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. Oregon's efforts were recently recognized in the national Report Card on State Price Transparency Laws, an annual assessment conducted by Catalyst for Payment Reform. Due largely to the data unlocked by the OAHHS legislation along with this website, Oregon was ranked fourth in the nation for its performance in health care price transparency. 

Procedures that occurred in calendar year 2015 are the most recent available and are displayed on this website. 

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, as well as patient-paid amountssuch 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. If the attending physician or specialists were not employed by the hospital, the paid amount does not include their professional fees.

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. 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. 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. Quality of care, patient satisfaction, and patient outcome are not collected in APAC, making it difficult to link these factors to the paid amount. 

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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 including 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 350 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)
  • Veterans Administration
  • Workers Compensation
  • ERISA self-insured plans
  • Commercial insurance with fewer than 5,000 covered lives
 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

The following tables contain all the individual billing codes included with each reported procedure. Outpatient surgeries and imaging procedures are coded using the Current Procedural Terminology (CPT) coding system and are five digit numbers with no decimals. Inpatient procedures are coded using the ICD-9 PCS codes and are four digit numbers with a decimal or ICD-10 PCS codes which are seven digit alpha-numeric. Pregnancy codes are grouped using MS-DRG codes and are three digit numbers with no decimal.
 
Procedure                                                                  Codes
 Bone study  77071, 77072, 77073, 77074, 77075, 77076, 77077, 77080,
77081, 77085
 CT scan: Abdomen  74150, 74176, 74261, 74263
 CT scan with contrast: Abdomen  74160, 74170, 74174, 74177, 74178, 74262, 74270, 74280
 CT scan: Chest  71250
 CT scan with contrast: Chest  71260, 71270, 71275
 CT scan: Extremities  73200, 73700
 CT scan: Head and neck  70450, 70480, 70486, 70490
 CT with contrast: Head and neck  70460, 70470, 70481, 70482, 70487, 70488, 70491, 70492,
70496, 70498
 CT scan: Spine  72125, 72128, 72131, 72192
 CT scan with contrast: Spine  72126, 72127, 72129, 72130, 72132, 72133, 72193, 72194
 
 Cardiovascular: Heart catheterization
 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458,
93459, 93460, 93461, 93462, 93464, 93503, 93530, 93531,
93533
 Cardiovascular: ECG  93000, 93005, 93010
 Cardiovascular: ECG stress test  93015, 93016, 93017, 93018
 Cardiovascular: Echo  93303, 93304, 93306, 93307, 93308, 93312, 93315, 93317,
 93318, 93320, 93321, 93325, 93350, 93351, 93352
 Cardiovascular: EPS  93653, 93654, 93655, 93656, 93657
 Cardiovascular: Mobile heart monitoring  93225, 93226, 93227
 Inpatient procedure: Blood transfusion  99.00, 99.04, 99.05, 99.06, 99.07, 99.09, 30233N1,  30233R1
 Inpatient procedure: Chemotherapy  99.25, 3E0D705
 Inpatient procedure: Hemodialysis  39.95, 5A1D00Z, 5A1D60Z
 Inpatient procedure: Abdominal drainage  54.91, 0W9G3ZX, 0W9G3ZX, OW9G3ZZ
 Inpatient procedure: Appendectomy  47.01, 47.09, 0DTJ0ZZ, 0DTJ4ZZ
 Inpatient procedure: Bowel removal  17.33, 17.36, 45.62, 45.73, 45.74, 45.75, 45.76, 0DTF0ZZ,
 0DTF4ZZ, 0DTN0ZZ, 0DTN4ZZ
 Inpatient procedure: Brain excision  01.51, 01.52, 01.53, 00B00ZZ, 00B70ZZ
 Inpatient procedure: Closed fixation  79.02, 79.05, 79.06, 79.11, 79.12, 79.13, 79.14, 79.15,  79.16,
 79.17
 Inpatient procedure: Central line insertion  38.93, 38.95, 38.97, 02H633Z, 02HV33Z, 05HM33Z
 Inpatient procedure: Colonoscopy  45.23, 45.24, 45.25, 0DBE8ZX, 0DBN8ZX
 Inpatient procedure: Coronary bypass  36.11, 36.12, 36.13, 36.14, 021009W, 021109W, 021209W,
 021309W
 Inpatient procedure: Disc excision  80.51, 0RB30ZZ, 0SB20ZZ, 0ST20ZZ
 Inpatient procedure: Gallbladder surgery  51.22, 51.23, 51.24, 0FT40ZZ, 0FT44ZZ
 Inpatient procedure: Heart catheterization  37.21, 37.22, 37.23, 4A023N6, 4A023N7, 4A023N8
 Inpatient procedure: Heart valve replacement  35.12, 35.21, 35.22, 35.23, 35.24, 35.25, 02RF08Z,  02RF0JZ
 Inpatient procedure: Hernia repair  53.31, 53.59, 53.61, 53.62, 53.63, 53.69, 53.71, 0WUF0JZ,
 0WUF4JZ
 Inpatient procedure: Hip replacement  81.51, 81.52, 0SR90JA, 0SR90JZ, 0SRB0JA, 0SRB0JZ
 
 Inpatient procedure: Hysterectomy
 65.31, 65.39, 65.41, 65.49, 65.61, 68.25, 68.29,  68.31,68.39,
 68.41, 68.49, 68.51, 68.59, 68.69, 68.71, 0UB90ZZ,  0UT90ZZ,
 0UT94ZZ, 0UT97ZZ, 0UT9FZZ
 Inpatient procedure: Kidney removal  55.51, 55.53, 55.54, 0TT00ZZ, 0TT04ZZ, 0TT14ZZ,  0TT24ZZ
 Inpatient procedure: Knee replacement  81.54, 0SRC0J9, 0SRC0JZ, 0SRD0J9, 0SRD0JZ
 Inpatient procedure: Open fixation  79.31, 79.32, 79.33, 79.34, 79.35, 79.36, 79.37, 0QSG04Z,
 0QSH04Z
 Inpatient procedure: PTCA  00.66
 Inpatient procedure: Shoulder replacement  81.80, 81.81, 0RRJ0JZ, 0RRK0JZ
 Inpatient procedure: Skin incision and drainage  86.01, 86.03, 86.04, 86.07, 86.09
 Inpatient procedure: Spinal decompression  03.02, 03.09, 00NW0ZZ, 00NY0ZZ
 Inpatient procedure: Spinal fusion  81.02, 81.03, 81.04, 81.05, 81.06, 81.07, 81.08, 0RG10A0,
 0RG20A0, 0SG00A0, 0SG00AJ, 0SG10AJ, 0SG30A0,  0SG30A1,
 0SG30AJ
 Inpatient procedure: Spinal tap  03.31, 009U3ZC, 009U3ZZ
 Mammography  77051, 77052, 77053, 77054, 77055, 77056, 77057, 77058,
 77059, 77062 77063, G0202, G0204, G0206
 MRI scan: Abdomen  74181
 MRI scan with contrast: Abdomen  74182, 74183, 74185
 MRI scan with contrast: Chest  71551, 71552, 71555
 MRI scan: Extremities  73218, 73221, 73718, 73721
 MRI scan with contrast: Extremities  73219, 73220, 73222, 73223, 73719, 73720, 73722, 73723
 MRI scan: Head and neck  70336, 70540, 70544, 70547, 70551
 MRI scan with contrast: Head and neck  70542, 70543, 70545, 70546, 70548, 70552, 70553
 MRI scan: Spine  72141, 72146, 72148, 72156, 72157, 72158, 72195
 MRI scan with contrast: Spine  72142, 72147, 72149, 72159, 72196, 72197, 72198
 Nuclear medicine: Cardiovascular system  78445, 78451, 78452, 78466, 78472, 78494, 78496
 Nuclear medicine: Endocrine system  78000, 78012, 78013, 78014, 78018, 78020, 78070, 78071,
 78072, 78075
 Nuclear medicine: Digestive system  78201, 78205, 78206, 78215, 78216, 78226, 78227, 78230,
 78261, 78264, 78267, 78268, 78278, 78290
 Nuclear medicine: Musculoskeletal system  78300, 78305, 78306, 78315, 78320
 Outpatient procedure: Abdominal drainage  49000, 49002, 49020, 49082, 49083, 49084
 Outpatient procedure: Appendectomy  44950, 44955, 44960, 44970
 Outpatient procedure: Arthrocentesis  20600, 20605, 20606, 20610, 20611, 20612
 Outpatient procedure: Arthrography  23350, 24220, 25246, 27093, 27095, 27096, 27370, 27648

 Outpatient procedure: Big toe surgery
 28200, 28208, 28210, 28220, 28225, 28232, 28234, 28238,
 28240, 28250, 28262, 28270, 28272, 28285, 28286, 28288,
 28289, 28290, 28292, 28293, 28294, 28296, 28297, 28298,
 28299, 28300, 28305, 28306, 28308, 28309, 28310, 28312,
 28313, 28315, 28320, 28322, 28344, 28345
 Outpatient procedure: Breast biopsy  19081, 19082, 19083, 19084, 19085, 19100 ,19101, 19110,
 19120, 19125, 19260
 Outpatient procedure: Breast reconstruction  19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350,
 19355, 19357, 19361, 19366, 19370, 19371, 19380, 19499
 Outpatient procedure: Carpal tunnel  64702, 64704, 64708, 64712, 64714, 64716, 64718, 64719,
 64721, 64722, 64726
 Outpatient procedure: Cataract  66982, 66983, 66984, 66985, 66986
 Outpatient procedure: Central venous catheter  36556, 36557, 36558, 36560, 36561, 36563, 36568, 36569,
 36571

 Outpatient procedure: Colonoscopy
 45300, 45305, 45308, 45309, 45320, 45330, 45331, 45332,
 45333, 45334, 45335, 45338, 45339, 45340, 45341, 45342,
 45346, 45349, 45370, 45378, 45379, 45380, 45381, 45382,
 45383, 45384, 45385, 45386, 45388, 45389, 45390, 45391,
 45392, 45398, G0104, G0105, G0120, G0121
 Outpatient procedure: Cystoscope lithotripsy   52320, 52325, 52327, 52330, 52332, 52341, 52344, 52345,
 52346, 52351, 52352, 52353, 52354, 52355, 52356
 Outpatient procedure: Gallbladder surgery  47562, 47563, 47564, 47579, 47600, 47605
 Outpatient procedure: Hernia repair  49451, 49452, 49465, 49491, 49492, 49495, 49496, 49500,
 49501, 49505, 49507, 49520, 49521, 49525, 49540, 49550,
 49553, 49557, 49560, 49561, 49565, 49566, 49568, 49570,
 49572, 49580, 49582, 49585, 49587, 49590, 49650, 49651,
 49652, 49653, 49654, 49655, 49656, 49657, 49659
 Outpatient procedure: Hysterectomy  58150, 58180, 58260, 58262, 58263, 58270, 58290, 58291,
 58292, 58294, 58541, 58542, 58543, 58544, 58545, 58546,
 58548, 58550, 58552, 58553, 58554, 58570, 58571, 58572,
 58573, 58578, 58579, 58660, 58661, 58662, 58670, 58671,
 58672, 58673, 58679
 Outpatient procedure: Hysteroscopy  58555, 58558, 58559, 58560, 58561, 58562, 58563
 Outpatient procedure: Knee arthroscopy  29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875,
 29876, 29877, 29879, 29880, 29882, 29883, 29884, 29886,
 29887, 29888, 29889, 29891, 29892, 29893
 Outpatient procedure: Skin lesion removal  11100, 11200, 11305, 11310, 11400, 11401, 11402, 11403,
 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426,
 11440, 11441, 11442, 11443, 11444, 11446, 11450, 11451,
 11462, 11470, 11600, 11601, 11602, 11603, 11604, 11606,
 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641,
 11642, 11643, 11644, 11646
 Outpatient procedure: Liver biopsy  47000
 Outpatient procedure: Mastectomy  19300, 19301, 19302, 19303, 19304, 19305, 19307
 Outpatient procedure: Nasal endoscopy  31231, 31237, 31238, 31239, 31240, 31254, 31255, 31256,
 31267, 31276, 31287, 31288
 
 Outpatient procedure: Nerve block
 64400, 64405, 64413, 64415, 64416, 64420, 64421, 64425,
 64430, 64445, 64447, 64448, 64449, 64450, 64479, 64480,
 64483, 64484, 64488, 64490, 64491, 64493, 64494, 64495,
 64505, 64510, 64520, 64530
 Outpatient procedure: Shoulder arthroscopy  29804, 29805, 29806, 29807, 29819, 29820, 29821, 29822,
 29823, 29824, 29825, 29826, 29827, 29828
 Outpatient procedure: Spinal injection  62267, 62268, 62269, 62270, 62272, 62273, 62281, 62282,
 62284, 62290, 62291, 62302, 62303, 62304, 62305, 62310,
 62311, 62318, 62319
 Outpatient procedure: Spinal laminectomy  63001, 63003, 63005, 63012, 63015, 63017, 63020, 63030,
 63035, 63040, 63042, 63045, 63046, 63047, 63048, 63050,
 63055, 63056, 63081, 63082, 63200
 Outpatient procedure: Subcutaneous incision and drain  10021, 10022, 10030, 10060, 10061, 10080, 10120, 10120,
 10121, 10140, 10160, 10180
 Outpatient procedure: Thyroidectomy  60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260,
 60270, 60271, 60280, 60281, 60300, 60500
 Outpatient procedure: Tonsillectomy  42800, 42804, 42806, 42808, 42810, 42820, 42821, 42825,
 42826, 42830, 42831, 42835, 42836, 42842, 42860, 42870
 Outpatient procedure: Tympanostomy  69420, 69421, 69424, 69433, 69436, 69440, 69450
 Outpatient procedure: Upper endoscopy  43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242,
 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251,
 43253, 43254, 43255, 43257, 43259
 Pregnancy: Ultrasound  76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816,
 76817, 76818, 76819, 76820, 76821, 76825, 76826, 76827,
 76828
 Pregnancy: Normal delivery without  complication  775
 Pregnancy: Normal delivery with complications  774
 Pregnancy: Cesarean section without complications  766
 Pregnancy: Cesarean section with complications  765
 Pregnancy: Newborn care without complications  795
 Pregnancy: Newborn care with complications  794
 X-ray: Abdomen  74000, 74010, 74020, 74022, 74220
 X-ray: Chest  71010, 71020, 71021, 71022, 71023, 71030, 71035, 71100,
 71101, 71110, 71111, 71120, 71130
 X-ray: Extremities  73000, 73010, 73020, 73030, 73040, 73050, 73060, 73070,
 73080, 73090, 73092, 73100, 73110, 73115, 73120, 73130,
 73140, 73510, 73520, 73525, 73540, 73550, 73560, 73562,
 73564, 73565, 73590, 73592, 73600, 73610, 73620, 73630,
 73650, 73660
 X-ray: Head and Neck  70020, 70030, 70100, 70110, 70140, 70150, 70160, 70200,
 70210, 70220, 70250, 70260, 70310, 70328, 70330, 70355,
 70360
 X-ray: Spine  72010, 72020, 72040, 72050, 72052, 72069, 72070, 72072,
 72074, 72080, 72090, 72100, 72110, 72114, 72120, 72170,
 72190, 72200, 72202, 72220


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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.