How To Find The Average Cost Of A Medical Service/Treatment In Your Area

Most health care providers, including doctors, hospitals, scanning and treatment facilities, have a series of price structures that apply to different types of patients. Uninsured patients generally pay the highest rate. Before you negotiate with a health care provider, find out what a fair price should be in your area (prices vary across the country). Following is a guide about how to find a fair price in your area:

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• If a service is involved:
  • Check on line for local prices. For instance:
    • Clear Health Costs
    • Fair Health Consumer
    • Health Care Bluebook
    • New Choice Health
    • NerdWallet.com has created a consumer-friendly tool to research hospital charges as well as the average Medicare payment. At www.nerdwallet.com/health/hospitals y ou can choose a hospital service and enter your location. The result will be the average charges for the service and the average Medicare payment in your location.
  • If one of the above does not include the service you need or used:
    • Ask your doctor for the CPT codes on procedures the doctor ordered for you. CPT codes are the numeric codes used by the American Medical Association to identify health services. Once you have the CPT code, use it to look up the Medicare reimbursement rate for the procedure in your area at  www.cms.hhs.gov/apps/pfslookup/step1.asp . 
    • Call other hospitals in your area to learn what they charge to patients in your situation. Also ask what is the lowest they charge for the service you received and who receives that charge. They may not tell you, but it can't hurt to ask.
    • Check companies that help with bill reviews such as Medical Billing Advocates of America
• If you received or used a product, find out what it cost the hospital. For example, if the hospital charges you $10 for a box of xyz, you may find from a local supplier or from a bit of research on line, that bulk purchasers of boxes of xyz only pay $.50 a box. Keep in mind that what a hospital charges for a service, and what the service costs, generally have little to do with each other. Much hospital pricing appears to be arbitrary or based on historical rather than current costs.

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