Outpatient Charges


What is the difference between an "inpatient" and "outpatient" procedure?
"Inpatient" procedures require that the patient be admitted into the hospital for at least an overnight stay. An "outpatient" procedure can be performed at a hospital but the patient does not typically need to be admitted before or after the procedure is performed. An exception to this definition is an observation patient. If you have questions about your patient classification, ask your hospital of choice.

How do you determine the "average charge" of a procedure?
The average charge amount is calculated by adding the total hospital charges for all patients in the last 12 months who obtained a specific outpatient test or procedure. This total number is then divided by the number of patients in that same category. The information below reflects calendar year 2005 outpatient billed patients.

Not all hospitals offer all procedures or tests. You should ask your hospital of choice about availability of the procedure or test on an outpatient basis.

When comparing charges, you should consider the likelihood that other procedures may be performed at the same time. For example, patients who undergo a left heart catheterization almost always undergo other procedures at the same time. Ask your physician if you are likely to undergo procedures other than the principal procedure. Insured and self pay patients may qualify for a payment amount less than the charged amount. Ask your hospital if you qualify for a payment less than charges.

Please also note that the charges are for the facility only. They do not include physician charges. Since these are statewide average charges per procedure or test, individual facility charges may vary significantly. You should ask your hospital for more current facility information.

Category

Test or Procedure
The number in parenthesis is the International Classification of Diseases (ICD-9-CM) procedure code

This information reflects calendar year 2011 outpatient billed patients.

Average Charge without another procedure

Average Charge
with
another procedure

Eye

Ultrasonic Destruction and Removal of Cataract (13.41)

$7,602

$6,369

Insertion of Artificial lens at time of cataract extraction, 1 stage (13.71)

$8,211

$9,093

Ear

Insertion of Drainage Tube into Ear (20.01)

$5,560

$5,131

Tonsil-Adenoid

Removal of Tonsils and Adenoids (28.3)

$8,162

$9,844

Removal of Tonsils w/o Removal of Adenoids (28.2)

$7,394

$10,527

Removal of Adenoids (28.6)

$8,044

$9,376

Breast

Needle Biopsy of Breast (85.11)

$5,351

$5,674

Local Excision of Lesion of Breast (85.21)

$9,590

$11,583

Shoulder

Rotator Cuff Repair (83.63)

$24,204

$19,920

Other Removal/Destruction of Shoulder Joint Tissue (80.81)

$18,872

$16,228

Other Repair of Shoulder (81.83)

$18,288

$15,393

Carpal Tunnel

Carpal Tunnel Release (04.43)

$7,988

$9,612

Knee

Removal of Knee Cartilage (Meniscus) (80.6)

$11,536

$10,527

Removal/Destruction of Other Knee Cartilage (80.86)

$10,852

$11,273

Removal of Soft Tissue Lining (Synovium) from Knee (80.76)

$10,584

$11,478

Diagnostic Cardiac Catheterizations

Left Heart Cardiac Catheterization (37.22)

$24,054

$14,740

Right & Left Heart Cardiac Catheterization (37.23)

$23,580

$16,268

Right Heart Cardiac Catheterization (37.21)

$10,319

$14,347

Gallbladder

Laparoscopic Gallbladder Removal (51.23)

$14,897

$14,441

Appendix

Laparoscopic Appendectomy (47.01)

$19,911

$18,916

Esophagus/
Stomach/
Small Intestine

Endoscopic Examination with Biopsy (45.16)

$4,867

$4,648

Other Endoscopic Examination of Small Intestine (45.13)

$4,472

$4,668

Dilation of Esophagus (42.92)

$6,587

$3,993

Endoscopic Removal/Destruction of Stomach Tissue or Lesion (43.41)

$6,312

$4,799

Colon

Colonoscopy (45.23)

$3,272

$4,715

Endoscopic Biopsy of Large Intestine (45.25)

$4,425

$5,004

Endoscopic Examination of Sigmoidoscopy of Colon (45.24)

$3,561

$4,893

Endoscopic Removal/Destruction of Polyps - Large Intestine (45.42)

$4,602

$4,634

Endoscopic Removal/Destruction of Other Tissue - Large Intestine (45.43)

$4,350

$6,207

Endoscopic Removal/Destruction of Polyps from Rectum (48.36)

$4,601

$4,748

Male Sterilization

Vasectomy (63.73)

$8,173

$11,171

Female Sterilization

Tubal Ligation (66.29)

$10,504

$12,485