, the format is extremely cumbersome and probably impossible to read for most consumers. We could make no sense of it. Possible files are in a difficult-to-read Excel format with CPT code or ICD-9 abbreviations. The 2014 procedures with average prices could be colonoscopy, upper or lower GI endoscopy, EGD, polpectomy, knee arthroscopy, cataract and laser eye procedures, myringotomy (ear tubes), tonsillectomy, cardiac cath, pacemaker, spinal injection, cochlear implants, carpal tunnel release, complex laparoscopic procedures (e.g. lap choley gall bladder removal), septoplasty. Report by UT Department of Health. Please send us an email if you can make it work for you.

Vermont – 2019 Outpatient Diagnostic Test Prices Editor's Pick

Compare 2019 hospital prices for lab work, x-ray & imaging tests. MRI charges averaged $1942 [pelvis angiography] to $4134 [MRI-brain, multiple sequences] with physician fee. CT scan of head, neck, face, chest, spine, pelvis, abdomen (overall CT average $1358 to $4120); digital screening mammograms average $548 with physician charge. Specific test prices for urinalysis, glucose, Metabolic Panel ($111 average), lipid panel ($97), PSA (average $131, range 61 to 267), CBC (range $59 to $72), strep test group A (range from $74 to $82), Pap test (average 122 to 129), pregnancy test (average $58), blood typing, OB ultrasound first trimester (average $903), x-rays, Cardiology EKG or echocardiogram, PT evaluation ($302 average, moderate complexity), colonoscopies ($3660 without biopsy) and more. CPT codes listed. Vermont probably has the best State site for hospital outpatient diagnostic test cost comparison. Some average prices in VT have gone down this year, which may support useful price comparisons among hospitals. Prices good through Sept. 2019. Tables 3B through 3O.

Vermont – Hospital Outpatient Surgery Prices, 2017 (pdf)

What does ambulatory surgery cost in in Vermont? See Section called Pricing, Charges by Hospital. Table 2A lets you compare average gross charge (the closest you will get to average cost) for most common outpatient surgical procedures at 14 general hospitals in VT. Prices for procedures such as cataract surgery (average $6074), upper GI endoscopy ($5420), knee cartilage surgery ($9520 average), arthrocentesis joint aspiration ($700), gall bladder removal (average $13,484), breast biopsy (avg. $4213), other biopsies, ear tubes (average $3530), tonsillectomy ($6948), pacemaker ($9254), bunion removal (12,114 avg), colonoscopy $3694 average; range $1575 at Northwestern Medical Center to $5169 at North Country Hospital; hernia repair $12,000; excision of skin lesion $2417; fetal monitoring cost $784; circumcision cost $4239; outpatient hysterectomy $21,995; peritoneal dialysis ($10,575), and many more procedures. 12-month avg. charges ending Sept. 30, 2017, DO NOT include the surgeon or other physician fees. As with all of Vermont’s reports, the font size is about as small as you can get. About two years old, published 2019. Table 2B shows how many of those procedures the hospital did.

Virginia Hospital OP Charges, Case Numbers & Patient Satisfaction

Consumers can view median charge in 2016 for selected outpatient surgery by hospital, ambulatory surgery center and for the state. Surgeries show case volume and average (median) price for breast, hernia repair, colonoscopy, knee arthroscopy, fibroid removal, laparoscopy, gallbladder, hysterectomy. Hospital report shows inpatient cases by service line, financial performance & efficiency; patient satisfaction. Must click on additional tabs to see more information. See detail and read carefully. Prepared by Virginia Health Information (VHI) using 2016 price data, financial results for 2017, and patient satisfaction for 2017-2018.

Wisconsin – Ambulatory Surgery Facility Charges, 2017

How much does outpatient surgery cost in WI?  Find average 2017 charges in Wisconsin for 20 common ambulatory surgery procedures, such as Colonoscopy (6 codes), Endoscopy, Biopsy, Spinal Injection, Cataract & Lens ($7353 hospital average), outpatient Knee surgery/arthroscopy ($11,285), Carpal Tunnel ($6463), Ear Tubes, and more. Volumes for each hospital and surgical center are shown for top 20 only. Go to Table 28 in Chapter VI for a longer list of 40 procedures including colonoscopy & biopsy, code 45380 ($5155 average) and gall bladder removal (laparoscopic cholecystectomy at $17,429). Chapter VII compares average prices (along with median charge and volume) at each hospital for twenty 2017 ambulatory surgeries. 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 2019 facility prices. Scroll to bottom of page for Chapters VI and VII Ambulatory Surgery, published by WHA Information Center July 2018.

Wisconsin PricePoint – Outpatient & Ambulatory Surgery Cost

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 for reference. Prices exclude surgeon and other doctors’ fees which may double the numbers you see here

Other Helpful Listings

Maine – Average Charge for Hospital and Doctor Visits (2017)

Typical vaginal delivery costs (charges) in Maine in 2017 averaged $11,347 for Childbirth delivery and 60 days of related care. (Does include physician care, but probably not newborn charges). Add $9000 for an uncomplicated C-Section. A few other charges by hospital, for hip or knee joint replacement, arthroscopy and gall bladder surgery. Find many median (middle) prices here physician office visits ($97 average cost for 15-minute appt for an established patient 99213), CT, MRI, x-ray, lab tests and more. Uses CPT codes. From Maine Health Data Organization in State of Maine

Self-Reported Average Costs – Medica (Health Plan Contract Rates) Editor's Pick

Main Street Medica provides average cost ranges by hospital or clinic name, for 19 common hospital inpatient stays, 29 outpatient surgery procedures, over 50 diagnostic imaging tests, nearly 80 types of office visits; medical equipment, prosthetics, & supplies for diabetes & ostomy care, chiropractors. Also gives comparative costs for a few generic vs. prescription drugs. General range of lab test costs are in the Choosing Quality Care section. Includes Minnesota, Fargo, Bismark and Grand Forks, ND, Sioux Falls, SD and many WI hospitals and clinics. Reported price estimates apply to Medica Choice Network services, not necessarily the general public. Dates of prices are not disclosed.Links to quality reports from MN Health Scores and Hospital Compare. Site is very responsive and easy to use if you search by Procedure, Disease or Condition. Medica is a Twin Cities-based NCQA-accredited health insurance plan serving 1.2 million people.

South Dakota Charges for Inpatient Hospital Stays – 2017

Find out and compare SD hospitals on 2017 average charges, or median (typical) price. After you select one hospital, you can see the average charge in all of South Dakota (e.g. avg $5077 for normal newborn, or $3905 median. Vaginal delivery for mom was $10,736 average price, and $9868 median. C-section average cost $23,518.) All common hospitalizations shown, such as births and maternity delivery, knee replacement (average price about $47,000), heart failure, pneumonia, bowel procedures, COPD, angioplasty, kidney transplants (median $247,637), inpatient laparoscopic gallbladder removal (average price $48,000, but $50k to $55k avg. in Sioux Falls) and much more. Also shows volume and length of stay. PricePoint site sponsored by SDAHO (hospital association)

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