Sacramento Outpatient Surgery Cost Comparisons

We are constantly being told that increasing health insurance premiums are a result of ever increasing health care costs. Some people have expressed the notion that consumer directed health care plans will help lower premiums when patients can compare the cost of outpatient surgery procedures. This might be the case if consumers of health care could easily compare prices. Most often it is impossible to get a hospital to quote a price.

Sacramento outpatient surgery cost comparisons

In an effort to shed a little light on the range of outpatient surgery costs a health care consumer might have for a particular procedure, Anthem Blue Cross in association with WebMD created a cost comparison website. If you have a Preferred Provider Organization (PPO) insurance plan, the insurance company can’t dictate which surgery center or hospital you choose to perform the procedure. All they can do is provide you with information and encourage you to select a provider with a more competitive price. As a patient, you have more incentive to carefully consider the lower priced options if you have a high deductible plan.

Why are surgery centers lower in cost than hospitals?

As you can see, there are a range of prices for the same procedure. Surgery centers tend to have lower prices for the same procedure than the larger regional hospitals. Of course, part of the selection is dictated by the physician that is performing the procedure. I selected outpatient surgeries for comparison based on those that are most frequently performed and for which a comparison was available. The initial geographic radius was 20 miles around Sacramento. Only facilities that Anthem Blue Cross has contracts for their PPO plans showed up in the results. Absent from the results are Sutter and Kaiser facilities.

Comparisons as guide posts

These comparisons are best used as illustrations for the range of costs for a particular procedure and budgeting. Below are all the disclaimers and assumptions posted by Anthem Blue Cross and WebMD about the comparisons. Other insurance companies have similar programs but I don’t have access to them. Even these comparisons highlight the difficulty of making any solid cost comparison between facilities.

All the comparisons were generated on June 13, 2013. Prices may have increased or, most unlikely, decreased since that date.

Anthem Care Comparisons

Text that appears throughout the comparisons from Anthem Blue Cross and WebMD

Disclaimer: We make it convenient to find healthcare providers and facilities that match your particular situation. However, it is important to note that you may need services from a provider such as a radiologist, an anesthesiologist, a pathologist or a neonatologist. Although we make every effort to ensure that these providers are participating providers, not all facilities may require these providers be in our network.

Therefore, please insure your provider is in network prior to receiving care by checking your online provider directory, calling the Customer Service number on your ID card, or by contacting the provider. Should you need the services of an out of network provider, you may be subject to balance-billing (charges over and above your plan’s reimbursement) except where the law provides otherwise.

Legend

Typical High/Low cost: Most procedures involve a particular bundle of related services, tests and visits. Based on our members’ history, we’ve developed a standard bundle that’s typical for this procedure. Each price range includes the typical price for this procedure’s bundle of related services, including facility, physician and other services, like lab tests and x-rays, so you can see the total price of having a procedure done, not just the surgery itself. Whether your actual price falls within the range depends on which of these related services your doctor recommends or prescribes for your treatment, as well as your own condition.
* = No cost data available due to provider refusal
** = No cost data due to insufficient data
N/A = Information is not available
About this facility listing: This report is not an all-inclusive listing of participating providers. For a complete directory of participating providers, please check your online provider directory, call the customer service number on your ID card, or contact the provider directly.

Methodology

The cost information provided here is based on a methodology your health plan has applied to help predict typical costs for certain services provided related to certain procedures or diagnostics at different facilities. This methodology may be changed from time to time. Your actual cost for the procedure may be different and will depend on the actual services provided and may also vary based on other factors as well such as the complexity of the services rendered, your plan type and your health plan’s contractual arrangements with the providers who perform the services for you.

Your health plan has used claims information and PPO contracted facility cost rates to help develop the cost ranges displayed and this information will be updated from time to time and may result in variation of cost ranges reported on this site. The independently contracted provider networks change periodically and provider participation should be verified prior to receiving services. The information on this site is only applicable to the facilities listed. The information is not applicable for Medicare or Medicaid members, or otherwise where your health plan is not the primary payer.
Additional Information

Individual hospitals may disagree with the methodology used to define the cost ranges, the cost data, or quality measures. Many factors may influence cost or quality, including, but not limited to, the cost of uninsured and charity care, the type and severity of procedures, the case mix of a hospital, special services such as trauma centers, burn units, medical and other educational programs, research, transplant services, technology, payer mix, and other factors affecting individual hospitals.
California hospitals sharing additional information about cost of care estimation may be accessed by simply clicking on the following link.

WebMD disclaimer: This information is applicable to your health plan members only. The information is provided for informational purposes only and does not guarantee coverage in a particular amount. Your benefit coverage will be determined by all of the terms of your health plan, and will ultimately take into consideration factors such as actual services provided to you, your eligibility, deductibles, co-insurance amounts, any plan restrictions such as authorization or pre-certification requirements and any exclusions or limitations. Additionally, this website presents information relating to a broad number of providers who may or may not participate in the independently contracted network applicable to your particular plan. Please check the appropriate on-line provider directory to determine whether a particular provider participates in your network. You should consult with your own physician about your particular medical condition.

20 mile radius around Sacramento for cost comparisons

This report compares providers within 20 miles of Sacramento, CA . This is just one of several sources you should consult to select a service provider; always consult your physician about what decision is right for you. The cost comparison images pulled from the website aren’t always easy to read. At the end of the post are the same images that you can click on and enlarge to the largest size possible for easier viewing.

Eye Surgery – Cataract Removal

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Cataract removal with insertion of plastic lens
• Anesthesia
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Knee – Ligament Repair (Anterior Cruciate Ligament by Arthroscopy)

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Crutches, walker, implant, knee brace
• Anesthesia
• Arthroscopy (a tube with a light through which a joint can be seen and surgery performed) to repair or reconstruct knee ligaments
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

 

Knee Arthroscopy with Cartilage Repair

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Surgical removal or repair of the cartilage
• Arthroscopy (a tube with a light through which a joint can be seen and surgery performed)
• Crutches, walker, implant, knee orthrosis
• Anesthesia
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Groin – Hernia Repair 5 Years and Older

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Repair initial groin hernia, age 5 years or over
• Anesthesia
• Outpatient procedure price comparison is calculated based on the date the service was performed

Tonsillectomy and Adenoidectomy, over age 12

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Blood tests
• Anesthesia
• Removing the tonsils and adenoids through the mouth, in a child 12+ years old
• Tissue biopsy

Shoulder – Rotator Cuff Repair (using Arthroscopy)

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Arthroscopy (a tube with a light through which a joint can be seen and surgery performed)
• Injection, anesthetic agent
• Implant, shoulder brace
• Anesthesia
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Shoulder Arthroscopy

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Arthroscopy (a tube with a light through which a joint can be seen and surgery performed)
• Injection, anesthetic agent
• Implant, shoulder orthrosis
• Anesthesia
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Breast Lumpectomy

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Removal of breast lump
• Anesthesia
• x-ray exam (breast specimen)
• Special examination of tissue for signs of disease
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Hammertoe Correction

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Surgical correction of hammertoe
• Anesthesia
• Alignment of toe joints
• Release of foot contracture
• X-ray exam of foot
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Hand Surgery – Carpal Tunnel

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Surgery of median nerve at carpal tunnel in the wrist
• Anesthesia
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed

Back Surgery – Outpatient Laminectomy

Prices in the chart above are based on PPO contracted rates and include a bundle of related services that are generally a standard part of this procedure or treatment:
• Laminectomy with pressure relief off of nerve roots
• Anesthesia for procedures in lumbar region
• Microsurgical techniques with operating microscope and x-ray guidance
• X-ray of spine
• An examination of a tissue sample for signs of disease
• Remove calcium deposits from tissue
• Other – may include recovery room, drugs, and supplies, etc., administered during your outpatient procedure
• Outpatient procedure price comparison is calculated based on the date the service was performed