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Hospital Clinic and Office Visit Charges and Medicare Payments 2020

Find Hospital Clinic and Office Visit charges (average price) for 2020, 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 a large dataset 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 $149) and 99214 (average charge about $222). Medicare allowed about $72 for code 99213 and about $105 for 99214. Therapeutic exercise (code 97110) had average charge of $63, with Medicare allowing about $26. Lab tests, x-ray, emergency department visits are in the file. An Emergency Department visit (code 99285) had a national average facility charge of $1,201, with Medicare allowing just $174 for the ER visit facility charge. A CBC lab test 85025 had an average charge of $35 (Medicare allowed $8); a blood test coded 88053 had an average charge of $56, with Medicare allowing $10. State by state average prices are also listed. Physician charges may be available in the Provider dataset. Calendar year 2020 data from CMS updated July 2022.

Office Visit Costs Allowed by Medicare (2012)

Medicare reported its average allowed cost for established patients’ physician office visit in 2012: $69 for CPT code 99213 (the most common office visit), $102 for 99214. For new patients, office visit 99203 was $103, and 99204 was $158 Allowed by Medicare. More allowed costs and Medicare payments are shown, including ear wax removal ($49 allowed) and Annual wellness visit for new Medicare enrollees ($165 allowed, and $165 paid by Medicare). Average payments exclude the amount the patient pays directly for co-pays and deductibles. Consumers are expected to know CPT codes and how to use Excel files. Terribly outdated; 2012 data published Sept. 2013. No updates as of March 2022.

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.

Cost of an Office Visit (MEPS)

MEPS provides the average and median cost for a doctor’s office visit. Average cost paid (payments) for an office-based physician visit in 2016 was $265 (about $311 in 2022 dollars with medical inflation). For primary care (family medicine, internists and general practice) the 2016 average visit cost was $186. (For all 2016 numbers add about 17.2% to estimate 2022 prices.) Pediatrics came in at $169; psychiatry at $159, Dermatology at $268, OB/GYN was $280 per visit. Specialists in Ophthalmology were $307, but Orthopedics and Cardiology jumped to $419 and 335 respectively. Other specialists (as a group) averaged $365. Median or typical expenses were considerably lower at $116 overall, and $107 for primary care, $103 for psychiatry and ranging up to $134 median for ophthalmology and orthopedics. Mean out of pocket expense was highest for ophthalmology ($125) and lowest for pediatrics ($40). Primary care was $50 average out of pocket, if the patient had some responsibility. Statistical Brief # 517, pub. October 2018 by AHRQ using Medical Expenditure Panel Survey (MEPS) data; household component.

Healthcare Expenses for Seniors (MEPS)

Healthcare expenses for seniors are outlined in this MEPS report on Health Care Expenditures for the Elderly Age 65 and over. Median annual expenditures were $4,206 per person (about $5,724 in 2022 dollars). Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 is about $13,424 in 2022 dollars. Medicare paid over 62% (up considerably from 10 years earlier); private insurance paid 16%; out-of-pocket amount declined to 12%. 96% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $76 per purchase. For seniors, the inpatient room rate averaged $3,199 per day (sticker shock, and nearly $4,354 in 2022 dollars); ER visit was $884 on average ($1,203 in 2022 dollars); office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014. Add about 36% to account for medical inflation to 2022.

How Much Does an Office Visit cost compared to an ER visit?

An average physician office visit in 2019 cost $287, compared to $1,082 for an Emergency Room visit. Average expenses were down 3.7% for a physician office visit. But costs were up 7.1% for an ER visit. Median expenditure per PERSON with an expense was $463 for office visits and $832 for ER visits. The median expenditures cover the total for the year, including multiple visits. Consumers should expect higher costs for 2021; $287 in 2019 is about $302 in 2021 using medical inflation factors. With inflation, $1,082 is about $1,139 in 2021 dollars.  The data from MEPS (Medical Expenditure Panel Survey) informs consumers about the large difference between cost of care in a doctor’s office vs. Emergency Dept, more than 3 times higher. Separately, the most recent AHRQ Statistical Brief #318 that analyzes Expenses and Characteristics of Physician Visits in Different Ambulatory Care Settings is quite old – 2008 data, published in March 2011. It is mentioned here only for reference. The link is to the interactive database.

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.

MN – Average Cost Per Procedure

Average cost per procedure at medical clinics in MN. The average cost per procedure (ACP) in Minnesota is defined as the Allowable charge that commercial health insurance plans (including the patient responsibility portion) PAID in 2020 to medical groups. Physician fees only, not facility fees. Median costs listed include Eye exams, Colonoscopy, Endoscopy with biopsy, Imaging (x-ray, CT, MRI, with and without contrast, screening mammogram, ultrasound), Lab tests (about 30 common tests), Vaccines, Mental health services and psychotherapy, doctor Office Visits, Physical therapy, minor in-office surgery (e.g. skin lesion or earwax removal or vasectomy) and more. Medicare and Medicaid payment rates are also shown for reference. Minimum and maximum (range of costs) are reported for each procedure, visit or test. List of 2020 average costs starts on page 18 of the 2020 Health Care Cost & Utilization Report Appendices. Unfortunately, the most recent report does not show costs by medical group name. Report by Minnesota Community Measurement, mncm.org, published Nov. 2021.

South Carolina – Medicaid Fee Schedule Payments for Health Care Services – 2022

Find the average fee that Medicaid pays for healthcare services in South Carolina. SC Department of Health & Human Services shows Fee Schedules for doctors, dentists, optometrists (eye doctors) and more. For example, the Medicaid cost for a doctor visit with the code 99214 was $81.15. You must know the code, since these Excel files are published for healthcare professionals. Fee schedules include Ambulatory Surgery, Ambulance, Lab & X-Ray, Outpatient Hospital and other providers. Inpatient hospital and nursing home fees are NOT shown. 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.

VT Hospital Physician Office Visit Prices 2022

Compare what hospitals in Vermont were charging for physician office visits in 2022. For example, code 99213 averages $162 for the physician. Since hospitals may charge an additional fee, the total charge in the state was about $240 per visit.  Fees ranged from $69 at Copley’s physician groups and $98 at Northeastern VT Regional Hospital to $866 at North Country) for an established patient code 99213. Code 99214 average price was $311. New patient prices also shown. If non-hospital medical groups exist in VT, their fees are not shown. Provided by state of Vermont; prices are good only through September 30, 2022. The state and its hospitals seem to be back on track with their reporting, after relaxing their rules during the pandemic.

Childbirth – Average Total Cost for Having a Baby (AHRQ MEPS pdf)

Childbirth expenses. The average total cost of having a baby was about $12,000 in 2009 if you were privately insured and had an uncomplicated pregnancy. Adjusting for medical inflation (only), the total childbirth cost would be about $17,400 in 2022 dollars. The estimate includes actual payments (expenditures, not charges) for all prenatal office visits, hospital childbirth (inpatient maternity and newborn delivery), prescription medications and other services for an uncomplicated pregnancy. In 2009, privately insured patients paid just under 10% out of pocket. Report from the Agency for Healthcare Research and Quality uses Medical Expenditure Panel Survey (MEPS) data for 2006 to 2009 patients; Research Findings #32 published June 2012. No update available as of November 2022. Very old data.

Other Helpful Listings

Average Cost of a Hospital ER Visit, MEPS

What is the average cost of a hospital ER visit?  According to the Medical Expenditure Panel Survey (MEPS), the average cost of an ER visit was $1,082 in 2019, up 7% from 2018. (If you add medical inflation to 2021, the ER cost estimate would be about $1,139.) Adults ages 18 to 64 had the highest average visit cost at $1,320. Infants and children under age 18 cost $796 per visit on average. Age 65+ averaged $782. The average ER visit cost for someone uninsured was $1,220 in 2019, up a whopping 58%. Someone with private insurance had an average ER visit expense of $1,474. Many people made more than one trip to the Emergency Room in 2019. Consequently, the total expenditure per person with one or more ER visits during the year, was $1,687 in 2019. The median expenditure per person with an expense was $832.

The costs reported by MEPS are the expenditures (total amounts paid by all parties including insurance) for the ER visits. Actual charges would be much higher. An older, but detailed explanation – using cost to charge ratios – was published in December 2020 (HCUP Statistical Brief #268). It reports an average cost (different methodology) for an Emergency Department visit in 2017 of only $530 (which would be about $585 in 2021 dollars). The federal government has not released costs for the 2020 Emergency Department visits yet. The interactive tool may be difficult for many people to use.

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