US Freedom Foundation

We Believe...
That restoring a true free market for health care in the United States will produce the best health care system in the world. Restoring that free market requires the financial re-empowerment of the American middle class. Every American should have access to affordable health insurance, regardless of their health status or income level. Individual Americans - not employers - should choose and own their health insurance plan. Every American should be free to choose their health care provider, hospital, and treatments. Americans should pay cash for their everyday health care needs, and insure only against medical costs in excess of their ability to pay cash. No patient who pays cash for health care or prescription drugs should be charged more than an insurance compnay would pay for the same service or drug. Every American should be able to fully enforce the terms of their health insurance contract in state court, including the ability to seek economic, non-economic, and punitive damages for breach of contract as allowed under their respective state laws.

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The 2003 USFF Fair Health Care Pricing Initiative

The U.S. Health Care Services Retail Price Guide Project
July 31, 2003
Retail Price Guide News Conference
Remarks by USFF President John Stone
The Uninsured, Self-pay patients and Health Care Pricing

In December, at the U.S. News and World Report Health Care Issues Briefing at the National Press Club, CMS Director Tom Scully said three competing forces create our health care market – hospitals, insurers, caregivers.

What happened to the patient?

As long as the final end-user of any product or service has no control over what they buy and how much they pay, there is no free market.

Nowhere is that more evident than with the estimated 85+ million Americans today who try to access health care without an insurance umbrella. They are the 75 million Americans who go uninsured at some point during a calendar year, and the 10 million and growing number of patients who participate in consumer-driven health care through flexible spending accounts, medical savings accounts, and health reimbursement arrangements.

When these families try to pay cash for their health care services, they are being charged between three-and seven times the going rate, while the largest managed care companies pay for the same service frequently at below cost. Those who can least afford to pay are being gouged, primarily on hospital and pharmaceutical prices, but also in a small but growing number of caregiver offices. And they’re being gouged to pay for the discounts for the largest corporations in America.

The American media is only beginning to grasp the magnitude of this problem. A Wall Street Journal article by Lucette Lagnado graphically demonstrates the devastating effect on these type prices on uninsured Americans. Similar articles in the Christian Science Monitor and other publications reveal the same across the country.

Consumer-driven health care is America’s best and brightest hope for restoring a free health care market. But we have a message today for Chairmen Thomas and Tauzin, Senators Frist and Grassley, and the President.

Unless this problem of pricing is corrected, consumer-driven health care will fail. We already have insurers telling physicians to charge MSA patients the full inflated retail price until the patient’s savings are exhausted, and only then revert to the standard rate, when the insurer starts paying the bill.

There is no free market in America today. Consumers have no idea of health care costs, and are prevented from learning by our corporate system. They know a reasonable price for nearly every other product or service in our economy, from oil changes to television sets, but on health care they face a mammoth information blackout.

Employer sponsored health care advocates constantly bash “irresponsible” consumers who unnecessarily access expensive health care procedures, while creating a system that bars all choices and information for consumers.

Amazing – a retail industry consuming 17% of our gross domestic product, and consumers have no idea of prices.

What is a fair price? The “usual and customary” amount received for the service. That’s what the majority of patients agree to pay when being admitted to the hospital, and that’s all they should pay.

So what is the “usual and customary” amount?

We’ve spent six months investigating the answer, to produce today’s price guide.
The figures contained in the Guide were obtained from:
1. Patient receipts for both cash and insurance-reimbursed purchases
2. Phone surveys of Washington-Baltimore area providers and pharmacies
3. Online price quotes from U.S. and Canadian pharmacies
4. Physician records and interviews nationwide
5. Reimbursement information supplied by unions
6. Federal and State records on reimbursements and costs
7. Hospital input nationwide
8. Insurer records nationwide

We will protect the confidentiality of all parties who voluntarily participated in the project.

There are reasons it hasn’t been done before.

1. For low-deductible insured patients, it doesn’t matter – that’s been the bulk of the market.

2. Health care pricing is terribly complicated, each treatment situation is different, and trying to apply averages to specific treatment programs is difficult.

3. Some consumers will try to re-price their bills without full knowledge of their treatments, and wrongfully accuse honest providers of overcharging.

4. Most consumers won’t understand the terminology.

5. Publication of health care prices will undermine quality.

These were all good reasons in the past – but times have changed.

100 Million Americans currently pay all or part of their own health costs.
75 million uninsured per year
10 million consumer-driven health plans
15 million hi-deductible policy holders

These Americans are being gouged on a regular basis, and they don’t have to take it as long as they have the knowledge to fight back. They currently have no access to even the most basic, broad information on pricing, which makes fighting back difficult if not impossible.

We offer the Guide as just that – a Guide, not to establish set prices.

What the Guide reflects is generally slightly higher than the lower managed care reimbursement averages, as insurers pay different discount rates. But they should reflect the usual overall range received for a particular service or treatment.

• Retail Price Example Sheet
• Straight Talk for Patients

If the price guide indicates your service should be $60, and it’s $85, you might not have a gripe. But if it’s $300, consumers will know to question it.

If the guide indicates a hospital bill of $3000, and you’re being asked to pay $5000, ask for an explanation, but don’t hit the ceiling. If the charge is $25,000, you know you have a problem.

Thank you, and now to the guide itself and your questions.

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Straight Talk for Patients on Health Care Pricing:

Using the U.S. Health Care Services Retail Price Guide

Health care pricing determination is the most convoluted, bureaucratic process in our national economy. For this reason, other organizations and government agencies have avoided any attempt to produce a basic retail health care price guide. The fear that consumers will look up one particular fee, discover their charge to be higher, and unjustifiably complain without understanding the entire bill, has resulted in consumers being left in the dark for decades.

In the past, this situation didn’t affect many people. Most Americans receive health care benefits through insurers, and only have to pay the co-insurance as their part of the bill, which in most cases was the same low set fee regardless of the cost of a procedure or service.

But this neglect of consumer access to pricing information has now created a health care market situation that demands access to at least broad, general rate information, and U.S. Freedom Foundation committed to producing this guide for public access. Up to 75 million Americans are uninsured at some point during a given calendar year. An additional 10 million Americans are now paying cash for most everyday health services due to higher deductible insurance policies – and this group is growing rapidly as more families choose consumer-driven health insurance plans to escape shoddy HMO’s.

Both groups lack access to a negotiated rate from an insurer, and are frequently charged three-to-seven times the rates paid by insurers. Those who must pay these bills are losing homes to foreclosure, having their wages garnished, and are forced into bankruptcy through this price-gouging scheme.

If they are charged $14,000 for an appendectomy, how do they know if that’s a fair price?

When they were admitted to the hospital, they agreed to pay the “reasonable and customary” charges, with no idea of what their final bill would be. If a major car repair was performed under these rules, every consumer activist in the country would be screaming, and trial attorneys would be falling over each to take the case to court. Yet this is precisely what is happening in American health care today, and the injured consumer has had no place to turn for basic pricing information to determine whether their bill is out-of-line.

According to the Wall Street Journal, a major managed care insurer would only pay about $2500 for that appendectomy in New York City. Medicaid would pay around $5000. So what is the “usual and customary” charge?

According to the U.S. Health Care Services Retail Price Guide, the national average price received for an appendectomy is around $772 a day. The average patient stays in the hospital 3.3 days. So a total average bill – at the “usual and customary” charge – comes to $2550.

Now here’s where caution is advised before calling for an attorney. Fair prices are higher in New York City and other major metropolitan areas than in rural and suburban markets. Prices are generally higher in the Northeast than the South or Midwest. The initial listings in the Price Guide are for NATIONAL AVERAGE prices only. If you have an appendectomy in Manhattan, expect to pay more. If you have an appendectomy in Tupelo, Mississippi, expect to pay less. If your bill comes to $2500 anywhere, you’re likely being treated fairly. If it’s $4,000, ask for an explanation of charges before hitting the roof.

But if the bill is $14,000, and you had no medical problems other than the appendectomy, demand a massive reduction. If you don’t receive one, seek arbitration or an attorney.

All hospitalization charges in the Price Guide are listed as per-day charges, to make it easier to determine the “usual and customary” fee regardless of the length of your stay. However, be aware that while your total bill will be less if your time in the hospital is shorter than normal for your procedure, the per day charges will likely be higher, as the most expensive portion of treatment is usually undertaken up front, such as emergency room admittance, operating room fees, and intensive care following surgery.

Another major caution – there are a small number of caregivers and hospitals who accept nothing other than cash payments. They do not participate in insurance plans, Medicare, or Medicaid. Their prices are the same for everyone, so whatever they charge IS their usual and customary fee. It may be more or less than the Price Guide – they can charge whatever they like and it is still fair pricing, as all of their patients are billed the same. It is therefore imperative that you, the consumer, ask about their rates before seeking treatment. The caregiver or hospital may be worth every penny of their charges – but you need to know what those charges are before you’re in front of the cash register after receiving treatment.

We hope this Price Guide will be useful to patients, caregivers, researchers, government entities, consumer activists, and legal counsels.

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U.S. Health Care Services Retail Price Guide

July 31, 2003

U.S. Health Care Services Retail Price Guide

U. S. Freedom Foundation Health Care Pricing Research Project, January – July, 2003: Prices reported by caregivers, institutions, patients; major managed care reimbursement rates; federal and state public access health care statistics and records; retail rate quotes by all providers.

National Average Prices*

*Pricing varies significantly by region and city

Hospital Service Usual and Customary Daily Charge

HEART FAILURE & SHOCK

$1,029

APPENDECTOMY W COMPLICATED PRINCIPAL DIAGNOSIS

$772

VAGINAL DELIVERY OF INFANT W COMPLICATED DIAGNOSIS

$942

SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC

$925

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

$905

MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY

$2,177

OTHER PERMANENT CARDIAC PACEMAKER IMPLANT

$3,739

SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA

$1,073

PSYCHOSES

$601

REHABILITATION

$691

ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC

$902

NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC

$905

CHEST PAIN

$1,157

G.I. HEMORRHAGE W CC

$152

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC

$1,057

KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC

$853

SEPTICEMIA AGE >17

$1,193

CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE

$1,343

RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC

$1,090

ATHEROSCLEROSIS W CC

$1,096

TRANSIENT ISCHEMIC ATTACK & PRECEREBRAL OCCLUSIONS

$1,019

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG

$1,734

MAJOR SMALL & LARGE BOWEL PROCEDURES W CC

$1,737

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC

$1,405

RENAL FAILURE

$1,210

OTHER VASCULAR PROCEDURES W CC

$1,956

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT

$2,079

SYNCOPE & COLLAPSE W CC

$1,014

RED BLOOD CELL DISORDERS AGE >17

$990

DIABETES AGE >35

$886

MEDICAL BACK PROBLEMS

$757

CELLULITIS AGE >17 W CC

$764

EXTRACRANIAL VASCULAR PROCEDURES

$2,456

ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC

$859

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG

$1,911

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC

$899

OTHER CIRCULATORY SYSTEM DIAGNOSES W CC

$1,251

PERIPHERAL VASCULAR DISORDERS W CC

$910

G.I. OBSTRUCTION W CC

$917

CORONARY BYPASS W CARDIAC CATH

$3,038

CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE

$1,400

OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC

$1,128

DEGENERATIVE NERVOUS SYSTEM DISORDERS

$768

ANGINA PECTORIS

$936

RESPIRATORY NEOPLASMS

$1,113

ORGANIC DISTURBANCES & MENTAL RETARDATION

$682

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

$1,816

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

$1,159

CORONARY BYPASS W/O CARDIAC CATH

$3,128

PULMONARY EDEMA & RESPIRATORY FAILURE

$1,155

LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC

$1,636

SEIZURE & HEADACHE AGE >17 W CC

$1,147

BRONCHITIS & ASTHMA AGE >17 W CC

$808

MAJOR CARDIOVASCULAR PROCEDURES W CC

$2,907

SYNCOPE & COLLAPSE W/O CC

$997

BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC

$1,893

OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC

$1,068

PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY

$851

NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC

$699

SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC

$733

TRACHEOSTOMY EXCEPT FOR FACE,MOUTH & NECK DIAGNOSES

$2,715

FRACTURES OF HIP & PELVIS

$719

AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE

$1,285

CIRCULATORY DISORDERS W AMI, EXPIRED

$1,926

OTHER RESP SYSTEM O.R. PROCEDURES W CC

$1,564

MAJOR CHEST PROCEDURES

$1,953

O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES

$1,668

HYPERTENSION

$850

CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W CARDIAC CATH

$4,326

DYSEQUILIBRIUM

$853

TRANSURETHRAL PROSTATECTOMY W CC

$1,309

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

$1,569

CRANIOTOMY AGE >17 EXCEPT FOR TRAUMA

$2,351

PULMONARY EMBOLISM

$1,089

G.I. HEMORRHAGE W/O CC

$843

BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC

$1,734

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC

$1,300

LYMPHOMA & NON-ACUTE LEUKEMIA W CC

$1,401

CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS

$1,561

DISORDERS OF THE BILIARY TRACT W CC

$1,150

CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W/O CARDIAC CATH

$3,999

CELLULITIS AGE >17 W/O CC

$583

UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC

$1,484

POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC

$1,207

DIGESTIVE MALIGNANCY W CC

$1,153

LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC

$1,953

OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES

$1,889

KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC

$688

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS

$1,167

TRANSURETHRAL PROSTATECTOMY W/O CC

$1,286

STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC

$2,059

BRONCHITIS & ASTHMA AGE >17 W/O CC

$733

CRANIAL & PERIPHERAL NERVE DISORDERS W CC

$953

PERIPHERAL VASCULAR DISORDERS W/O CC

$884

SEIZURE & HEADACHE AGE >17 W/O CC

$951

SPINAL FUSION EXCEPT CERVICAL W CC

$2,818

G.I. OBSTRUCTION W/O CC

$689

SIGNS & SYMPTOMS W CC

$837

CIRRHOSIS & ALCOHOLIC HEPATITIS

$1,232

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

$1,587

SPINAL FUSION EXCEPT CERVICAL W/O CC

$3,039

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

$1,331

COMPLICATIONS OF TREATMENT W CC

$1,231

TRANSURETHRAL PROCEDURES W CC

$1,393

SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC

$1,026

DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC

$1,167

OTHER VASCULAR PROCEDURES W/O CC

$2,308

POSTOPERATIVE & POST-TRAUMATIC INFECTIONS

$992

LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC

$1,507

OTHER DISORDERS OF NERVOUS SYSTEM W CC

$1,127

RESPIRATORY SIGNS & SYMPTOMS W CC

$1,098

PLEURAL EFFUSION W CC

$1,076

OTHER RESPIRATORY SYSTEM DIAGNOSES W CC

$1,014

KIDNEY,URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM

$1,865

FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0-17

$782

LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC

$1,551

ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION

$821

UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC

$1,498

SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE

$810

PERITONEAL ADHESIOLYSIS W CC

$1,516

SKIN ULCERS

$764

MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC

$1,267

URINARY STONES W CC, &/OR ESW LITHOTRIPSY

$1,204

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC

$1,584

NERVOUS SYSTEM NEOPLASMS W CC

$1,086

COAGULATION DISORDERS

$1,610

DEPRESSIVE NEUROSES

$613

ENDOCRINE DISORDERS W CC

$994

RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC

$1,290

TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC

$789

WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS

$194

HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC

$1,420

TOTAL MASTECTOMY FOR MALIGNANCY W/O CC

$1,791

TOTAL MASTECTOMY FOR MALIGNANCY W CC

$1,630

OTHER O.R. PROCEDURES FOR INJURIES W CC

$1,793

FEVER OF UNKNOWN ORIGIN AGE >17 W CC

$1,020

VAGINA, CERVIX & VULVA PROCEDURES

$1,550

PRM CARD PACEM IMPL W AMI,HRT FAIL OR SHK,OR AICD LEAD OR GNRTR PROC

$2,531

COMPLICATED PEPTIC ULCER

$1,129

BONE DISEASES & SPECIFIC ARTHROPATHIES W CC

$802

INTERSTITIAL LUNG DISEASE W CC

$1,021

PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC

$1,639

HIV W MAJOR RELATED CONDITION

$1,630

MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC

$1,603

MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY

$2,512

OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC

$911

AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE

$1,021

TENDONITIS, MYOSITIS & BURSITIS

$834

PNEUMOTHORAX W CC

$964

MAJOR MALE PELVIC PROCEDURES W/O CC

$1,788

INFLAMMATORY BOWEL DISEASE

$959

LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP & FEMUR

$1,601

SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC

$1,852

TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC

$1,247

BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY

$3,192

HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC

$1,349

KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC

$1,791

CONNECTIVE TISSUE DISORDERS W CC

$1,163

NONTRAUMATIC STUPOR & COMA

$997

NONSPECIFIC CEREBROVASCULAR DISORDERS W CC

$1,052

INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC

$1,390

FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W/O CC

$584

OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC

$1,638

RECTAL RESECTION W CC

$1,584

DISORDERS OF THE BILIARY TRACT W/O CC

$1,072

MAJOR MALE PELVIC PROCEDURES W CC

$1,711

AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS

$1,216

THYROID PROCEDURES

$2,160

PANCREAS, LIVER & SHUNT PROCEDURES W CC

$2,329

UNCOMPLICATED PEPTIC ULCER W CC

$1,005

MAJOR CARDIOVASCULAR PROCEDURES W/O CC

$2,904

VIRAL ILLNESS AGE >17

$888

OTHER SKIN, SUBCUT TISS & BREAST PROC W CC

$1,235

ATHEROSCLEROSIS W/O CC

$1,125

O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES

$1,028

KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC

$884

RESPIRATORY SIGNS & SYMPTOMS W/O CC

$1,130

UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS

$1,117

OTITIS MEDIA & URI AGE >17 W CC

$859

CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC

$992

OSTEOMYELITIS

$897

KIDNEY TRANSPLANT

$2,923

ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17

$2,086

TRANSURETHRAL PROCEDURES W/O CC

$1,546

RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC

$859

DEEP VEIN THROMBOPHLEBITIS

$667

ANAL & STOMAL PROCEDURES W CC

$1,237

CARDIAC PACEMAKER DEVICE REPLACEMENT

$2,851

TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC

$693

EPISTAXIS

$868

OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC

$1,157

POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC

$930

UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC

$1,624

CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC

$1,141

URINARY STONES W/O CC

$944

MINOR BLADDER PROCEDURES W CC

$1,567

SIGNS & SYMPTOMS W/O CC

$703

OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES

$1,314

STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC

$1,802

INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC

$1,385

Caregiver Services Usual and Customary Charge

Family/General practice office visit, new patient $87

Family/General practice office visit, established patient 50

Longer physician office visit, established patient 56

Flu shot 8

Remove impacted ear wax 65

Wart, mole, skin lesion removal 16

Biopsy of skin lesion 87

Chest X-ray 12

Foot X-ray 25

Hip X-ray 25

3D Heart Image 342

Mammogram 44

Mammogram, both breasts 66

PSA Assay 29

Urinalysis 5

Potassium Assay 4

Iron Assay 10

Allergy Skin test 5

Upper GI endoscopy, biopsy 213

Diagnostic colonoscopy 308

Cardiovascular stress test 130

IV infusion, 1 hour 50

Chemotherapy infusion 70

Initial Hospital Exam 131

Emergency room exam 72

Critical Care, 1^st hour 242

Contract Surgery Fee 802

Eye exam, new patient 95

Eye exam, established patient 68

Psychological therapy, office visit, 45 min 123

Psychological therapy, hospital visit, 30 min 72

Psychological therapy, group session 35

CT Brain/Head w/o dye 62

Chiropractic manipulation 40

Prescription Drug Average Prices

Drug U.S. Retail U.S. Managed Care Rate Canadian Internet Retail

Lipitor $118.66 71.93 56.66

Celebrex 100.99 82.00 21.60

Fosamax 230.00 114.00 50.00

Prozac 124.00 28.50 43.33

Prilosec 148.91 92.04 54.00

Aciphex 131.99 72.60 75.00

Accupril 36.33 21.07 24.66

Norvasc 128.00 64.00 57.00

Pepcid 72.00 22.00 40.00

Prevacid 135.00 73.00 68.00

Pravachol 131.00 79.90 65.33

Plavix 114.00 69.50 71.07

Vioxx 95.00 51.30 37.50

Zestril 34.70 19.00 28.80

Zocor 129.70 70.00 70.00

Zoloft 83.00 44.82 48.00

-end-

Health Care Price Guide Pricing Examples

Pricing Examples

U.S. Health Care Services Retail Price Guide Examples

Appendectomy, 3 day hospital stay

Typical Hospital Charge $12,500

Usual Managed Care Payment $2500

Usual Medicare Payment $2217

Price Guide National Average Payment $2550

Heart Failure and Shock, 5 day stay

Typical Hospital Charge $24,875

Usual Medicare Payment $4475

Usual Managed Care Payment $4975

Price Guide National Average Payment $5145

Existing Patient Family Practice Visit

Typical Retail $100

Usual Medicare Payment $48

Usual Managed Care Payment $44

Price Guide National Average Payment $50

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