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Doctors' Charges, Physician Prices, Average Cost, Anesthesia


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Physician Payments: Average Medicare payment for 25 Common Office visits

Difficult file to use for find out what Medicare paid for certain types of office visits and procedures in 2012. Average doctor's price is NOT SHOWN, but only the allowed amount determined by Medicare, and how much Medicare paid on average (for every state). Must know how to use Excel files and billing code knowledge also helpful. Medicare paid $49 for a 99213 office code (15 minute office visit for an established patient) and $73 for a 25-minute office visit, and just $101 for a 60-minute visit (est. patients). If the patient was new, Medicare paid $73 on average for a 30 minute visit, and $116 for 45 minutes. Medicare's annual wellness visit was paid at $165 for new enrollees, then $111 for subsequent annual visits. The most common EKG was paid at $14, ear wax removal at $36, pneumonia or annual flu shot at $23. Updated Sept. 2013

Physician: Average Cost for 25 Common Ambulatory Surgery Center Procedures

Difficult file for consumers to use unless familiar with Excel. Allowed amounts (rather than prices) in the Ambulatory Surgery file for 25 Common high volume outpatient surgical procedures in a Surgery Center, shows what Medicare paid during 2012 for cataract surgery, different types of endoscopy, spinal injections, some hernia repairs, carpal tunnel release, kidney stone crushing, prostate biopsy (avg $530 paid on $670 allowable charge), correction of bunion, and more. Uses CPT codes, and all states are listed. Last updated Sept. 2013

Childbirth - Average Total Cost for Having a Baby, 2009 (AHRQ MEPS pdf)

If you were privately insured and had an uncomplicated pregnancy, the average cost of having a baby was about $12,000 in 2009, according to a report from the Agency for Healthcare Research and Quality. The estimate includes actual payments for all prenatal office visits, hospital childbirth (inpatient maternity and newborn delivery), prescription medications and other services for an uncomplicated pregnancy. If the person had both prenatal care and hospital delivery, the average expense was nearly $13,000 in 2009 dollars. Uses Medical Expenditure Panel Survey (MEPS) data for 2006 to 2009 patients; Research Findings #32 published June 2012. No update available as of Oct. 2015

Cosmetic (Plastic) Surgery Prices - Physician Fees, 2010 (pdf)  Editor's Pick

Find the average surgeon's fees and volumes for cosmetic surgery in this online book of national statistics by the American Society for Aesthetic Plastic Surgery. Average prices (2009) shown on page 11: e.g. $5332 for tummy tuck, $3500 to $3700 for breast augmentation, liposuction about $3000, eyelid surgery at $2912, breast reduction $5384, facelift at $6629, botox injection at $398, laser hair removal $314. Costs were lower in 2009 than in 2008. Numbers do not include facility fee nor anesthesia cost. Cosmetic surgical procedures increased about 9% in 2010; nonsurgical procedures decreased by 9%. Average number of procedures performed by ASAPS physicians shown for each type. See Quick Facts (pg. 14) for for how long cosmetic surgery or botox procedures or spider vein treatments take, average surgeon's fees, how long before you're back to work, etc. ASAPS active members are Board-certified in Plastic Surgery

Healthcare Expenses for Seniors (MEPS 2011 data)

Special report on Health Care Expenditures for the Elderly Age 65 and over, shows median annual expenditures were $4206. Average expenses for those with expense were $9863 in 2011. Medicare paid over 62% (up considerably from 10 years ago); 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 $3199 per day (sticker shock); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429, Jan. 2014

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

An average physician office visit in 2008 cost $199, compared to $922 for an Emergency Room visit (median was $89 for doctor's visit, vs. $422 for ER). Top 5 conditions shown for each ambulatory care visit type. Consumers should expect considerably higher prices since 2008. MEPS data published in Statistical Brief #318, March 2011

Maine Charges for Surgery, x-ray, imaging tests (MHDO)

Maine Health Data Organization's HealthCost website shows average charges (prices) and actual average payments for surgery such as knee arthroscopy, tonsillectomy, gall bladder removal, hernia repair, breast biopsy, carpal tunnel, kidney stones, total hip replacement; tests such as colonoscopy, mammogram, x-ray, CT, MRI, ultrasound. Good news is that both physician and hospital charges are shown to give you an idea of total cost (and discounts); CPT codes also shown. Bad news: prices date from 2008-2010, or nearly 3 years old. From maine.gov

New Hampshire Costs - Outpatient Surgery, Tests and Maternity

Shows typical prices for many outpatient procedures, plus inpatient maternity care. NH Health Cost shows expected average cost for over 30 common tests and ambulatory surgeries including colonoscopy, mammogram, ER visit; chest x-ray or x-ray for spine, shoulder, knee, ankle, or foot; bone density scan, CT scan (3 types), MRI for back, brain, knee, or pelvis; myocardial imaging; arthrocentesis, arthroscopy of knee, breast biopsy, destruction of lesion, outpatient gall bladder surgery, hernia repair, kidney stone removal, tonsillectomy, breast ultrasound, and other maternity ultrasound tests, births. Site uses 2010-2011 costs increased for price inflation, common language instead of requiring codes, and includes physician fees. Must supply zip code and insurance information (or no insurance). Report by The NH Department of Insurance updated 2012

South Carolina - Average Medicaid Payments for Health Care Services - 2007

SC Department of Health & Human Services shows how much the state paid for Medicaid costs, by type of service. Average amount paid per visit (July 2006 to June 2007) is shown statewide for Inpatient Hospital Services ($7500), Clinics ($1168), Nursing Home Facilities ($25,403), Pharmacy, Physicians, Dentists ($266), DME and more. Consumers can also compare what each provider was paid, by clicking on SELECT, although services may differ among Medicaid patients. Full charges (prices) are NOT shown. Medicaid Transparency Reporting project has very slow response time; 2007 latest available as of March 2011

Vermont - Insurance Reimbursement for Office Visits 2010  Editor's Pick

Find out the average amount 3 insurance companies (Blue Cross, Cigna and MVP) paid for office visits, well child care, preventive visits, strep tests, immunizations, EKGs, injections, and more. Shows average Allowed Charge also. Jan.-June 2010 data from state of Vermont, published Dec. 2010

Virginia Healthcare Prices (2012)  Editor's Pick

Find average price PAID for 30 common healthcare services, including 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 facility cost PLUS the surgeon or other physician fees. Each service shows the average allowed amount that you or your insurance plan paid in 2012. More comprehensive than most pricing information. From Virginia Health Information (VHI), updated Dec. 2013

VT Hospital Physician Office Visit Prices 2011

Compare what hospitals in Vermont charge for physician office visits. For example, code 99213 averages $116 (range $93 to $163) for an established patient; code 99214 average price is $175. New patient prices also shown. If non-hospital medical groups exist in VT, their fees are not shown. Provided by state of Vermont; prices good thru Sept 2011.

What is the healthcare cost for influenza? (MEPS data)

Data from 2001-2003 flu seasons show 1.5 percent of the population reported treatment of influenza. Average expenditures were $52 for drugs, $116 for ambulatory care, and $397 for hospital ER visit (for those who used these services), shown in 2003 dollars. Consumers are advised to inquire about 2015 prices, which will be substantially higher. MEPS Statistical Brief #116, March 2006

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