Average Medicare charges (average prices) for selected hospital outpatient services are listed here for calendar year 2018. Types of services include biopsy, breast surgery, musculoskeletal (e.g. bunions, knee cartilage, broken bone added together) procedures, ENT, cochlear implant, pacemaker charges, upper GI procedures, endoscopy, and more. File includes charges, what Medicare allowed, and what Medicare paid, and how many Medicare beneficiaries used that service. File shows charges to Medicare patients by physician name, state average and national average prices. Extremely difficult to use, even if somewhat familiar with using Excel files. High level price summary for about 60 categories in APC. More detail (such as bunions and bone spurs) is found in the HCPCS file, a couple of thousand procedures are listed there. In 2018, this file shows that the most common type of comprehensive Observation Services in the Emergency Dept (given to over 1 million Medicare patients) had an average charge over $16,700, with Medicare allowing $2,294 on average; Medicare paid an average of $1,821. A Level 3 Pacemaker was about $49,000 in charges, with Medicare allowing less than $10,000 (and paying $8,235 on average). Good information, very user-unfriendly. From CMS updated November 2020.
Find out how much outpatient surgery and imaging tests cost in Montana in 2019-2020. Compare MT hospital charges for ambulatory surgery and diagnostic tests such as colonoscopy (median charge $2,611 for a diagnostic colonoscopy code 45378), sigmoidoscopy, breast biopsy, cardiac stress tests, cardiac catheterization. All prices EXCLUDE surgeon fees and other physician costs. PricePoint system shows facility prices in the past, for common surgical procedures such as tonsillectomy (median $6,004 with adenoid removal, under age 12, code 42820), cataracts, ear tubes, knee cartilage, bunions, child’s appendix removal, carpal tunnel, gallbladder removal, skin lesions, upper GI endoscopy; x ray, CT, MRI (e.g. spine MRI without dye had a median price of $1,692, code 72148) and other radiology imaging prices listed. Costs are from July 2019-June 2020. Consumers may wish to add medical inflation to estimate 2021 prices, although these costs are more current than many other sites.
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.
Find average costs in the Medica Health Plan contract rates. Main Street Medica self-reports average cost ranges by hospital or clinic name, for 19 common hospital inpatient stays, 29 outpatient surgery procedures, over 50 diagnostic imaging tests, nearly 80 types of office visits; medical equipment, prosthetics, & supplies for diabetes & ostomy care, chiropractors. Also gives comparative costs for a few generic vs. prescription drugs. General range of lab test costs are in the Choosing Quality Care section. Includes Minnesota, Fargo, Bismarck and Grand Forks, ND, Sioux Falls, SD and many WI hospitals and clinics. Reported price estimates apply to Medica Choice Network services, not necessarily the general public. Dates of prices are not disclosed. Site is very responsive and easy to use if you search by Procedure, Disease or Condition. Medica is a large Twin Cities-based NCQA-accredited health insurance plan.
How much Medicare will pay for a COVID-19 lab test is either about $36 or $42 or $45 or $51 or $100. It depends on whether the laboratory is using tests developed by the CDC, or developed its own test. It also depends on whether it is a diagnostic test or a serology (antibody) test. It might also vary by type of laboratory and the technology used to process the test. There is no charge to the consumer for the test for the coronavirus SARS-CoV-2 under Medicare. See this fact sheet from CMS, May 19, 2020 to find payment rates to the Medicare Administrative Contractors for claims using HCPCS codes U0001, and U0002. The fact sheet also lists Medicare payment prices for CPT codes: 87635, 86769 and 86328. The last two codes 86769 and 86328 are the serology tests. Diagnostic Test Codes U0003 and U0004 are not shown on the Medicare sheet, but we understand that CMS has authorized $100 payment rate for such tests. The prices on the sheet do not include any specimen collection costs or additional services.
If you need help negotiating your medical bills, Medical Cost Advocate, a commercial company, will help get the price down. They take 35% of the savings. In addition, they have a prospective negotiation service that may get you a lower price before you have the service.