Under Construction

See also Medicare - Medigap

Note: After some time in the library and Internet and calling several local hospitals I could not find any good summary of costs.
You can lookup Medicare Physician Fee Schedule (MPFS) by HCPC code, but have to have a list of codes and look them up one at a time. There's got to be a better list out there somewhere. I'll keep looking.


Doctor / ER


The average E.R. visit costs $650, while the national average doctor's office visit is approximately $60 . (American Medical Association, "Physician Socioeconomic Statistics," 2001.)
A 1996 New England Journal of Medicine Report, "The Costs of Visits to Emergency Departments," said the cost was $383.

About 10% of visits to the ER were for non-emergencies. So, you should call your own doctor first if in doubt.

In N. Central NJ in 2006 my doctor charges from $77 (simple exam. e.g. upper respaaritory) to $165 (Something that requires more tests or time). An EKG is $88 extra.
An ER visit at Somerset Medical Center starts at $1,000

Some Samples from The Minnesota Council of Health Plans, 2005.
Note: These are costs and individual would pay. Insurance companies and HMO's negotiate discounts of up to 50% for the same services.
Medical Treatment Description Cost
A common cold, office visit You feel rotten, go to the doctor and are told to go home, get plenty of rest and drink fluids. $80
A common cold, ER visit You feel rotten, and instead of going to your clinic during the day, you wait until midnight and go to the ER. $181
Sore throat, office visit Your throat hurts, you go to the doctor. Price includes visit with physician and Strep test. Test was negative. $109
Sore throat, ER visit ItÕs the middle of the night and your throat really hurts. You decide to go the emergency room. Includes ER charges and test for Strep. The test was negative. $406
Ear ache, Urgent Care visit Your 2-year-old daughter is pulling on her ear. You go to Urgent Care. Visit and exam. No infection is diagnosed. $111
Ear ache, ER visit Your 2-year-old daughter is pulling on her ear. You go to the emergency room. ER visit and exam. No infection is diagnosed. $151
Chest X-ray You go to the clinic with a bad cough. Your physician thinks it may be pneumonia and orders a set of X-rays to help make the diagnosis. Price includes clinic visit, X-ray and reading of the results. $183
Allergic reaction to a bee sting Price includes the ER visit and diagnosis, in addition to drugs to treat allergic reaction. Treatment could also include a hospital stay for a severe reaction. $1,050
Broken ankle You broke your ankle playing soccer. Includes trip to the ER, X-ray of ankle and applying short leg cast. $1,386
Step on a rusty nail You step on a nail while taking a walk. Price includes laceration on foot, ER fee, repair, tetanus shot or antibiotics if needed. $1,030
Broken arm Your child jumped off the swing set. Price includes ER visit, X-ray, simple cast. $2,523
Colonoscopy Full, flexible colon scope test conducted by specialist on an outpatient basis. Includes test and reading of the results. $1,985
Skin cancer diagnosis A black, purple odd shaped mark on your arm requires a consultation with a specialist, biopsy and removal of skin lesion. $1,533
Stress test Your primary care doctor orders a stress test. This price includes a trip to the specialist, administering test, reading results. $1,885
Eye exam Exam by ophthalmologist. $176
PAP test Woman of childbearing age, includes exam by gynecologist, test and reading of results. $229
Routine mammogram Women 35 and older, includes the test and reading of results. $125
General physical, charges vary by age: Exam of a person in good health. Simply a physical, not a problem-focused clinic visit.
Well-baby check $134
Age 5 to16 $232
Age 18 to 39 $302
Age 40 to 64 $371
Age 65 and older $323

In 2004, total national health expenditures rose 7.9 percent -- over three times the rate of inflation.

Hospital/Healthcare center:
Hospital $1,000-$3,000/day
Transitional care $150-$250/day

Hospital costs can be broken down by services but it is difficult to determine what is what from the bill you get. And I couldn't find any good average costs on the Internet. Here are some ballpark numbers:

          Room: $1,500/day
           ICU: $4,000/day
Operating Room: $500-$2,000 per half-hour.

             Chest X-Ray: $75
               Bone scan: $440
Arterial blood gas tests: $330
          Echocardiogram: $2,371

A 4/13/2004 USA Today article reported the following scenario:

When Karen Hamers' teenage daughter Michele needed knee surgery, Hamers called several hospitals near her home in Vero Beach, Fla., and asked how much the surgery would cost. At the time, her family did not have health insurance. After choosing a hospital, Hamers paid the surgeon and then also paid the hospital what it said the surgery would cost: $4,200. "Six days after surgery, we receive a letter from the hospital asking for an additional $21,000," Hamers says. She asked for an explanation and got an itemized bill. "It was two pages of gobbledygook," Hamers says. "We could not understand it. They could not explain it. We showed it to our doctor, and he didn't understand it." Hamers had kept a detailed log of her daughter's 20 hours in the hospital, including a list of all the staff who cared for her and what drugs she was given. After reviewing the log and its own records, the hospital reduced its additional billing to $610.

A Jan 2003 Consumer Reports Article "Decoding your hospital bills" reported the following:

In April 2000, shortly after his father died, Richard Clarke went to Boca Raton, Fla., to check on his 84-year-old mother, Opal. She promptly handed him a shoebox stuffed with medical bills from 20 different providers who had treated his father. "She said, 'Here, you figure this out,'" says Clarke, 54. Despite the fact that he is a former hospital chief financial officer, Clarke says, "Even I couldn't tell what, if anything, she owed." Sorting out the charges took him a year, but in the end he found about $2,000 in errors. "Dealing with it firsthand showed me how screwed up the billing system is," says Clarke.

The United States has much higher hospital costs than any other country. The cost per day is three times the OECD median country cost per day, and cost per capita is twice the OECD ( Organisation for Economic Co-operation and Development) median country.
Source: The Commonwealth Fund.

Average cost 2004: $6,280
The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $10,800 in 2005. Workers contributed $2,713, or 10 percent more than they did in 2004.
In 2005, employer health insurance premiums increased by 9.2 percent. (Source: Health Insurance Cost at The National Coalition on Health Care.)

Cost of insurance (total employer plus employee contributions) through an employer group plan is usually much lower than individual plans.

Percentages are as of 2001
Conventional Plans - 7% and dropping
HMO - Health maintenance organizations - 23% and dropping
PPO - Preferred provider organizations - 48% and rising
POS - Point of Service - 22%

A 2005 Consumer Reports survey found that:

  • HMOs scored slightly higher in overall satisfaction than PPOs
  • People in HMOs had more trouble obtaining care than members of PPOs.
  • Nearly one-third of all PPO members reported billing problems, nearly three times the rate for people in HMOs.


See Also: Long Term Care Insurance
  and Medicare/Medigap

In 2004, the United States spent 16 percent of its gross domestic product (GDP) on health care. It is projected that the percentage will reach 20 percent in the next decade
Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.

ADLs - activities of daily living
CCU - Critical Care Unit
CHC - Community Health Care Center
DRG - diagnosis-related group
ED - Emergency Department
EOB - Explanation of benefits
ER - Emergency Room
FICA - Federal Insurance Contributions Act
GPCI - geographic practice cost index
HCFA - Health Care Financing Administration
HCPC - Healthcare Common Procedure Code
HIPAA - Health Insurance Portability and Accountability Act of 1996
ICD - International Classification of Diseases
ICU - Intensive Care Unit
LOS - Length of Stay
MCO - Managed Care Organization
HMO - health maintenance organizations
MEI - Medicare Economic Index
MFS - Medicare Fee Schedule
MPFS - Medicare Physician Fee Schedule
OPD - outpatient departments
POS - Point of Service
PPO - preferred provider organizations
RBRVS - Resource-Based Relative Value Scale
RVUs - Relative Value Units
SNP - Special Needs Plans

See also:Definitions Of Health Insurance TermS - bls.gov

How Much Does It Cost? at Minnesota Council of Health Plans, 2005.
Health Insurance Cost at The National Coalition on Health Care
lookup Medicare Physician Fee Schedule (MPFS) by HCPC code at the Dept of Health and Human Services' Centers for Medicare and Medicaid Services (CMS).
Long Term Care Insurance
Trends in Employer-Sponsored Health Insurance | U. Indiana 2007
What is the difference between traditional insurance, HMOÕs, PPOÕs and POS plans? - PRO-ACT Counseling, Pasadena TX

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last updated 14 Nov 2006