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Hospital Clinic and Office Visit Charges and Medicare Payments 2019

Find Hospital Clinic and Office Visit charges (average price) for 2019, 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 $143) and 99214 (average charge about $216). Medicare allowed about $71 for code 99213 and about $104 for 99214. Therapeutic exercise (code 97110) had average charge of $62, 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 $1,171, with Medicare allowing just $171 for the ER visit facility charge. A CBC lab test 85025 had an average charge of $34 (Medicare allowed $8); a blood test coded 88053 had an average charge of $55, with Medicare allowing $11. State by state average prices are also listed. Physician charges may be available in the Provider Summary Table. Calendar year 2019 data from CMS updated August 2021.

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, 2020 Hospital Chargemaster

California provides average prices for inpatient and outpatient procedures as of June 1, 2020, as listed in each hospital’s chargemaster. All CA hospitals are included; however, the prices are now one year out of date. 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 2020 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 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 2020. Consumers can see one hospital at a time.  Provided through California OSHPD, the state government Office of Statewide Health Planning and Development.

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.

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 $5,507 in 2021 dollars). Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 is about $12,915 in 2021 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 $4,200 in 2021 dollars); ER visit was $884 on average ($1,158 in 2021 dollars); office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014. Add about 31% to account for medical inflation to 2021.

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 (2019 and 2021)

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 2018 to Sept. 30, 2019 was $341 for Level 1 minor problem, before adding tests or procedures. Very few visits are this “simple”. Level 2 low severity ER visit average price was $501 before adding test costs. Level 3 moderate severity and complexity ER visit (the most common in the US)  average price was $843 for hospital and physician charges, excluding tests and medications etc. Level 4 average price was $1,292. Top base price for a Level 5 visit was $1,830 per visit ($1,275 hospital, $555 doctor fee). 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 was $1,215; the University of Vermont Medical Center’s Level 5 ER charge was just shy of $3,000. Prices do NOT include lab tests, imaging tests or procedures during the ER visit. Prices were good from October 2018 to September 2019.  Unfortunately, there was no report for 2019-2020 prices. Additionally, only 3 hospitals reported their Oct. 1, 2020 to September 30, 2021 prices, when rules were relaxed because of the pandemic. Table 3D.

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 11% medical inflation rate to estimate 2022 costs. Virginia Healthcare Pricing Transparency, from Virginia Health Information (VHI), updated June 2020. No new updates as of May, 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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