A recent visitor to OutofPocket.com contacted me because he couldn’t find prices for a specific procedure he was looking up in our directory. This is a great question and I want to share my response with others.
It’s important to understand that the OutofPocket.com directory is a collection of user generated content. Because insurance plans and providers are not willing to make their true prices public, we rely on consumers to post/share prices they paid for actual visits – to share with other consumers. Our database is limited to the prices/services supplied by other consumers. As awareness for OutofPocket.com builds, we will have a more comprehensive directory of services and prices supplied by consumers – including services like the one you are looking up but cannot find in OutofPocket.com.
If you do not find your service in OutofPocket.com there are several other tools you can use to research prices for specific health care services, procedures or tests. The Government CMS website includes a tool that can be very useful. If you know the specific CPT code you will be able to match the exact procedure to determine what CMS reimburses providers for that procedure. CMS Medicare payment data is always a good starting point if you need to know the lowest possible payment for any CPT code. I'm not sure insurance plans have negotiated rates as low as Medicare, but it's a good benchmark.
Here are links to four tools you might find useful to look up prices for specific health care services.
AMA CPT Code Search Tool to look up CPTs to determine Medicare reimbursement amounts
MyHealthScore online tool to look up fees for specific procedures
USA HealthCare Costs online tool to look up what Medicare pays for specific CPTs
VIMO search tool to compare medical procedure prices at hospitals