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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.

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.

California – Average Inpatient and Outpatient Prices, 2022 Hospital Chargemaster

California provides average prices for inpatient and outpatient procedures as of June 1, 2022, as listed in each hospital’s chargemaster. All CA hospitals are included. Excel files show prices for at least 25 common outpatient procedures. 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 2022 inpatient prices are listed only in each hospital’s 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 may need to wade through more than 10,000 individual services listed in the chargemaster to find what you want to know.  Files are in Excel file format. Prices are from 2022. Consumers can see one hospital at a time by downloading their chargemaster file.  Provided through California OSHPD, the state government Office of Statewide Health Planning and Development.

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.

Emergency Dept. Report – Florida 2018 prices (pdf)

Find average prices for an Emergency Department visit in Florida in this report. Summary report shows average cost (charges) in 2018 for a hospital ER visit based on acuity. Low acuity Pediatric visit for under age 10 cost about $1,100 in 2018. The more common high acuity pediatric ER visit (through age 17) had an average cost of $3,655, up almost 7% from the prior year. For adults, a high acuity average 2018 charge was $8,164. Common symptoms average cost shown, e.g. $10,506 adults for abdominal pain visit to the ER; $6,215 for back pain; $5,167 for a sprain; $5,450 for a superficial injury/contusion; $2,772 for upper respiratory infection visit; $5,287 for adult pregnancy complication; adult urinary tract infection averaged $7,598. Average pediatric visit for upper respiratory infection cost $2,114. Self-pay uninsured average charge was $1,201 for a low acuity visit, to $6,736 for high acuity. Medical inflation has been about 11% since 2018, and should be considered in estimating 2022 prices. 26 pages, published by FL Agency for Health Care Admin. This is the latest available report as of April 2022, and it appears Florida has no plans to update the Emergency Department reports.

Florida ER Visit Charges, 2019

Florida ER visit charges for each hospital in 2019. Find the average cost of an emergency room (ER / ED) visit at each Florida hospital in 2019. State average ER visit cost (charge) was $7,321 (about $68 Billion for over 9.2 million ED visits). Average cost was up about 10.8% from 2018. HCA Fawcett Memorial Hospital in Port Charlotte had the highest average charge in FL again in 2019, at a whopping $17,330 per ER visit in 2019. Their average price went up 12.6%. Three additional hospitals had average charges over $16,000: HCA Mercy Hospital a campus of Plantation General Hospital, HCA North Florida Regional Medical Center in Gainesville, and HCA Regional Medical Center Bayonet Point – the same as in 2018. All of the most expensive (average charges) for ED visits are for-profit hospitals. Only 4 hospitals in Florida had an average charge of $1,500 or less. The least cost was Madison County Memorial Hospital in Madison, with an average ER visit cost of just under $1,200.  Number of ER patient visits are shown here. The highest volume Emergency Department was Lakeland Regional Medical Center, with 172,000 visits. Its average price was $7,815.  They are not-for-profit. Complexity and seriousness of the visit vary from hospital to hospital. Easy to use tool, but not severity-adjusted. Average charges for broad diagnostic groups can be found, by using the filters in the search tool. From FloridaHealthFinder.gov.  Check our listing for Hospital Compare to see each hospital’s most recent star ratings and performance on emergency care. The site defaults to 2018 costs, so make sure you check the 2019 box to see the latest. No updates as of March 2022 for 2020 or 2021 costs of an ER visit.

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.

Nevada Hospital Inpatient, ER and Ambulatory Surgery 2021 Average Charges Editor's Pick

Find average hospital, ER, and ambulatory surgery charges in Nevada for 2021. Each hospital is listed by name. Nevada Compare Care shows average hospital charges (prices) for every NV inpatient DRG (Diagnosis Related Group), and overall average ER or ambulatory surgery charge. Overall Nevada 2021 inpatient charge was a whopping $109,256 per stay, or $19,505 per day. Average charges increased 13% over last year; with a slightly higher case mix index. Sample DRGs: Psychoses (average $21,914, down 1%), Normal Newborn ($5,923, up 4%), uncomplicated vaginal delivery ($30,447, up 11%), Septicemia ($161,023 for DRG 871), Major joint replacement (hip or knee) at $152,973, Cesarean Section ($48,477 without complications).

Average 2021 NV emergency room visit charge was $11,105 statewide (up 7%). The number of ER visits in Nevada rose to almost 1 million from 925,000 visits the prior year. Average ER charges ranged from $2,389 average at Banner Churchill Hospital, to $17,404 average at Centennial Hills hospital. Statewide average Ambulatory Surgery Center charge was $8,955 (up 2%), but no breakout by procedure type is shown. Endoscopy Center average charges are included. Outpatient surgery at a hospital averaged $52,265 in charges, up by 21%. Standard Reports also show case volume by facility. No information about how much was actually paid. NV reports are a joint effort between Center for Health Information Analysis (CHIA) and the Division of Health Care Financing and Policy (DHCFP). Updated May 2022.

Vermont – Compare Hospital ER Prices (2022) Editor's Pick

Compare published prices for hospital Emergency Room visits, for all 14 hospitals in VT, according to level of severity and complexity. Statewide average ER price from Oct. 1 2021 to Sept. 30, 2022 is $433 for Level 1 minor problem, before adding tests or procedures. The price has risen an average of 9% per year since 2019. Very few visits are this “simple”. Level 2 low severity ER visit average price was $591 before adding test costs. Level 3 moderate severity and complexity ER visit (the most common in the US) average price is $990 for hospital and physician charges, excluding tests and medications etc. Both Level 2 and Level 3 average prices for an ER visit rose about 6% per year over the past 3 years. Level 4 average price is $1,490.  Top base price for a Level 5 visit was $2,097 per visit ($1,546 hospital, $551 doctor fee). Level 4 and Level 5 Emergency Department visits have risen about 5% per year, over the past 3 years in Vermont.

For consumer planning purposes, billing code Levels 3, 4 and 5 are most likely to occur. A recent study of Medicare patients found that the most common ER visit charge was for a Level 5 visit, right at the top of the complexity scale. Both facility and physician charges are shown – an amazing show of leadership in price transparency. Springfield Hospital’s Level 5 charge is $1,441; the University of Vermont Medical Center’s Level 5 ER charge is over $3,000. Prices do NOT include lab tests, imaging tests or procedures during the ER visit. Prices are good from October 2021 through September 30, 2022. Table 3D published in 2022. Editor’s Pick because VT got this report out while the published prices were still in effect – if even for only a few months.

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 ER and Hospital Urgent Care Prices (Emergency Department)

Find 2021 ER visit and urgent care prices for common visits to WI emergency departments (ER) or hospital-based urgent care. Examples of typical charges: mood disorders, urinary tract infection (UTI), abdominal pain, nausea and vomiting or teeth problems. Shows median (middle) price for ER (2021) WITHOUT the physician’s fee. It also shows how many cases the hospital treated. If the hospital has on-site urgent care, it will show that price also. Example: Statewide, hospitals charged $2,910 (median charge during 2021) in the ER for urinary tract infection (UTI), but a lower $530 in its urgent care service. Free-standing community Urgent Care clinics are not included in these prices.  Fifty (50) services are listed. The tool did not provide information for every hospital, when tested May 24, 2022. Nor did statewide or county results show every time. It also may be difficult to find what you’re looking for, since common problems such as “breathing problems” are not listed. Still, Wisconsin Hospital Association’s PricePoint makes comparing hospital prices possible. This site is one of the more timely sites for healthcare price transparency. Compare hospitals downtown vs. those in the suburbs. Consumers may wish to add at least 2.5% medical inflation, depending on the hospital, to estimate 2022 prices. The average hospital price increase for WI hospitals that raised prices in 2021, was 4.46% (reported Jan. 14, 2022). But 4 hospitals raised prices more than 15% last year. Updated 2022.

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