UNDERSTANDING THE DATA
Below you will find information to help you understand the data presented on this site.
Procedure Costs
General InformationInterpreting 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 2016 are the most recent available and are displayed on this website.
Due to the U.S. Supreme Court’s March 2016 ruling in Gobeille v. Liberty Mutual Insurance Company, the Oregon Health Authority may no longer require self-insured Employment Retirement Income Security Act (ERISA) covered health plans to submit claims. It is estimated that Oregon's All Payer All Claims (APAC) database has over 300,000 fewer covered lives reported from the commercial market since the Gobeille decision. As a result, the number of procedures reported has decreased, which in turn affects whether data can be reported.
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.
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.
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.
Back to top of pageWhat’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. |
|
Facilities | Oregon acute care hospitals |
|
Outpatient procedure codes | Codes for the 100 most common outpatient procedures |
|
Inpatient procedure codes |
Codes for the 50 most common inpatient procedures |
|
Insurance types | Most commercial insurers |
|
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:
- Hospitals differ in their approach to prices based on their unique circumstances. Some hospitals try to spread the cost of all services and equipment among all patients. Others base their prices on the cost of providing that specific service. Some hospitals may provide certain services at a loss while other operations subsidize those losses. Any of these situations can result in different prices among hospitals for a given type of service.
- Intensity of care – Some hospitals, such as trauma centers, are equipped to care for more severely ill patients than others. Patients within the same diagnosis or procedure category may need very different levels of service and staff attention, causing variation in prices.
- Range of services provided – A hospital that provides vital, highly specialized services, such as emergency room care or trauma and burn units, has a different pricing structure than one that does not.
- Physical location – The economic makeup of a community has an influence on hospital prices. Hospitals care for all patients, but depending on their location, their “mix” of patients may vary. For example, some hospitals may be located in the middle of a business district with a high percentage of people who have commercial insurance. Another hospital may be located in a remote area where most residents are Medicare and Medicaid beneficiaries, and may have to set their prices higher than another hospital because they have fewer commercial patients that can pay the higher discounted rate.
- Service frequency – The price of services is generally higher if the type of hospitalization doesn’t occur very often at the hospital. One single case with unusually high or low prices can greatly affect the average cost if the hospital reported only a few cases in a given time period.
- Staffing costs – Salary scales may differ by region. Shortages of nurses and other medical personnel may affect different regions differently. Where shortages are more severe, staffing costs, and, therefore prices, may be higher.
- New technology – The equipment hospitals use to provide services differs in age, sophistication and frequency of use. Hospitals with the latest technology may have higher prices than those with older, less sophisticated equipment.
- Disaster preparedness – Hospitals are complex organizations that have to be prepared to respond to any emergency, 24 hours a day, 7 days a week. This means having well-trained and experienced staff ready to work at all times. It also means having the technology, building, safety equipment and utilities to respond to any disaster.
- Capital expenses - Hospitals differ in the amount of debt and depreciation they must cover in their financial structure. A hospital with a lot of debt may have higher prices than a hospital not facing such expenses. Furthermore, hospitals may choose to lease or purchase equipment or hospitals. The choices made about financing of capital projects may affect prices in different ways.
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-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 | 302(7)3H, 302(7)3J, 302(7)3K, 302(7)3L,
302(7)3M, 302(7)3N, 302(7)3P, 302(7)3Q, 302(7)3R, 302(7)3S, 302(7)3T, 302(7)3W, 302(7)3V |
|
Inpatient procedure: Chemotherapy | 3E0**0, XW0**5 | |
Inpatient procedure: Hemodialysis | 5A1D | |
Inpatient procedure: Abdominal drainage | 0D96, 0D97, 0D98, 0D99, 0D9A, 0D9B,
0D9C, 0D9E, 0D9F, 0D9G, 0D9H |
|
Inpatient procedure: Appendectomy | 0DBJ**(X), 0DTJ | |
Inpatient procedure: Bowel removal | 0DT9, 0DTA, 0DTB, 0DTE, 0DTF,
0DTG, 0DTK, 0DTL, 0DTM, 0DTN, 0DB9**(X), 0DBA**(X), 0DBB**(X), 0DBE**(X), 0DBF**(X), 0DBG**(X), 0DBK**(X), 0DBL**(X), 0DBM**(X), 0DBN**(X) |
|
Inpatient procedure: Colonoscopy | 0DBE8ZX, 0DBF8ZX, 0DBG8ZX,
0DBH8ZX, 0DBK8ZX, 0DBL8ZX, 0DBM8ZX, 0DBN8ZX, 0DJD8 |
|
Inpatient procedure: Coronary bypass | 0210, 0211, 0212, 0213 | |
Inpatient procedure: Disc excision | 0SB2, 0SB4, 0RB3, 0RB5, 0RB9, 0RBB | |
Inpatient procedure: Gallbladder surgery | 0FB4**(X), 0FT4 | |
Inpatient procedure: Heart catheterization | 4A023N | |
Inpatient procedure: Heart valve replacement | 02RF, 02RG 02RH | |
Inpatient procedure: Hernia repair | 0DQS, 0DQT, 0WMF, 0WQF**(2),
0WUF, 0YQ5(X), 0YQ6(X), 0YQ7(X), 0YQ8(X), 0YQA(X), 0YQE(X), 0YU5, 0YU6, 0YU7, 0YU8, 0YUA, 0YUE, 0BQR, 0BQS, 0BUR, 0BUS |
|
Inpatient procedure: Hip replacement | 0SR9, 0SRB, 0SRA, 0SRE, 0SRR, 0SRS | |
Inpatient procedure: Hysterectomy |
04LE**T, 04LF**U, 0UB0**(X),
0UB1**(X), 0UB2**(X), 0UB9**(X), 0UT0, 0UT1, 0UT2, 0UT9 |
|
Inpatient procedure: Kidney removal | 0TB0, 0TB1, 0TT0, 0TT1, 0TT2 | |
Inpatient procedure: Knee replacement | 0SRC, 0SRD, 0SRT, 0SRU, 0SRV, 0SRW | |
Inpatient procedure: Open fixation | 0PS*04, 0PS*06, 0NS*04, 0QS*04, 0QS*06 | |
Inpatient procedure: PTCA | 0270(0), 0271(0), 0272(0), 0273(0) | |
Inpatient procedure: Shoulder replacement | 0RRJ, 0RRK | |
Inpatient procedure: Skin incision and drainage | 0J9*3, 0JH*3W, 0JH*3X, 0W903,
0W923, 0W933, 0W943, 0W953, 0W963, 0W9K3, 0W9L3, 0W9M3, 0W9N3, 0X9*3, 0Y9*3 |
|
Inpatient procedure: Spinal decompression | 00BT, 00BW, 00BX, 00BY, 00C3,
00CT, 00CW, 00CX, 00CY, 00JU0, 00JV0, 00NT, 00NW, 00NX, 00NY, 0RB0, 0RB1, 0RB4, 0RB6, 0RBA, 0RC0, 0RC1 0RC4, 0RC6, 0RCA, 0RJ00, 0RJ10, 0RJ40, 0RJ60, RJA0, 0RN0, 0RN1, 0RN4, 0RN6, 0RNA, 0SB0, 0SB3, 0SB5, 0SB6, 0SB7, 0SB8, 0SC0, 0SC3, 0SC5, 0SC6, 0SC7, 0SC8, 0SJ00, 0SJ30, 0SJ50, 0SJ60, 0SJ70, 0SJ80, 0SN0, 0SN3, 0SN5, 0SN6, 0SN7, 0SN8 |
|
Inpatient procedure: Spinal fusion | 0RG0, 0RG1, 0RG2, 0RG4, 0RG6, 0RG7, 0RG8, 0RGA, 0SG0
0SG1, 0SG3, 0SG5, 0SG6, 0SG7, 0SG8 |
|
Inpatient procedure: Spinal tap | 009U3, 009U4 | |
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 |
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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.