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Average Medicare Charges for Hospital Outpatient Services

Find the average price in calendar year 2016 for various types of hospital outpatient charges to Medicare patients. File should show charges by physician name, state average and national average prices. Extremely difficult to use, even if somewhat familiar with using Excel files.  From CMS updated 2019.

Other Helpful Listings

Fact Sheet: Underpayment by Medicare & Medicaid (2019)

Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $77 billion. This cost ends up being borne by other payors and commercial insurance. Using 2017 data, it is estimated Medicare pays 87 cents on the dollar, and Medicaid also pays 87. January 2019 report

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.

Pennsylvania Total Hip and Knee Replacements (pdf)

2016 report shows hospital complication rates for hip & knee replacements in 2014. Statewide, the rate was 2.2% for knees and 2.8% for hip complications. The older 2015 report by PHC4 shows 2013 volume and readmission rates by hospitals in Penn. Average PA hospital charges also shown, with 2013 prices (excluding surgeon fee) at $52,912 and $55,493 for knees and hip replacements, respectively. Separately, consumers can find surgeon volume and what Medicare paid (less than 25% of the average charge) in 2012

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