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Average Medicare Charges for Hospital Outpatient Services, 2017

Average Medicare charges (average prices) for selected hospital outpatient services are listed here for calendar year 2017. Types of services include biopsy, breast surgery, musculoskeletal (e.g. bunions, knee cartilage, broken bone) 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 is found in the HCPCS file, a couple of thousand procedures are listed there. In 2017, 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 $16,000, with Medicare allowing $2,151 on average; Medicare paid an average of $1,708. From CMS updated 2019.

Colorado Diabetes and Cardiac Care Costs by City

Find the general average cost of diabetes care and cardiovascular care in Colorado in 2016.  Scroll to page 11 where the cost summary begins. Shows costs in seven different markets: Denver, Colorado Springs, Fort Collins, Pueblo, Grand Junction, Boulder and Greeley, as well as overall average for Colorado. Retail drug costs are not included. Click on 2017 Healthcare Data Summary. Published by Colo. Business Group on Health (CBGH), 2017.

Montana Hospital Outpatient Surgery and Test Costs

Find out how much outpatient surgery and imaging tests cost in Montana. Compare MT hospital charges for ambulatory surgery and diagnostic tests such as colonoscopy (median charge $2,127 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, cataracts, ear tubes, knee cartilage, bunions (median $6,797, add $3,000 more for a bunion removal on the big toe), child’s appendix removal, carpal tunnel, gallbladder removal, skin lesions, upper GI endoscopy; x ray, CT, MRI and other radiology imaging prices listed; 2018 costs. Consumers may wish to add 5.8% medical inflation to estimate 2020 prices.

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

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

Main Street Medica provides 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, Bismark 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.Links to quality reports from MN Health Scores and Hospital Compare. Site is very responsive and easy to use if you search by Procedure, Disease or Condition. Medica is a Twin Cities-based NCQA-accredited health insurance plan serving 1.2 million people.

Other Helpful Listings

How much does Medicare pay for the COVID-19 lab test?

How much Medicare will pay for the COVID-19 lab test is either about $36 or $51. It depends on whether the laboratory is using tests developed by the CDC, or developed its own test. Payment rates to the Medicare Administrative Contractors for claims using HCPCS code U0001 (CDC test) will get $35.91 to 35.92.  The test price for U0002 (labs performing non-CDC lab tests) is $100 for laboratories that use high-throughput technologies.  Otherwise, the outside lab receives about $51. There is no charge to the consumer for the test for the coronavirus SARS-CoV-2 under Medicare. See this fact sheet from CMS, March 12, 2020 which states the original prices. The $100 price for selected labs for U0002, U0003 or U0004 was raised from $51 to $100 effective April 14.

Medical Cost Advocate Editor's Pick

If you need help negotiating your 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.

Prevention Makes Common "Cents"

Detailed report by US Department of Health and Human Services (September 2003) addressing the cost of disease and illness. Specific sections are included on Overweight and Obesity, Diabetes, Cardiovascular (Heart) Disease, Asthma, and Tobacco Use. Metabolic Syndrome also discussed

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