U.S. hospital outpatient prices for private health plans

According to a study conducted using 2020-2022 claims data, private health plans in the United States paid on average 325.72 U.S. dollars per outpatient service. This is the allowed amount*, which includes amounts paid by the health plan and the patient (depending on deductible and other cost sharing). This was 261 percent of what Medicare would have paid for the same service.

Hospital prices for outpatient services paid by private employer-sponsored insurance (ESI) in the U.S. from 2020 to 2022, by type of outpatient service (in U.S. dollars)

Characteristic	Standardized price* for outpatient services in U.S. dollars
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Release date

May 2024

More information

Region

United States

Survey time period

2020 to 2022

Special properties

Over 4,000 Medicare-certified community hospitals in 49 states and DC except Maryland

Supplementary notes

The source adds the following:

*"Prices are calculated based on allowed amounts, including amounts paid by the health plan and the patient. Relative prices represent the allowed amount paid by the private plan as a percentage of what Medicare would have paid to the same hospital for the same services. Standardized prices represent the allowed amount paid by the private health plan per service, standardized using Medicare's case mix grouping and relative weights."

Claims data included "provider identifiers and allowed amounts, for enrollees in employer-sponsored health plans from three types of data sources: self-insured employers, state-based all-payer claims databases from Arkansas, Colorado, Connecticut, Delaware, Maine, Minnesota, New Hampshire, Oregon, Rhode Island, Utah, Vermont and Washington, and health plans that chose to participate. Together, those data sources include claims data for hospital services provided by more than 4,000 hospitals in 49 states and DC." See study for exact methodology.

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