How medical service prices are calculated

The hospital, or outpatient center the “Typical price of this service at this location” is the median price – this is the “patient-in-the-middle price”. For half of the patients the price was higher and for the other half the price was lower than this median price. And, the “Typical low and high prices” are reported using the 25th percentile and 75th percentile amounts paid at that facility.

The price is the total amount paid to the facility for the service:  a combination of payments by the insurer and the patient.

Hospital and outpatient center prices are calculated by combining records for patients who got a particular treatment or service at that facility. The price includes fees paid to the facility, the doctor and any other health professionals. The prices are computed using claims records for people with commercial health insurance who got care during the current year. The claims are supplied by insurers that provide health insurance coverage in the state and cover about 2 million people many of whom buy insurance through their job.

The prices for office visits and other care that is usually done in a doctor’s office are reported by county. The amounts paid for all of the patients who got that service in the county are combined to calculate the median and the low and high prices. The county is selected using the ZIP code you entered. In some instances, there are too few patients in the WA-APCD records to report a price for a county.

Explore your insurer’s cost calculator to see whether your health insurer provides personalized cost estimates based on your insurance coverage.

Don’t have health insurance, visit the Washington Health Benefit Exchange to explore available options.