UNDERSTANDING THE DATA

Below you will find information to help you understand the data presented on this site.


Procedure Costs

General Information
Interpreting the Data
Variations in Price
What's Included and What's Not
FAQs
Specifics on Procedure Codes
 

The procedure cost information on this website is for comparison purposes only, and should not be substituted for a direct conversation with your insurer, your caregiver, and/or your hospital. 


General information on Procedure Costs

Background:

In 2015, the OAHHS worked with the Oregon Legislature to pass Senate Bill 900 mandating an annual reporting of the median amounts paid, by commercial insurance companies, for common procedures performed by Oregon hospitals. The data released by that bill provides a source of transparency and public accountability for hospital prices.

Procedures that occurred in calendar year 2014.

The data source is Oregon's All Payer All Claims database (APAC). APAC is a database of health care insurance claims submitted to the state by entities identified as mandatory reporters according to ORS 442.464. This report only includes payments to hospital inpatient and outpatient facilities.

The report uses the median paid amount. A median represents the point where half the observations are below and half the observations are above the paid amount. Averages are not used because a small handful of very high priced cases, or outliers, have the ability to greatly affect an average. Median amounts are not as affected by outlier data and more accurately represent the typical paid amount.

Paid amounts represent what a commercial insurance company paid to the hospital performing the procedure. It does not include patient paid amounts, such as co-pays, deductibles or co-insurance amounts. In the case of outpatient procedures, the paid amount is inclusive of all elements related to the procedure with the exception of professional fees, which are billed separately. In the case of inpatient procedures, the paid amount is intended to represent the amount paid for the entire hospitalization event. However, depending on whether the attending physician or specialists were employed by the hospital, this paid amount may not be inclusive.

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Interpreting the data

The data on this website contain four main points of information: the procedure type, the number of procedures, the median paid amount, and the median for the state for the procedure. Only procedures that were performed at one of Oregon's sixty acute care hospitals are included. The procedure count is reported next to the hospital name under “Number of Procedures”. This is the number of times the hospital was paid for the procedure. The median paid amount is displayed under “Hospital Median”.  There are several ways to show the middle or average in a range of data. The state chose to use the median because it represents the point that divides the paid amounts in two parts, half above and half below the median amount. This is also known the 50th percentile. Finally, the statewide median paid amount is provided under “Statewide Median”.

The variance in the paid amounts within a hospital come from the different co- payment and deductible amounts paid by patients, as well as different levels of severity in the patient's condition. The differences in paid amount between hospitals include reasons below, as well as each hospital’s negotiated payment rate with commercial insurance companies.

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Variations in prices

Variation in median paid amount from hospital to hospital can be attributed to a variety of factors. Geography often plays a role due to the variation in the cost of doing business.  For example, there may be lower availability of healthcare professionals in one part of the state compared to another, resulting in higher labor costs. There may also be significant variation in overall patients’ health status or severity of illness upon admission that may require higher intensity of care at one hospital compared to another.  Likewise, the contracting and discount arrangements between insurers and hospitals – whether based on volume, on types of procedures performed, or specific savings targets – all play a role in the final paid amount. And finally, the quality of care patient satisfaction, and patient outcome are not collected in APAC, making it difficult to derive any linkage of these variables to the paid amount.  Paid amounts are presented for individual hospitals that have performed the procedure ten or more times during the reporting period. Procedures included in this report were determined based on statewide frequencies. Details about the reporting methodology are available in the next section of this report.

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What’s included and what’s not

A number of factors determined whether data were to be included in or excluded from the state’s report. The summary table below details these decisions. A hospital facility that did not meet the inclusion criteria for a procedure is not listed for that particular procedure. This does not preclude the same facility from being reported under other procedures if it meets the inclusion criteria.

Included Excluded
 
Amounts
 
Median paid amounts to hospital facilities
  • Patient paid amounts
  • Hospital billed amounts
  • Allowed amounts
  • Professional fee amounts
 
 
Facilities
 
 
Oregon acute care hospitals
  • Non-Oregon facilities
  • Free Standing Ambulatory Surgical Centers (ASCs)
  • Specialized clinics not located within the hospital or that bill as a separate entity
Outpatient procedure codes  
Codes for the 100 most common outpatient procedures
  • Codes for procedures performed less than 500 times statewide
  • Codes for outpatient procedures not in the top 100
 
Inpatient procedure codes
 
Codes for the 50 most common inpatient procedures
  • Codes for procedures performed less than 100 times at the statewide level
  • Codes for inpatient procedures not in the top 50
Insurance types  
Commercial insurers
Public insurers (Medicare, Medicaid, VA, Workers Compensation)
Service volumes Procedure was performed 10 or more times at a particular hospital Procedure was performed less than 10 times at a particular hospital
 
Outliers
Individual paid amounts larger than three standard deviations from statewide median for a procedure.

 





































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FAQs:

Q:  Are these prices what I will be charged?
A:  No, OregonHospitalGuide.org lists the prices paid to hospitals from commercial insurers. This is different from the amount that the hospital charges. Your responsibility as a patient could include services from specialists, a co-pay, coinsurance and/or your deductible. The prices displayed on this site give a general sense of what commercial insurers are paying hospitals for the particular procedures.
 
Q:  How can I know what price I will be charged?
A:  Call your hospital and ask for a price estimate. Contact information for every hospital in Oregon is listed on this site under the “cost estimates” tab.
 
Q: Why do prices vary so much?
A: There are many factors that go into a particular price paid. These include: Back to top of page

Specifics on included procedures

Listed below is the codes that were grouped together to create the reported procedures, including both Current Procedural Terminology (CPT) or International Classification of Disease (ICD). CPT codes are used in the outpatient setting and ICD codes are used in the inpatient setting.
 
 
Procedure Group CPT codes ICD codes
Appendectomy N/A '4709','4701'
Arthrogram '23350','51600','62284','27093' N/A
Bone Scan '78306','78305','78315','78320' N/A
Breast Biopsy '19081','19083','19085','19100','19101',
'19100', ’19120','19125'
N/A
Cataract Surgery '66982','66983','66984' N/A
Central Line '36590','36589','36569','36561','36558',
'36556'
'3897','3895','3893'
 
Chemotherapy
'96401','96402','96409','96411','96413',
'96415','96416','96417','96420','96450',
'96446'
 
‘9925’
Colonoscopy '45378','45380','45381','45383','45384', '45385','G0105', 'G0121' '4525','4524','4523'
Coronary Bypass N/A '3614','3613','3612','3611'
 
CT Scan
'74176','74150','72192','72131','72125',
'70486','71250','70450','73700','70480',
'73200','72128','70490','74261', '76380'
 
N/A
 
 
CT Scan w/Contrast
'71260','74160','74170','74174','74175',
'74177','74178','72193','70491','70496',
'70498','70470','71275','70487','70481',
'73701','73132','71270','70492','73706',
'75574', '75572','75635','70460','73701'
 
 
N/A
DEXA Scan '77072','77073','77077','77075','77080' N/A
 
Echocardiograph
'93303','93304','93306','93308','93350',
'93351','93325','93312','93307','93320', 'G0389'
 
'8872'
 
EGD
'43235','43239','43242','43244','43245',
'43246','43247','43248','43249','43250',
'43251','43253','43254','43255', '43259'
 
'4513','4516'
EKG '93000','93005','93010' N/A
Gallbladder Surgery '47562','47563' '5124','5123','5122'
Gastroenterostomy N/A '4438'
 
Heart Catheterization
'93451','93452','93453','93454','93455',
'93456','93457','93458','93459','93460',
'93461','93503','93505','93530','93531'
 
'3723','3722','3721'
Heart Stress Test '93015','93016','93017','93018' N/A
Heart Valve Replacement N/A '3525','3524','3523','3522',
'3521','3512'
Hernia Surgery '49500','49507','49505','49520','49560',
'49561','49585', '49587','49650','49653'
'5371','5369','5363','5362',
'5361','5359','5351'
Hip Replacement N/A '8152','8151'
 
Hysterectomy
'58542','58552','58558','58561','58563',
'58571','58661','58662','58262','58260',
'58554','58292','58291','58553','58290',
'58263','58270','58550'
'6871','6869','6859','6851',
'6849','6841','6839','6831',
'6829','6825','6561','6549',
'6541','6539','6531'
Kidney Removal N/A '5551','554'
Knee Replacement N/A '8154'
 
Knee Surgery
'29870','29871','29873','29874','29875',
'29876','29877', '29879','29880','29881',
'29882','29883','29884','29886', '29887'
 
N/A
Liver Scan '78226','78227' N/A
Mammogram '77055','77056','77057','G0202','G0204', 'G0206' N/A
 
Mastectomy
 
N/A
'8532','8533','8534','8535',
'8536','8541','8542','8543', '8544'
Mobile Heart Monitoring '93224','93226','93225','93270','93271', '0295T','0296T', '0297T' N/A
 
MRI
'72141','72146','72148','73718','73721',
'70551','73221','70543','70544','72195',
'74181','73218','71550','75557','71555'
 
N/A
 
MRI w/Contrast
'72156','72157','72158','70553','74183',
'77059','72197','73720','73723','73223',
'73222','73220','71552','70552','70549',
'70548','70546','75561','73722'
 
N/A
ORIF N/A '7937','7936','7935','7934',
'7933','7932','7931'
Percutaneous Abdominal Drainage N/A '5491'
 
Pregnancy Ultrasound
'76801','76805','76811','76815','76816',
'76817','76819','76830','76885','76818',
'76820','76825','76827','76821'
 
N/A
PTCA N/A '0066'
 
 
 
Radiation Therapy
'77401','77402','77403','77406','77407',
'77412','77413','77414','77416','77421',
'77295','77300','77301','77306','77315',
'77316','77317','77318','77321','77331',
'77332','77333','77334','77338','77417',
'77418','77290','77014','77336','77373',
'77280','77263','77285','77470'
 
 
 
N/A
Procedure Group CPT codes ICD codes
Sigmoidectomy N/A '4576','4575','4574','4573',
'4562','1736','1733'
Spinal Fusion N/A '8102','8103','8104','8105',
'8106','8107','8108'
Spinal Reduction N/A '0309'
Spinal Tap N/A '0331'
Spine Injection '62310','62311','64479','64483','64483',
'64493','64494','64495','27096','G0260'
N/A
Tonsillectomy '42820','42821','42825','42826','42830',
'42831','42835','42836'
N/A
Transfusion N/A '9904'
 
 
Ultrasound
'76856','76857','76700','76705','76770',
'76775','76776','76881','76882','76645',
'76536','76870','76604','76800','76512',
'76510','76506','93925','93880','93970',
'76831','76872','76886','76513','76519'
 
 
N/A
 
 
 
 
 
 
 
 
 
 
X-Ray
'71010','71020','71100','71101','72020',
'72040','72050','72052','72069','72070',
'72080','72114','72090','72072','72100',
'72110','72114','72202','73520','72170',
'73550','72220','73000','73030','73060',
'73070','73080','73120','73130','73140',
'73100','73110','73560','73562','73564',
'73565','73600','73610','73620','73630',
'73650','73660','74010','74020','74022',
'74000','73510','73590','73090','74246',
'74240','74220','74250','73050','70160',
'70220','70030','72010','73500','72190',
'73020','72200','72120','70360','70355',
'70210','70150','73010','70110','72074',
'70250','70260','70100','74241','71120',
'71111','71110','77076','70190','73540',
'73592','73592','71130','70330','70328',
'70200','71035','71030','71023','71021',
'71022','70140','73092'
 
 
 
 
 
 
 
 
 
 
N/A
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Be sure to also sort the performance of Oregon hospitals by measure, including heart attack care, emergency room service, and patient experience.