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Hospital Clinic and Office Visit Charges and Medicare Payments 2017

Find Hospital Clinic and Office Visit charges (average price) for 2017, and the payments that Medicare made. Find average charges for about 13,000 different codes (depending whether office or hospital facility-based).  National average prices are in the Procedure Summary file. Extremely difficult to use, even if somewhat familiar with using Excel files. File uses HCPCS codes. The most common codes were office visits 99213 (average charge about $134) and 99214 (average charge about $201). Medicare allowed about $71 for code 99213 and about $105 for 99214. Lab tests, x-ray, emergency department visits are in the file. Physician charges may be available in the Provider Summary Table. Calendar year 2017 data from CMS updated 2019.

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

The American Hospital Directory at ahd.com shows average charge and average cost for many hospital outpatient services. Charges and average costs for the 20 outpatient Ambulatory Payment Classifications (APCs) that made up the highest Medicare outpatient payment to each hospital. Critical access hospitals are excluded. List varies by hospital. Top 20 procedures may include volume (number of claims) and 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 find 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 Prices, 2019 Hospital Chargemaster

California provides average prices for inpatient and outpatient procedures for 2019, as listed in the hospital’s chargemaster. All CA hospitals are included. The most useful and understandable Excel files are the ones that show prices for at least 25 common outpatient procedures. Look for separate file names (e.g. Common25 in the filename), or the tab sheet for form AB 1045. ER visits, MRI and CT test prices should be included, along with selected outpatient surgery. The average cost (charge) for top 25 types of outpatient procedures or surgery includes CPT codes. Outpatient reports may show hospital prices for Emergency Room visits, office visit code 99213, lab tests, CT, MRI, Mammogram, x-ray, ultrasound, Physical Therapy visit, Arthroscopy, colonoscopy, endoscopy, carpal tunnel, hernia repair, gall bladder removal (laparoscopic cholecystectomy), lumbar injections, tonsillectomy, ear tubes and more, depending on each hospital’s highest volume.

California 2019 inpatient prices are listed only in the massive and complicated Charge Master, which shows the charge for every pill, lab test and hospital room rate. This is where you will find maternity, obstetrics, newborn nursery, labor and delivery charges. But you will need to wade through a few thousand services listed in the chargemaster to find what you want to know.  Look for CDM in the file name.

Files are in Excel file format. Prices are from 2019. Consumers can see one hospital at a time.  Rate increases are also shown in these files. Provided through California OSHPD, the state government Office of Statewide Health Planning and Development.

Florida Outpatient Surgery Prices & Visit Volume (2018 data)

Compare Florida hospital and freestanding surgical center prices for outpatient surgery in 2018. Find hospital and ambulatory surgery visit volumes and range of charges for common adult and pediatric outpatient surgery procedures. Prices are listed by hospital or surgery 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. Average cost is not shown.  When we checked outpatient hernia repair prices last year, individual hospitals ranged from $945 to a high charge over $72,000 (ages 18 to 64, Level 1). Last year, cataract procedures at the highest volume center listed charges from about $17,000 to $19,000. But the second largest center did cataract procedures for $1,400 (ages 18-64). Might be worth asking about price before scheduling your outpatient surgery. Links to inspection reports. FloridaHealthFinder.gov 2018 data updated September 2019. Because the average price is not quickly visible to compare across facilities, we have eliminated the Editor’s Pick designation. Terminology between the selection page and the report pages are not consistent.

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 arthroscopy priced at over $33,000 average in IL, bunionectomy [which had a statewide list price nearing $20,000], 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 2019, using 2017 prices and 2018 quality data

Iowa – Average Price for Ambulatory Surgery 2019

Compare average prices for ambulatory outpatient surgery at IA hospitals, before adding surgeon fee or other professional charges. 2019 prices. Check one procedure at a time. Average charge billed last year for Upper GI endoscopy was between $5,900 and $7,300; Diagnostic Colonoscopy averaged $5,193 excluding physician fees; simple cataract $7,929 to $8,581; Tonsillectomy over age 11 $10,056 (child) or up to $11,649 for an adult; one ear tube $8,062; shoulder surgery $22k to $24,000; laparoscopic gall bladder removal averaged $19k in hospital charges; inguinal hernia repair (laparoscopic) averaged over $24,000; knee ACL repair averaged $31,042 in Iowa; bunion correction surgery was $19,518 in average charges. Individual hospitals shown if they have enough volume. However, volumes are not shown. More ambulatory surgery procedures are listed. From the Iowa Hospital Association; reasonably easy to use. Updated 2020.

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)

Compare recent charges in Maine for surgery, x-ray, imaging and lab tests across hospitals and medical groups. MHDO Maine Health Data Organization’s website shows average charges (median prices) 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. Surgical prices from 2018-2019. Office visit and test prices are from 2018-2019 charges. Updated in 2020. Search by city or zip code radius. From maine.gov

Minnesota – Hospital Price Check (Inpatient & Outpatient)

Minnesota Hospital Price Check gives 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. Because the site uses medical terms (e.g cholecystectomy instead of gall bladder), consumers should be prepared ahead to type in the correct term. Compare 3 hospitals, one procedure at a time; excludes doctor charges; by Minnesota Hospital Association, 2018 prices and volumes of cases

Montana Hospital Outpatient Surgery and Test Costs

Find out how much outpatient surgery and imaging tests cost in Montana. Compare MT hospital charges for ambulatory surgery and diagnostic tests such as colonoscopy (median charge $2,127 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, cataracts, ear tubes, knee cartilage, bunions (median $6,797, add $3,000 more for a bunion removal on the big toe), child’s appendix removal, carpal tunnel, gallbladder removal, skin lesions, upper GI endoscopy; x ray, CT, MRI and other radiology imaging prices listed; 2018 costs. Consumers may wish to add 5.8% medical inflation to estimate 2020 prices.

New Hampshire Prices for Physician Visits, ER, Outpatient Hospital and Dental Care – Compare (free)

Compare New Hampshire prices for physician office visits, Emergency Room, psychotherapy, dental care, hospital outpatient lab tests, PT visits and some surgery. Ambulance and medium level ER prices are included in NH. Prices are estimated at 2018-2019 prices plus 5% inflation. Statewide cost estimate is also shown. Choose Medical or Dental. Select insurance, or uninsured to compare charges with your deductible.  Select procedure or test (e.g. lab, Radiology such as x-ray, MRI, CT or ultrasound). Tonsillectomy, hernia repair, colonoscopy and about a dozen different surgeries are bundled to include surgeon and anesthesia costs. Price transparency project developed by the New Hampshire Insurance Department. NH HealthCost is an 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.

Oregon – compare hospital and outpatient surgery costs (2017)

Compare hospital and outpatient surgery costs in Oregon. The most recent set of 5 reports by the government OHA – Oregon Health Authority, shows the median amount PAID by commercial insurance companies in 2017. Costs paid, are after any discounts off charges (prices) have been taken.  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. These helpful reports cover a large set of services, are easy to use, and show each hospital’s payment, along with what was paid the year before. Unfortunately, the information is two years old. When estimating, consider medical inflation which has been about 4.1% from 2017 to 2019. Pub. July 1, 2019

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, 2018

Wisconsin ambulatory surgery facility charges (prices) for 2018 for each hospital and freestanding ambulatory surgery center How much does outpatient surgery cost in WI?  Scroll to bottom of page for Chapters VI and VII Ambulatory Surgery. Find average 2018 charges for 20 common ambulatory surgery procedures, such as Colonoscopy (6 codes), Endoscopy, Biopsy, Spinal Injection, Cataract & Lens ($7,439 hospital average), outpatient Knee surgery/arthroscopy ($11,699), Carpal Tunnel ($6,548), 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 ($5,478 average) and gall bladder removal (laparoscopic cholecystectomy at $18,389). Chapter VII compares average prices (along with median charge and number of cases) at each hospital and surgery center for twenty 2018 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. Health Care Data Report 2018 published by WHA Information Center September 2019.

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 on the consumer site. Must use the healthcare professionals site to see the dates and the volumes done at each hospital; 2018-2019 prices are shown. 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 (2018-2019)

Find the average charge for both hospital and doctor visits in 2018 to 2019. Typical vaginal delivery costs (charges) in Maine in the 12 months ending March 31, 2019 averaged $12,659 for Childbirth delivery and 60 days of related care. (Does include physician care, but probably not newborn charges). An uncomplicated C-Section averaged just over $21,000. 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 ($102 average cost for 15-minute appt for an established patient 99213), CT, MRI, x-ray, lab tests and more. A one hour crisis psychotherapy visit averaged $225. An ongoing 60 minute psychotherapy visit (90837) cost $100 on average. 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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