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Average Medicare Charges for Hospital Outpatient Services, 2020

Average Medicare charges (average prices) for selected hospital outpatient services are listed here for calendar year 2020. 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 2020, this file shows that the most common types of Comprehensive Observation Services (given to over 1.6 million Medicare patients) had an average charge close to $19,000, with Medicare allowing $2,172 on average; Medicare paid an average of $1,814. A Cataract removal with lens insertion was about $10,000 in charges, with Medicare allowing $2,004 (and paying $1,595 on average). A Repair of Knee Joint had an average charge in 2020 of $59,600. Medicare allowed $11,717, and it paid $10,309 on average. Good information, very user-unfriendly. From CMS updated August 2021 and September 2022.

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.

Montana Hospital Outpatient Surgery and Test Costs

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 2022 prices, although these costs are more current than many other sites.

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.

Self-Reported Average Costs – Medica (Health Plan Contract Rates) Editor's Pick

Find average costs in the Medica Health Plan contract rates. Main Street Medica self-reports average cost ranges by hospital or clinic name, for 15 common hospital inpatient stays, 32 outpatient surgery procedures, nearly 60 diagnostic imaging tests, nearly 70 types of office visits; chiropractors; medical equipment, c-pap, oxygen rental, prosthetics, wheelchairs, & supplies for diabetes & ostomy care. 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, unfortunately. 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.

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Medical Cost Advocate Editor's Pick

If you need help negotiating your medical bills, Medical Cost Advocate, a commercial company, will help get the price down. While the percentage is no longer disclosed on the website, they used to 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.

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