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Colorado Hospital Price Report

Welcome to the Colorado Hospital Price Report, a joint project of the Colorado Hospital Association and the Department of Regulatory Agencies, Division of Insurance.

This website is intended to provide consumers and purchasers of health care with information about hospital charges and insurance company or health maintenance organization reimbursement rates. This includes the 25 most common inpatient medical conditions and surgical procedures performed in Colorado hospitals in 2008. Please go to this link for additional information:

Select “View Reports”, above, to see detailed information by hospital or by insurance company or health maintenance organization. Below is a side by side summary of the information received. While this can help you make more informed decisions about your health care, it is important to keep in mind that the information cannot be used to judge the quality of health care. To see how Colorado hospitals compare on various quality measures, visit http://www.cohospitalquality.org. 

 

Together, the hospital charge, reimbursement, and quality information data can help you ask better questions and become a more informed patient.

 

Hospital Charges/Insurance Reimbursement Side by Side Comparison


Listed below are average hospital charges shown side-by-side with average reimbursement rates paid by insurance companies or health maintenance organizations.

• These hospital charges are the average of all bills that a hospital presented for service, whether covered by insurance or not.
• These reimbursement rates are the average amount an insurance company or health maintenance organization paid, and includes only care
covered by their policies.

The white/yellow shading below indicates related procedures within the Medicare Severity Diagnosis Related Group coding. This coding is a system to classify each hospital case into one of approximately 500 groups, developed for Medicare as part of their payment system. Severity, which is the level of complications experienced during a medical procedure, is taken into account as can be seen below.

 

Medicare Severity Diagnosis Related Group (MS-DRG) Codes for the Top 25 Most Common Procedures Colorado Hospital Association Data from Hospitals Division of Insurance Data from Companies  
Code # Code Description Number of Hospital  Discharges With These Codes Average Hospital Charge Average Company Reimbursement Number of Hospital  Reimburse-ments Paid Under These (or similar) Codes  
190 Chronic obstructive pulmonary disease with major complications 2,006 $27,057 $10,077 172  
191 Chronic obstructive pulmonary disease with complications 2,279 $22,218 $8,449 87  
192 Chronic obstructive pulmonary disease without complications/major complications 2,532 $16,590 $8,429 155  
193 Simple pneumonia & pleurisy with major complications 2,341 $32,479 $12,644 258  
194 Simple pneumonia & pleurisy with complications 5,817 $20,626 $10,156 629  
195 Simple pneumonia & pleurisy without complications/major complications 4,168 $13,513 $6,848 677  
202 Bronchitis & asthma with complications/major complications 1,948 $18,352 $8,823 274  
203 Bronchitis & asthma without complications/major complications 4,941 $10,202 $5,566 847  
246 Percutaneous cardiovascular procedure with drug-eluting stent with major complications or 4+ vessels/stents 680 $101,505 $44,528 66  
247 Percutaneous cardiovascular procedure with drug-eluting stent without major complications 3,683 $67,680 $31,945 649  
286 Circulatory disorders except acute myocardial infarction, with cardiovascular catheterization with major complications 486 $57,406 $67,858 54 *
287 Circulatory disorders except acute myocardial infarction, with cardiovascular catheterization without major complications 3,009 $29,006 $12,124 429  
291 Heart failure & shock with major complications 2,485 $33,297 $25,899 137  
292 Heart failure & shock with complications 2,682 $22,265 $9,753 90  
293 Heart failure & shock without complications/major complications 1,802 $16,111 $8,412 20  
312 Syncope & collapse 2,770 $16,739 $6,839 217  
313 Chest pain 5,159 $13,386 $6,249 594  
391 Esophagitis, gastroenteritis & miscellaneous digestive disorders with major complications 1,602 $25,482 $10,931 403  
392 Esophagitis, gastroenteritis & miscellaneous digestive disorders without major complications 9,890 $16,563 $8,289 1,720  
459 Spinal fusion except cervical with major complications 180 $183,311 $125,010 11  
460 Spinal fusion except cervical without major complications 3,535 $116,654 $54,892 895  
469 Major joint replacement or reattachment of lower extremity with major complications 871 $79,186 $23,529 61  
470 Major joint replacement or reattachment of lower extremity without major complications 14,788 $54,043 $22,887 1,901  
551 Medical back problems with major complications 338 $32,255 $37,991 284 *
552 Medical back problems without major complications 2,984 $17,934 $10,587 347  
602 Cellulitis with major complications 553 $32,505 $11,709 78  
603 Cellulitis without major complications 3,880 $16,210 $7,524 548  
640 Nutritional & miscellaneous metabolic disorders with major complications 1,362 $25,085 $8,401 119  
641 Nutritional & miscellaneous metabolic disorders without major complications 4,488 $15,033 $7,215 561  
689 Kidney & urinary tract infections with major complications 1,302 $25,515 $7,659 66  
690 Kidney & urinary tract infections without major complications 4,132 $16,365 $7,484 368  
742 Uterine & adnexa procedure for non-malignancy with complications/major complications 1,368 $31,802 $11,621 364  
743 Uterine & adnexa procedure for non-malignancy without complications/major complications 5,275 $21,703 $7,780 1,650  
765 Cesarean section with complications/major complications 7,102 $22,336 $10,784 2,077  
766 Cesarean section without complications/major complications 11,006 $14,542 $7,454 3,442  
767 Vaginal delivery with sterilization &/or dilation & curettage 2,004 $14,359 $7,360 348  
768 Vaginal delivery with operating room procedure except sterilization &/or dilation & curettage 34 $24,811 $5,089 41 *
774 Vaginal delivery with complicating diagnoses 7,338 $11,559 $5,991 1,872  
775 Vaginal delivery without complicating diagnoses 39,238 $8,365 $4,538 10,734  
781 Other antepartum diagnoses with medical complications 2,740 $13,343 $7,619 413  
782 Other antepartum diagnoses without medical complications 655 $8,885 $7,014 109  
789 Neonates, died or transferred to another acute care facility 886 $58,625 $15,048 685  
790 Extreme immaturity or respiratory distress syndrome, neonate 1,423 $223,266 $162,564 388  
791 Prematurity with major problems 1,249 $85,554 $48,791 286  
792 Prematurity without major problems 3,758 $17,129 $17,254 645 *
793 Full term neonate with major problems 2,526 $25,027 $12,085 634  
794 Neonate with other significant problems 11,083 $4,772 $3,168 2,223  
795 Normal newborn 42,074 $2,649 $1,482 8,161  
870 Septicemia or severe sepsis with mechanical ventilation 96+ hours 399 $169,960 $56,764 41  
871 Septicemia or severe sepsis without mechanical ventilation 96+ hours with major complications 3,821 $49,704 $27,883 300  
872 Septicemia or severe sepsis without mechanical ventilation 96+ hours without major complications 1,410 $26,582 $14,643 123  
885 Psychoses 10,874 $15,198 $7,087 1,988  
896 Alcohol/drug abuse or dependence without rehabilitation therapy with major complications 793 $43,747 $19,949 40  
897 Alcohol/drug abuse or dependence without rehabilitation therapy without major complications 4,682 $12,730 $5,798 679  
917 Poisoning & toxic effects of drugs with major complications 1,338 $37,996 $14,529 160  
918 Poisoning & toxic effects of drugs without major complications 2,821 $14,673 $7,911 334  
945 Rehabilitation with complications/major complications 4,825 $43,025 $55,209 489 *
946 Rehabilitation without complications/major complications 1,661 $26,328 $8,476 268  
             
    271,076     51,211  
           
* Some insurance companies and HMO's do not collect information by Medicare severity diagnosis related group codes.  Therefore they may have included procedures in another category than reported by hospitals.  This can result in what appears to be a mismatch between the billed charges and the reimbursement rates, or in the number of reported procedures