(Updated 2022) We have two main sources of information.
First, since 2011, we have conducted and refined a survey of providers’ cash or self-pay prices — what you would pay without insurance — for about 30-35 common, “shoppable” procedures in certain cities. Why? To show the range of pricing for simple medical items, which can more or less be compared — as apples to apples. If you see that an MRI can cost $300 one place and $6,000 another place, you’ll be better informed about the health care system, and better able to make money decisions relating to health care.
Second, since the new federal law on price transparency for hospitals came into effect, we have been collecting and sorting the data they put online in big price lists, and making those price lists searchable. More information about both sources can be found below.
Third, crowdsourced data from our community members.
Fourth, data supplied by health care providers themselves.
Our survey data
In our survey, we call doctors, hospitals, labs and clinics to ask prices for those procedures, including:
Imaging: MRI of the lower back without contrast; MRI of the lower back without and with contrast; MRI of the upper back without contrast; MRI of the upper back without and with contrast; pelvic ultrasound; abdominal ultrasound; screening or preventive mammogram.
Women’s health: Well-woman exam; Pap smear; sexually transmitted disease test; urinary tract infection test; IUD insertion; abortion; Depo-Provera birth control; screening or preventive mammogram.
Men’s health: Sexually transmitted disease test; vasectomy (traditional and non-scalpel).
Blood tests: Comprehensive blood count (CBC) blood test with differential; comprehensive metabolic panel (CMP); thyroid stimulating hormone (TSH); cholesterol (lipids) blood test.
Dental: Basic dental exam; teeth filling; teeth cleaning; teeth whitening.
Other: Walk-in clinic visit; basic eye exam; colonoscopy; cardio stress test; echocardiogram with Doppler; sleep study (polysomnogram; split-night sleep study; multiple sleep latency test).
Cosmetic or discretionary: Lasik, Botox, teeth whitening.
We chose this list because these are fairly common procedures, in which you have some discretion (where do I want to go?) and are fairly comparable (an MRI is, pretty much, an MRI).
You will also find other prices here, shared by community members; our prices are flagged in orange, community members’ in blue, and those from providers are in green.
Our journalists collect prices by phone, using a several-step process designed and then refined to find accredited providers across a range of facilities: hospital, self-standing radiology center, individual physician, clinics, chains and the like, in various locales (city locations, different neighborhoods, suburban towns, etc.).
We identify ourselves as being from a new independent consumer health-care research organization, and asking for a cash or self-pay price for these procedures. We invite detail about discounts, mandatory consultation or referral visits, and other things we might want to know.
Color coding of our data
Our data is color-coded. The data input by our reporters is in orange, carrying a flag reading “PriceCheck journalist.”
If it’s from an online pricing database, that information will be displayed in the “notes” field.
Anything supplied from our community — the “crowdsourced data” — is in blue, with a flag reading “community member.”
Anything directly from a provider — that is, not collected by our journalists in our survey or our data work, but sent directly by a provider — is in green, with a flag reading “health care provider.”
Medicare pricing is also included
Our software also displays the price Medicare pays for any procedure in any part of the United States. This price is important because it’s the closest thing to a fixed or benchmark price in the marketplace.
We taught the software to make this calculation based on the formula the government uses, deriving the final figure by using the tables of Professional Practice Relative Value Unit (PPRVU) downloaded from the site of the Centers for Medicare and Medicaid Services, as well as their zip code files by which CMS divides the country by localities.
The federal pricing transparency mandate for hospitals
When the federal government mandated pricing transparency for hospitals, we immediately began to assess hospitals’ performance in making data transparent. Unfortunately, their performance is spotty indeed.
We have collected data posted by hospitals under the federal ruling requiring them to post cash or self-pay prices for their procedures. Read about the federal transparency law, about spotty compliance by hospitals, and about our recent data collection experiences.
Generally, few hospitals have actually complied completely with the federal ruling. It seems from the reporting we’ve seen nationally that New York is better than some locales in price transparency compliance.
There have been reports that only 14.3 percent of hospitals are in compliance – we found in New York it’s somewhat better – but the data is hard to find on hospitals’ sites. It often comes in massive files that are hard for average civilians to process (we have data help to do that) and the actual processing requires a high level of understanding of what is going on in the health care system.
Some hospitals left compliance with a gesture — only their charged prices, no discounted cash price, no common coding system — and directed people to their existing cost estimator tools as a way of seeming to comply.
What we were able to find in the New York area, we collected and put it into our database to make it accessible.
Our phone SURVEY data collection methods
In our phone survey, we seek to use a HCPCS (Healthcare Common Procedure Coding System) number when valid. The HCPCS system uses a number of five-digit Common Procedural Terminology coding system numbers, and also a set of alphanumeric codes. Here’s an explanation of the codes, which govern many parts of the billing system for health care.
(Our Medicare pricing is also figured on HCPCS coding.)
We do not seek to be exhaustive or comprehensive — that is, we don’t collect prices from every single provider in a given region. Rather, we work to be representative.
We collect prices only from accredited facilities; in places where there is no accreditation, we use our journalism skills to determine if a provider is responsible. For example, in one city, we once surveyed a place that had an inexpensive STD test, but when we looked at their website, and then talked to them, they said they were a church, and they use inexpensive STD testing as part of their ministry to expand their congregation. We did not include them.
We also use other standardized data-collection methods.
Many places we contacted had a cash or self-pay price easily available that they were able to quote. Those prices we have listed here. Some respondents said they had some provision for need, a sliding scale for example, or “only for qualified patients.” We’ve used that detail in the “notes.”
If they cannot tell us a price, we list it as $0 (our database structure requires a number) and add in the notes: “No prices over the phone” or “Prices over the phone for patients only.”
When a provider has several locations, we usually do not list every location, but instead flag in the “notes” field by saying “Check website for locations.” Some providers with multiple locations use the same price at every location; some providers have different prices for the same procedure at different locations. Yes, it’s confusing.
We have also learned that the wave of mergers and acquisitions sweeping health care means that provider lists are frequently out of date. Even lists of accredited organizations from, say, the American College of Radiology are frequently out of date.
Providers go out of business, and new ones take their place. When hospitals acquire practices, the pricetag tends to go up (here’s a New York Times article about that). Our surveys reflect the best information we are able to get at the time, but the landscape is changing by the second.
None of these prices are guaranteed prices. We collect them in the manner described, but in every case an individual should ask the price: “What will that cost? What will that cost me?” Take notes. Take names. Take numbers.
You can:
- Pick the place(s) you want to go.
- Call the provider or providers.
- Confirm the price — get it in writing, or at least get a name (“Susie at 914-123-4567 said $250 on Sept. 1 at 2:30 pm.”).
- Schedule a procedure without worrying about a big “gotcha” bill later.
Read our terms and conditions first to be sure you’re right: In this case, these are not guaranteed prices, and you’ll need to do a little bit of work in advance.
Surveying the hospitals
In our survey — separate from the data collection approach under the federal transparency law mentioned above — we also approach hospitals directly for a number of prices. Hospitals are generally very hard to contact for pricing information: We get transferred around a lot, put on hold, sent to voicemail and the like.
In some cases, the people we spoke with asked us, for example, to send a spreadsheet of the procedures for which we were seeking prices, and then responded with some variation of “My boss says we will not participate.” In such cases, we recorded that as “no prices over the phone” or “prices over the phone for patients only,” depending on the response.
In some cases, after the federal transparency law came into effect, they sent us to the pricing page (which in some cases was not compliant, and in some cases was).
In some cases, the hospitals’ central pricing office declined to give prices over the phone, while a clinic location of the same hospital (urology or cardiology) was happy to give us prices. Cleveland Clinic Cardiology in Florida, for example, gave us prices, but the central office in Ohio said “no prices over the phone.”
When we were unable to establish contact with anyone for a definitive answer, or if their data displayed under the transparency law seemed flawed, we left them out of the database.
One hospital gave us several prices over the phone, and then when I called back and asked for a few more, my contact asked me to send a spreadsheet. Then she emailed me back saying her boss said they would be unable to participate. According to our experience, it depends who you talk to: One person might give a price, while another in the same office might refuse.
One big hospital chain, Hospital Corporation of America, has price estimates on its websites for individual hospitals. The central pricing office at HCA in Florida also gave us prices for most of the hospital-based procedures we survey on. They did say the notes field should read: “Estimate only; facility will call to give final price after scheduling. Pricing line: 800-617-7044.”
(There are 32 HCA hospitals in the Miami and Tampa-St. Petersburg areas, and we decided to list data not from all but rather from eight on each coast, based on location, for geographic diversity; size; and other factors like reputation.)
We identified ourselves as researchers
In our survey, when we find people who misunderstand and think that we are patients, not journalist-researchers, we seek to dispel that misunderstanding to insure that our methods were uniform.
When I first started doing this kind of phone survey, I called a number of providers in the New York City area in the fall of 2010 while I was researching this business concept, and misrepresented myself by telling them that I was a patient and had not met my deductible, and needed a test (in this case, a colonoscopy) and asked what it would cost if I was paying out of my own pocket (see blog post). This is not our policy now.
It’s worth noting, though, that when I asked this question in this fashion, as a patient, I found extraordinary support and good will: When respondents thought I was paying out of pocket, they uniformly and completely were sympathetic and helpful — up to and including the very nice Manhattan receptionist who added up the numbers and said that this procedure at her doctor’s rates would be well over $3,000, and that I should not go to him, but should rather shop around on the Internet for a better price.
How do I tell what’s crowdsourced?
In this software, prices collected by our journalists are displayed under an orange panel, the base color of the software, with a flag to the top right saying “PriceCheck journalist.”
Prices shared by our community members are in aqua blue, with a flag saying “Community member.”
When providers come to us directly and ask to put their prices in our database, those prices are in green, with a flag saying “Health care provider.”
Clearhealthcosts.com has already partnered with public radio stations in San Francisco, Los Angeles, New York City, the Delaware Valley (Philadelphia), Miami and Tampa-St. Petersburg on similar efforts. Click the links for examples; our news coverage can be seen here, here, here and here.
Want your prices in our database?
Here’s how to do it:
- Enter prices on our form on the page.
- Contribute a lot of prices: Download or send your administrator this spreadsheet Download (XLS, 33KB).
Do you have questions about prices listed here? Let us know. Email us at: info (at) clearhealthcosts (dot) com.
Anything else you want to say? Reach us at info (at) clearhealthcosts (dot) com.
