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Compare hospital prices

Hospitals are now legally required to post their prices online — but you’ll need to decipher the codes on your own.

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The cost of medical services vary wildly between hospitals, states and even doctors within the same facility. But that information is now public to patients thanks to the Centers for Medicare and Medicaid Services’ (CMS) “price transparency law,” which went into effect on January 1, 2021. Under the law, all US hospitals have to publish their price lists online — making it easier for patients to shop around.

How to compare hospital prices

For many patients, the cost of a procedure or surgery is a major factor in deciding on a hospital. There are a few techniques you can use to compare hospital prices:

  • Look up hospital price lists. Now that the price transparency rule is in effect, this information is more readily accessible. Go to the hospital’s website or call their billing department if you can’t find their price list.
  • Ask about price differences between doctors. A surgeon with 30 years of experience is likely to charge more than a surgeon who just completed their residency.
  • Consider additional costs. Unfortunately, the price of procedures is a small portion of what you can expect to pay. Most hospitals tack on other fees that can significantly raise the cost, like “facility charges,” medical supplies, laundry and support services — such as special dietary needs or financial counseling. Some hospitals may engage out-of-network providers — like anesthesiologists — for your procedure, so be aware of those costs, too.
  • Know what your health insurance covers. This helps you avoid surprise medical bills. Read your policy or call your insurer to find out which hospitals and/or doctors are in-network, if you’ll need to pay a deductible or coinsurance and if your procedure requires pre-authorization. To prevent payment disputes later, note the name and contact number of the person you spoke to or try to get this information sent over in writing.
  • Explore financial aid programs. If you can’t afford to pay the full cost of a procedure, speak to the hospital’s patient advocate or price transparency officer. You may be able to access financial aid or a payment plan.
  • Shop around. The price of up to 40% of medical services can be cut down by comparison shopping, according to a 2018 study by researchers at Harvard, Yale and Columbia University. So, you can potentially save hundreds or thousands of dollars by comparing baseline prices from a range of hospitals.

What else should I consider when choosing a hospital?

While you’re researching hospitals, look into the quality of care you can expect to receive. There are a few ways to do this:

  • Check hospital expertise. Call the hospital to find out if it has a dedicated unit for the procedure or surgery you’re having, and how often it’s performed. In the medical world, volume is a good thing — it means doctors are familiar with the procedure and receive a lot of referrals. It’s also worth asking about your doctor’s success rate. No procedure comes without risks, but a higher success rate points to fewer complications over time.
  • Look at the hospital’s quality measures. Most major hospitals report their quality measures to the public, and you can find their “report cards” by going to Medicare’s Care Compare platform and entering your ZIP code. The CMS rates over 4,000 hospitals across the country based on best practices, and you can access patient surveys, the timeliness of care and surgery complication rates. Pay close attention to the level of communication with doctors and nurses, as well as pain control methods and the number of infections.
  • Turn to nonprofit organizations. There are nonprofits that conduct surveys about hospitals on consumers’ behalf, including Leapfrog Group and the Commonwealth Fund. You can also double-check if the hospital is accredited by the Joint Commission, a group whose mission is to improve healthcare quality.
  • Check out patient forums. Along with asking your primary care provider for their thoughts on hospitals, read patient reviews online. Take note of any surgeons or doctors who are mentioned the most — whether that’s in a good or bad way.

What happened to HospitalCompare?

The CMS retired its HospitalCompare service on January 1, 2021. But you can use Medicare’s new Care Compare tool to read the CMS’ reports and narrow down your hospital choices.

How to find hospital price lists

Under the new rule, hospitals must display their basic price lists — known as “chargemasters” — on their sites without the user needing to create an account or enter a password. But the CMS doesn’t require hospitals to present these lists in a consumer-friendly format, so you may have to do some digging to get the data you want.

Try these tactics:

  • Go to the hospital’s billing or insurance section. In most cases, hospitals publish their price lists here, though you may have to click into a few sub-categories to reach it. A Quartz study found nearly 75% of hospital websites required users to click through three or more pages to get to the price list.
  • Scan the hospital’s legal or frequently asked questions page. Some hospitals have buried the information among legalities and terms and conditions.
  • Use the site’s search function. Enter terms like “price list,” “standard charges,” “chargemaster” or “billing codes.” If you get no results, try alternative spellings or phrasings, like “charge master” or “charge description master.”
  • Run a Google search. Some hospitals have outdated search functions, so you may be able to find a shortcut to the rates through a search engine.
  • Call the hospital’s billing department. They should be able to guide you through the site or give you the price for a particular procedure over the phone.

Once you’ve found the list, it’s worth contacting your health insurance company. Remember, the list only shows the base price charged by the hospital for a specific service — and patients can expect additional fees and charges. To get a more accurate rate, ask your insurer for the contracted rate they’re charged by the hospital — and how much you’ll need to pay out of pocket based on your current deductible.

How to read hospital price lists

Chargemasters list thousands of billable services and items — from gall bladder surgeries to gauze — and they’re written in terms and codes that mean nothing to the average person.

To decipher the list, ask your doctor for the exact name of the procedure you need and its CPT code. These three- or five-digit codes categorize the medical billing system, and there can be dozens of codes for a single service. For example, a 70551 MRI is a brain scan, a 72141 MRI looks at the cervical spine and a 74181 MRI focuses on the abdomen.

When you have a CPT code, you can search for it on the chargemaster to see how much the hospital charges for that service.

How do I know if a hospital is in-network?

You’ll almost always pay less if you go to an in-network hospital. To find out if a hospital has partnered with your insurer:

  • Go to your plan’s provider directory. Most insurers have an online portal or app that allows you to search for in-network doctors and hospitals.
  • Call the number on the back of your insurance card. Your insurer can tell you which hospitals accept your specific plan.
  • Contact the hospital’s billing department. They can let you know which doctors are in-network — and if any aren’t.

Average in-network costs of 10 common medical procedures in the US

To give you an idea of how much you’ll pay, we chose 10 of the most popular procedures from the CMS’ list of shoppable services and compared the costs across five ZIP codes in the US.

These are in-network base prices, so they apply to those who have insurance. You may be charged additional fees and charges — like facility fees — that raise your total cost, so treat these prices as an estimate.

Procedure & CPT codeBell, California (90201)Algonac, Michigan (48001)New York, New York (10001)Alexandria, Ohio (43001)Addison, Texas (75001)
Basic metabolic panel bloodwork (80048)$18$26$11$14$19
CT scan (70450)$77$52$99$82$100
MRI (70553)$221$131$240$226$500
Ultrasound of abdomen (76700)$85$75$155$84$169
EKG (93000)$48$24$54$34$33
Groin hernia repair (49505)$878$677$2,117$782$1,166
Colonoscopy (45380)$651$282$978$417$427
Gall bladder endoscopy (47562)$1,228$1,254$4,416$1,212$2,386
C-section (59510)$5,223$3,079$8,070$2,395$3,812
Physical therapy (97110)$37$55$53$33$35

Average out-of-network costs of 10 common medical procedures in the US

If you’re uninsured or go to an out-of-network hospital, you can expect to pay the full cost of the medical procedure upfront. These are the base prices for the same services with out-of-network hospitals, across the same ZIP codes.

Procedure & CPT codeBell, California (90201)Algonac, Michigan (48001)New York, New York (10001)Alexandria, Ohio (43001)Addison, Texas (75001)
Basic metabolic panel bloodwork (80048)$65$80$51$43$70
CT scan (70450)$236$109$246$173$608
MRI (70553)$520$276$600$475$1274
Ultrasound of abdomen (76700)$185$248$380$171$380
EKG (93000)$103$53$139$75$80
Groin hernia repair (49505)$1,707$1,300$5,000$1,500$2,438
Colonoscopy (45380)$1,500$700$3,025$1,037$1,121
Gall bladder endoscopy (47562)$2,200$2,300$10,000$2,224$4,870
C-section (59510)$8,000$4,500$13,120$4,000$5,973
Physical therapy (97110)$75$115$130$70$79

Ask an expert: What are the pros and cons of the new transparency law?

Dr. Kyle Zrenchik

Dr. Kyle Zrenchik
Licensed therapist and owner of All in Therapy Clinic

The best thing from the clinic’s side is that we put the decision-making power in the hands of the client. Historically, all medical decisions, including costs, are made without the client’s participation or voice. When a client is fully informed, they are much more likely to experience treatment as a positive, rather than a negative, event.

The downsides are that it takes time to have those conversations, and fully inform the client. Taking the time to explain costs, insurance reimbursements, and payment strategies up-front puts strain on the traditional way of doing intakes. For clinics and hospitals used to that traditional way, it will be a tremendous adjustment.

Do you think the new law will foster competition among hospitals and eventually lower prices for patients?

While it sounds like this will lower prices, I don’t anticipate that will be the result. Insurance companies set reimbursement rates and stipulate rules around how and when to collect copays, deductibles, and other costs. So, no hospital or clinic has full ability to decide prices and costs. Further, the cost of care is not an inflated cost; it costs what it costs. The savings would be in clients having more say in whether they receive a particular service because of the price.

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Bottom line

Thanks to the new price transparency law, it’s a little easier for patients to compare prices from a range of hospitals. While some out-of-pocket expenses are inevitable with many procedures, the rule makes that information more transparent — and will hopefully help patients to avoid surprise medical bills.

Time will tell whether the rule will make the healthcare market more competitive and lower hospital prices. Either way, cross-check the cost of any medical procedure with your health insurance plan to make sure you’re getting the most out of your coverage.

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