How Consumers Can Use This Data
By clicking on the drop down menu, you can find out how much Medicare pays local hospitals and outpatient procedure centers for 78 common outpatient treatments, services and procedures. Just pick the service you are interested in, and then select COUNTY and you will access the payment . You can select by hospital or by outpatient procedure center. If you do not receive a response, it may be that the data you are looking for is not available.
This information can be especially helpful if you are in a consumer-driven health plan with a health savings account, or if you are uninsured. Since you will likely pay out of pocket for the services listed here, it is important to get the best possible deal. While the Medicare payment will likely be lower than what commercial health plans pay, it provides a consistent benchmark and can help in any negotiations with healthcare providers over price. Your insurance plan may also have posted payment data on their own web site so you can check that as well. Make sure it is a payment, not a facility charge.
For example, John Smith needs an MRI for back pain and has a health savings account. Mr. Smith calls Provider X, tells them what he needs, that he will be paying out of pocket, and asks what it will cost. Mr. Smith notes that he has looked up the amount Medicare pays for an MRI in his county, and that’s what he wants to pay. So this now has become a negotiation and Mr. Smith is empowered with real and consistent payment information. It is similar to buying a new car, where the customer negotiates a payment with the car dealer.
Decisions about where to receive health care services should not be made solely on the basis of costs and charges. The quality reputation of the facility and its experience in treating patients for a particular procedure or providing a specific service should also be decisive factors in making the final selection of a facility.
User note: the payment amounts reported in this database reflect only the Medicare payment to the facility and DO NOT include professional fees (e.g., physician) and, possibly, other fees that may be associated with the procedure. (A more detailed version of this database can be found here.)