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Hospital Clinic and Office Visit Charges and Medicare Payments 2018

Find Hospital Clinic and Office Visit charges (average price) for 2018, 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 $138) and 99214 (average charge about $208). Medicare allowed about $71 for code 99213 and about $105 for 99214. Therapeutic exercise (code 97110) had average charge of $61, 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 $1,118, with Medicare allowing just $174. Physician charges may be available in the Provider Summary Table. Calendar year 2018 data from CMS updated November 2020.

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 Terribly outdated; 2012 data published Sept. 2013.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 April 2021.

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 $16,741 in 2021 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 September 2021.

Colorado 2019 Hospital Charges and Insurance Allowed Amounts

Compare average charges at Colorado hospitals and amounts allowed by insurance in 2019. More than 50 types of hospitalizations. Click on View Reimbursement by Diagnosis or Insurance Provider to see average total charge in 2019, and how much the insurance company allowed. Amazingly, the patient’s responsibility (called member liability) is also shown. Consumers can appreciate the transparency between prices and insurance-allowed amounts. Example: Major joint replacement without complications (such as a hip or knee replacement) had an average price near $82,000 in 2019, and had an average insurance allowed cost near $34,000, or about 41% of the charges; member liability portion was an average of $1,607. Uncomplicated delivery had an average price of $16,151 in 2018, with insurance companies allowing $8,104, or about 50% of the charge. The patient responsibility averaged $1,714. (Maternity 2019 prices were not yet available.) Consumers are also able to see actual hospital prices (Click View Hospital Charges, then select year 2019 and procedure). Example: Average 2019 price for major joint (hip or knee) replacement without major complications at CO hospitals that performed at least 100 procedures, ranged from $40,685 in Delta, to $211,612 at North Suburban Medical Center in Thornton (over 5 times higher). Physician charges are not included in the inpatient costs. However, outpatient prices on average for the state, or region, are also available for 2019. Cataract surgery, colonoscopy, emergency room visit, knee arthroscopy, physician office visit and pregnancy test prices are examples of average charges available on the insurance report. Regions are Denver, Ft. Collins, Boulder, Colorado Springs, Grand Junction, Greeley, Pueblo, East and West. The information is jointly published by the Colorado Hospital Association, in conjunction with the  state Division of Insurance’s Department of Regulatory Agencies (colo.gov). Updated 2020. Specific hospital prices are listed, showing both charges and amounts allowed by insurance, along with the member patient responsibility. All are excellent features. However, the site is no longer current enough to earn Editor’s Pick in 2021.

Cosmetic (Plastic) Surgery Prices – Physician Fees, 2020 (pdf) Editor's Pick

Cosmetic surgery (plastic surgery) average prices show physician fees for 2020. Average cost (2020) shown near the end of this document: e.g. $6,622 for tummy tuck, $4,866 for breast augmentation, $4,616 for breast lift, liposuction $2,584, eyelid surgery at $2,996, breast reduction $5,717 (male gynecomastia at $4,622), nose surgery $4,925, facelift at $9,025, neurotoxins at $408, dermal fillers at $759, and nonsurgical fat reduction $1,749. Prices do not include facility fee nor anesthesia cost. Average number of procedures performed by ASAPS physicians shown for each type. 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 $296 in 2020 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 12% to estimate 2020 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.

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 $5,447 in 2020 dollars). Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 is about $12,772 in 2020 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 over $4,100 in 2020 dollars); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014. Add about 30% to account for medical inflation to 2020.

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

An average physician office visit in 2018 cost $298, compared to $1,010 for an Emergency Room visit. Average expenses were up 12% for a physician office visit, and down 1% for an ER visit. Median expenditure per PERSON with an expense was $471 for office visits and $775 for ER visits. The median expenditures cover total for the year, including multiple visits. Consumers should expect higher costs for 2021; $298 in 2018 is about $322 in 2021 using medical inflation factors. With inflation, $1,010 is about $1,091 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 2019-2020 claims, excluding Medicare and Medicaid. Search by city or zip code radius. From maine.gov

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 2019 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 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 2019 costs starts on page 23 of the 2020 Health Care Cost & Utilization Report Appendices. A few procedures show costs by medical group name (page 17). Report by Minnesota Community Measurement, mncm.org, published Nov. 2020.

Virginia Healthcare Prices – Ambulatory Surgery, Tests, Hospital Stays

Find Virginia Healthcare Prices for 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). 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 7% medical inflation rate to estimate 2020 costs. Virginia Healthcare Pricing Transparency, from Virginia Health Information (VHI), updated June 2020.

VT Hospital Physician Office Visit Prices 2019 and 2021

Compare what hospitals in Vermont were charging for physician office visits in 2018-2019. For example, code 99213 averages $155 for the physician. Since hospitals may charge an additional fee, the total charge in the state was about $208 per visit.  Fees ranged from $98 at Northeastern VT Regional Hospital to $662 at North Country) for an established patient code 99213. Code 99214 average price was $262. New patient prices also shown. If non-hospital medical groups exist in VT, their fees are not shown. Provided by state of Vermont; prices were good only through September 2019. No reports were provided for the year ending Sept. 30, 2020. Additionally, only 3 hospitals reported their physician office visit prices for the year ending Sept. 30, 2021, due to relaxing of rules during the pandemic.

South Carolina – Average Medicaid Payments for Health Care Services – 2012

Find the average cost (payment) for healthcare services to Medicaid patients in South Carolina. SC Department of Health & Human Services shows how much the state paid for Medicaid costs, by type of service. It appears that the average amount paid per visit was about $38 (physician) and $88 (clinic); about $150 for a dental visit; $5,256 for a hospital inpatient stay, and $31,658 for a nursing facility resident in 2012. Consumers can also compare what each provider was paid by downloading the full datasheet (Excel file). Full charges (prices) are NOT shown. Medicaid Transparency Reporting project, FY 2012 data is latest available; very old.

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 $1,010 in 2018, down 1% from 2017. (If you add medical inflation to 2021, the ER cost estimate would be about $1,091.) Many people made more than one trip to the Emergency Room in 2018. Consequently, the total expenditure per person with one or more ER visits during the year, was $1,534 in 2018. The median expenditure per person with an expense was $775. The ER visit cost varied by age group. Adults ages 18 to 64 had the highest average visit cost at $1,177, followed by age 65+ at $804. Infants and children under age 18 cost $751 per visit on average. The average ER visit cost for someone uninsured was $774 in 2018, compared to $1,372 for someone with private insurance. The federal government has not released costs for the 2019 or 2020 Emergency Department visits yet. It has discontinued detailed explanations, in favor of the online interactive tool – which we think is unfortunate. The interactive tool provides basic overall statistics only, and is difficult for many people to use. Note, the costs reported by MEPS are the expenditures (total amounts paid by all parties including insurance) for the ER visits. Actual charges would be substantially higher.

Harris Poll: Doctor Visit Satisfaction (2015)

On their most recent visit to a health care provider, 88% said they were satisfied with the experience. This compares to 91% satisfied with their last visit to a restaurant, for example, 63% satisfied with their last interaction with their health insurance company, and 59% satisfied visiting a mobile phone store. The doctor’s overall knowledge, training and expertise ranked the highest of the Very Important factors contributing to a positive experience. Overall, 62% of consumers ranked an online cost estimator as the number one technology they would like, with only 7% of doctors already having this in place. Harris Poll during September 2015, was published January 2016.

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