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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.

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 $1,016 in 2017, up just 1.2% from 2016. (If you add medical inflation to 2020, the ER cost estimate would be about $1,096.) Many people made more than one trip to the Emergency Room in 2017. Consequently, the total expenditure per person with one or more ER visits during the year, was $1,482 in 2017, about the same as it was in 2016. The median expenditure per person with an expense was $776. The ER visit cost varied by age group. Adults ages 18 to 64 had the highest average visit cost at $1,203, followed by age 65+ at $830. Infants and children under age 18 cost $707 per visit on average. The average ER visit cost for someone uninsured was $887 in 2017. The federal government has not released costs for the 2018 or 2019 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.

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.

Emergency Dept. Report – Florida 2017 prices (pdf)

Find average prices for an Emergency Department visit in Florida in this report. Summary report shows average cost (charges) in 2017 for a hospital ER visit based on acuity. Low acuity Pediatric visit was about $1,050 in 2017; high acuity pediatric ER visit was $3,420. For adult women, the low acuity mean charge was $1,456; High acuity average 2017 charge for men was $7,824. Common symptoms (e.g. $10,442 adults for abdominal pain visit to the ER; $5,722 for back pain; $5,189 for a sprain; $3,241 for upper respiratory infection visit; $4,962 for adult pregnancy complication, adult urinary tract infection averaged $7,411 and more.) Average cost increased with age. Average pediatric visit for upper respiratory infection was close to $2,000. See Tables 4 and 5 for average prices for an emergency visit and Insurance status or Self-Pay charges. Self-pay uninsured average charge was $1,135 for a low acuity visit, to $6,417 for high acuity. 29 pages, published by FL Agency for Health Care Admin. June 2018. No updates as of early 2020.

Florida ER Visit Charges, 2018

Florida ER visit charges for each hospital in 2018. Find the average cost of an emergency room (ER / ED) visit at each Florida hospital in 2018. State average ER visit cost (charge) was $6,609 (about $60 Billion for over 9 million ED visits). Average cost was up about 7.7% from 2017. Fawcett Memorial Hospital in Port Charlotte had the highest average charge in FL at a whopping $15,360 per ER visit in 2018. Three additional hospitals had average charges over $14,000: Mercy Hospital a campus of Plantation General Hospital, North Florida Regional Medical Center in Gainesville, and Regional Medical Center Bayonet Point. Only 1 hospital (Regional General Hospital Williston) had an average charge of $1,000 or less, same as last year. Number of ER patient visits are shown here. The highest volume Emergency Department was Lakeland Regional Medical Center, with nearly 169,000 visits. Its average price was $6,993.  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.

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. Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 was about $12,194 in 2019 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 $4,000 in 2019 dollars); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014.

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

An average physician office visit in 2017 cost $267, compared to $1,016 for an Emergency Room visit. Median expenditure per PERSON with an expense was $445 for office visits and $$776 for ER visits. The median expenditures cover total for the year, including multiple visits. Consumers should expect higher costs for 2020; $267 in 2017 is about $288 in 2020 using medical inflation factors. With inflation, $1,016 is about $1,096 in 2020 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, nearly 4-fold. 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 2018 Average Charges

NevadaCompareCare.net shows average charges (prices) for every NV hospital DRG (Diagnosis Related Group), and average ER or ambulatory surgery charge in 2018. Overall Nevada inpatient charge was a whopping $81,368 per stay, or more than $15,000 per day. Sample DRGs: Psychoses (average $17,304), Normal Newborn ($4,654), uncomplicated vaginal delivery ($21,933), Septicemia (about $110,000 with complications, $57k without), Major joint replacement (hip or knee) at $113,000, Cesarean Section ($38,000 without complications, $46,000 with). Births overall (all types including very ill babies) averaged $27,580 in charges, from $2,170 at Banner Churchill to $68,049 at Sunrise Hospital and Medical Center. Average NV emergency room visit charge was $8,757 statewide for over 1 million visits. ER charges ranged from $1,651 average at Mount Grant General Hospital, to $12,758 average at St. Rose Dominican – San Martin Campus. Statewide average Ambulatory Surgery Center charge was $8,534, but no breakout by procedure type. Outpatient surgery at a hospital averaged nearly $33,000 in charges. 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 2019

Vermont – Compare Hospital ER Prices (2019) 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 is $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 is $501 before adding test costs.  Level 3 moderate severity and complexity ER visit (the most common in the US)  average price is $843 for hospital and physician charges, excluding tests and medications etc. Level 4 average price is $1292. Top base price for a Level 5 visit is $1830 per visit ($1275 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 is $1215; the University of Vermont Medical Center’s Level 5 ER charge is just shy of $3000. Prices do NOT include lab tests, imaging tests or procedures during the ER visit. Prices are good from October 2018 to September 2019.  Table 3D.

Virginia Healthcare Prices – Ambulatory Surgery, Tests, Hospital Stays

Virginia Healthcare Prices shows average price ALLOWED (commercial insurance prices) in 2017 for almost 40 common healthcare services in VA. Includes a mix of outpatient, clinic, hospital stays and other services such as an ambulance (average $522) or helicopter ride (almost $17,000). 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 office visits. 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 Virgina. Median physician office visit cost was $77.  The 2019 report shows the average allowed amount for each service that you or your insurance plan ACTUALLY PAID in 2017. More relevant than most pricing information, but lags in timeliness. Add at least 4.1% medical inflation rate to estimate 2019 costs. Virginia Healthcare Pricing Transparency, from Virginia Health Information (VHI), updated May 2019

Wisconsin ER and Hospital Urgent Care Prices (Emergency Department) Editor's Pick

Find 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), nausea and vomiting or teeth problems. Shows median (middle) price for ER (2018-2019) WITHOUT the physician’s fee, and how many cases the hospital treated. If the hospital has on-site urgent care, it will show that price also. Example: Mercy Health Hospital in Janesville charged $2,102 (median charge during April 2018 to March 2019) in the ER for urinary tract infection (UTI), but just $345 in its urgent care service. Free-standing community Urgent Care clinics are not included in these prices.  Wisconsin Hospital Association’s PricePoint makes comparing hospital prices possible. Compare hospitals downtown vs. those in the suburbs.

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