Pricing Tools for Procedures, Tests, and Services
The historic lack of price transparency in healthcare has made the quest for value a difficult one. Fortunately, several companies have risen to the occasion with tools to help you determine a reasonable and customary rate for services, tests, or procedures in your area.
In addition to these tools, check with your employer and your insurance plan to see if they have their own tools. Unless specifically noted below, none of these tools provide information specific to your insurance plan. Since each plan negotiates their own Allowed Amount, the rates you get from these tools will not be exactly equal to the Allowed Amount for your plan.
While this information can be very helpful, be certain that you’re also familiar with all of The Cost Beast’s nasty tricks and how to defeat them.
To use these tools most effectively, first ask your provider in advance for the CPT codes and descriptions for the procedures you are anticipating.
For most of us …
Healthcare Bluebook is a great place to start. Their tag line is ‘Join the Fair Price Revolution’. Enter the name (preferably the CPT description) of your procedure and your zip code, and receive (depending on the service and the available data for your area); a fair price, a range of prices, a list of providers in your area, ratings by provider relative to Fair Price, and other tips and information specific to that service. And get this … you can even download and print out a Binding Price Estimate for each provider involved in delivering the services included. For example, the Fair Price for a colonoscopy (screening) is broken down into separate fair prices for Facility Services, Physician Services, and Anesthesia. Great tool!
Guroo is a tool provided by the non-profit Health Care Cost Institute (HCCI) to help consumers with cost and quality transparency. Enter a care bundle or test name, and receive national average, state average, and your local average pricing along with helpful details on the care bundle, what to expect, questions to ask and how to prepare. You can also browse using a visual body map or search names alphabetically. HCCI also provides their own valuable resources on price and cost related topics, but they’re more oriented toward research.
New Choice Health allows you to enter procedure key word, insurance type and zip code to get info on Great Price, Fair Price, and Expensive Price; and then lists providers in your area offering that service. They also allow you to request a quote from participating medical facilities.
Fair Health Consumer Cost Lookup is a cost estimator for healthcare prices and health insurance. Based on your zip code, they return estimated Provider Charges and average actual payment (Allowed Amount), and even take a stab at estimating your out of pocket expenses based on your insurance.
Google does a pretty good job looking up CPT codes. Just type ‘CPT code for xxx’, where xxx is a keyword. Physician’s Group Management offers a Search CPT codes to look them up by region and code/keyword. Find a Code let’s you look up a CPT by keyword. The American Medical Association’s CPT Code/Relative Value Search can help you look up a CPT Code either by code or by key word in the description.
For some of us …
Medicare’s Physician Fee Schedule Search allows you to look up a procedure by CPT code, and get Medicare Pricing and other info specific to that CPT code. It’s not the most user friendly site in the world, but they do offer a ‘How to …’ booklet.
Medicare released claims and payment info on the 100 most common inpatient services and 30 common outpatient services. The New York Times published a site called How Much Hospitals Charge for the Same Procedures that uses the Medicare inpatient visit data, but presents it in a more user friendly way. Enter a city, state, or zip and get a map with local hospitals. Mouse over your hospital of choice and get a list of the top 100 procedures, how many cases for each were billed by that hospital, how much they billed Medicare (the Provider Charge), and how much Medicare actually paid (Medicare’s Allowed Amount). It also compares both to nationwide averages. While not the original intent, this illustrates the huge difference between Provider Charges and Allowed Amounts for the vast majority of hospitals. This may not be as helpful as the other tools in helping estimate out of pocket expenses, since it only includes Medicare and would only directly help Medicare patients who don’t have Medicare Supplemental insurance.
OpsCost uses both government claims data (presumably the Medicare data set, but we don’t know for sure) as well as user reported bills from all payers.
Clear Health Costs is another user interface on top of the Medicare data set. It covers outpatient and other procedures, but it only covers limited geographies (as of June 2016, NYC, SF, LA, Philadelphia, Miami, Tampa-St. Petersburg, DFW, Houston, San Antonio, and Austin).
The Surgery Center of Oklahoma has set a new standard for pricing transparency by publishing their service rates. Even if you don’t receive care there, this could serve as reference pricing.
If you live in New Hampshire, you can check out their tool to Compare Health Costs & Quality of Care.
If you live in Colorado, you can dip into their CO Medical Price Compare.
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