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One of my local hospitals has put out price transparency information. Unfortunately, its a mess to try and work your way through it and a lot of the codes are incomplete or don't work, but here's some information for people's amusement.
My intention was to check 2 insurances against each other ie. BCBS PPO against a Medicare plan, but the system in fact provides different sets of procedures for each insurance - so you can't really compare between insurances. My suspicion is they generated data for common procedures and if something is common under one but not common under the other this is what occurs.
I have rounded most numbers to try and make the information slightly less specific.
Outpatient Visits
They didn't include our standard 992** codes. They simply included G0463 which is identified as hospital outpatient clinic visit.
The gross charge for the visit is listed as $400. Their assumption is you'll have labs done so they list an average gross charge of $480 for the visit with a negotiated average of $430 BCBS. Medicare - $108 negotiated. This Medicare value is basically within a few dollars of 99203's 2020 charge in my area.
X-rays - 73600, *610, *620, *630 are all listed as gross charge of $600 with negotiated average payment of $200. Medicare - $58 negotiated. Medicare pays about $30 in this area for 3V done outpatient.
MRI lower extremity without 73718 - Gross charge of $3150 with negotiated average of $900. Medicare negotiated - $360
Surgery codes are in general very limited. Most of the time the specific charge for the procedure isn't provided even though the information is provided under the specific code. Sometimes more specific information, negotiated rates, etc are provided, but in general the information is still relatively a black box.
All negotiated charges for below are BCBS. If no negotiated average rate is listed its because it wasn't provided.
28725- They list the fusion cost as VARIABLE, claim a $21K general procedure services costs and suggest the total gross charge is $28K.
28725 - average gross charge listed as $41K.
27814 - average gross charge $42K AND average negotiated payment - $15K
27822 - average gross charge - $55K AND averaged negotiated payment - $12K
27650 - average charge of $24k AND average negotiated payment of $7600
28755 - Average gross charge is $50K.
11750 - gross charge of $8100 (ha). No negotiated rate. General procedure service is listed as $8K
28285 - $17K gross charge.
28250 - $17K gross charge.
28485 - $27K gross, charge AND Negotiated rate of $11k.
27870 - Average gross charge $44K ie. procedure, general services, labs, etc. Interestingly, specifically lists ankle fusion charge as $14500.
28415 - gross charged listed as $28500. Heel procedure charge specifically listed as $8100.
(if I get a chance later I may revise the above table to list the procedure next to the code)
In general, this is the usual "list of huge charges" game. Occasionally we get 2 things of interest to me. Their actual procedure charge and very infrequently their average negotiated rate.
What can be drawn?
Hospital care is expensive.
Its tough to draw conclusions about the outpatient visit above since that value includes labs and such and many specialties, but that's supposed to be an average rate of all visits. This same plan pays less than $175 for a 99204 in a non-facility clinic in my town.
The imagery negotiated payment rate for x-rays is 6-7 times what private practice is paid.
If I were following a non-displaced, non-operative, walk in a boot patient and I billed 99213 + 73630 last year I'd have been paid somewhere along the lines of $90-110 total per visit from most private insurance. That same service in a hospital would be $200 just for the imaging.
Kind of brings me back to another thread where we discussed the necessity of x-rays. How much did "cost" factor into the Ottawa ankle sprain rules.
BCBS-PPO is probably the best "common" payor in my area. Also again, brings to mind recent political discussion that private insurance pays hospitals a lot more than Medicare does.
My intention was to check 2 insurances against each other ie. BCBS PPO against a Medicare plan, but the system in fact provides different sets of procedures for each insurance - so you can't really compare between insurances. My suspicion is they generated data for common procedures and if something is common under one but not common under the other this is what occurs.
I have rounded most numbers to try and make the information slightly less specific.
Outpatient Visits
They didn't include our standard 992** codes. They simply included G0463 which is identified as hospital outpatient clinic visit.
The gross charge for the visit is listed as $400. Their assumption is you'll have labs done so they list an average gross charge of $480 for the visit with a negotiated average of $430 BCBS. Medicare - $108 negotiated. This Medicare value is basically within a few dollars of 99203's 2020 charge in my area.
X-rays - 73600, *610, *620, *630 are all listed as gross charge of $600 with negotiated average payment of $200. Medicare - $58 negotiated. Medicare pays about $30 in this area for 3V done outpatient.
MRI lower extremity without 73718 - Gross charge of $3150 with negotiated average of $900. Medicare negotiated - $360
Surgery codes are in general very limited. Most of the time the specific charge for the procedure isn't provided even though the information is provided under the specific code. Sometimes more specific information, negotiated rates, etc are provided, but in general the information is still relatively a black box.
All negotiated charges for below are BCBS. If no negotiated average rate is listed its because it wasn't provided.
28725- They list the fusion cost as VARIABLE, claim a $21K general procedure services costs and suggest the total gross charge is $28K.
28725 - average gross charge listed as $41K.
27814 - average gross charge $42K AND average negotiated payment - $15K
27822 - average gross charge - $55K AND averaged negotiated payment - $12K
27650 - average charge of $24k AND average negotiated payment of $7600
28755 - Average gross charge is $50K.
11750 - gross charge of $8100 (ha). No negotiated rate. General procedure service is listed as $8K
28285 - $17K gross charge.
28250 - $17K gross charge.
28485 - $27K gross, charge AND Negotiated rate of $11k.
27870 - Average gross charge $44K ie. procedure, general services, labs, etc. Interestingly, specifically lists ankle fusion charge as $14500.
28415 - gross charged listed as $28500. Heel procedure charge specifically listed as $8100.
(if I get a chance later I may revise the above table to list the procedure next to the code)
In general, this is the usual "list of huge charges" game. Occasionally we get 2 things of interest to me. Their actual procedure charge and very infrequently their average negotiated rate.
What can be drawn?
Hospital care is expensive.
Its tough to draw conclusions about the outpatient visit above since that value includes labs and such and many specialties, but that's supposed to be an average rate of all visits. This same plan pays less than $175 for a 99204 in a non-facility clinic in my town.
The imagery negotiated payment rate for x-rays is 6-7 times what private practice is paid.
If I were following a non-displaced, non-operative, walk in a boot patient and I billed 99213 + 73630 last year I'd have been paid somewhere along the lines of $90-110 total per visit from most private insurance. That same service in a hospital would be $200 just for the imaging.
Kind of brings me back to another thread where we discussed the necessity of x-rays. How much did "cost" factor into the Ottawa ankle sprain rules.
BCBS-PPO is probably the best "common" payor in my area. Also again, brings to mind recent political discussion that private insurance pays hospitals a lot more than Medicare does.
