What Private Insurance and Medicare pays for Common Hospital Tests

Knowing a Hospital Charge and what Private Insurance  and Medicare pays is valuable information.  The Healthcare Consumer with No Insurance can utilize the information to negotiate a price for services they need.

Blood tests:

Comprehensive metabolic panel: A blood test that assesses liver and kidney function as well as electrolytes

Hospital charge: $179 Private insurance: $15 Medicare: $15

Lipid Panel: A blood test that checks to tal cholesterol and breaks it down to good and bad components.

Hospital charge: $68 Private insurance: $19 Medicare: $19

Complete Blood Count: A blood test that checks your hemoglobin, hematocrit, white blood counts.

Hospital charge: $51 Private insurance: $11 Medicare: $11

Urine Analysis: Looks for blood, signs of infection or protein in your urine.

Hospital charge: $92 Private insurance: $5 Medicare: $4

Hemoglobin A1C: A single blood test that checks your average blood sugar for the last 3 months.

Hospital charge: $61 Private insurance: $14 Medicare: $13

Thyroid Stimulating Hormone: A blood test that evaluates your thyroid function.

Hospital charge: $108 Private insurance: $24 Medicare: $23

Prothrombin Time: A blood test to check Coumadin level and your blood’s ability to clot

Hospital charge: $36 Private insurance: $6 Medicare: $6

PSA: A blood test that helps to check for prostate cancer.

Hospital charge: $117 Private insurance: $26 Medicare: $22

HIV: Tests for HIV (obviously).

Hospital charge: $92 Private insurance: $20 Medicare: $19

Cardiology:

EKG: A screening test for abnormal heart rhythms and other signs of heart disease.

Hospital charge: $367 Private insurance: $26 Medicare: $26

Echocardiogram: An ultrasound of the heart to look at valves and assess function.

Hospital charge: $4,361 Private insurance: $317 Medicare: $291

Exercise Stress Test: This test is good for evaluating chest pain to see if your heart is the cause.

Hospital charge: $1,182 Private insurance: $123 Medicare: $123

Radiology:

(Price includes fee for Radiologist)

Chest X-Ray: To check for lung disease and some forms of heart disease.

Hospital charge: $375 Private insurance: $42 Medicare: $41

Mammogram: Screening test for breast cancer

Hospital charge: $336 Private insurance: $191 Medicare: $146

Ultrasound of the Abdomen: Can assess Kidneys, Liver, Gall Bladder and other organs.

Hospital charge: $1,440 Private insurance: $184 Medicare: $181

Ultrasound of the Pelvis: Images the Uterus and Ovaries

Hospital charge: $1,106 Private insurance: $170 Medicare: $169

CT of Head: Often used to look for lesions in the Brain.

Hospital charge: $2,621 Private insurance: $344 Medicare: $269

CT of Chest with IV Contrast: Can accurately evaluate lung disease and other problem in the chest.

Hospital charge: $5,295 Private insurance: $431 Medicare: $426

CT of Abdomen with IV Contrast: Accurately images the abdomen for tumors or other disease.

Hospital charge: $5,680 Private insurance: $463 Medicare: $458

CT of Pelvis with IV Contrast: Often done at the same time as the abdominal CT.

Hospital charge: $5,030 Private insurance: $408 Medicare: $403

MRIs:

MRI of the Brain: A more accurate way to image the brain than a CT scan but it’s more expensive and can’t be done as quickly or easily.

Hospital charge: $3,422 Private insurance: $578 Medicare: $654

MRI of the Cervical Spine: Accurately images the neck

Hospital charge: $3,041 Private insurance: $584 Medicare: $587

MRI of the Thoracic Spine: Accurately images the upper back

Hospital charge: $3,422 Private insurance: $584 Medicare: $596

MRI of the Lumbar Spine: Accurately images the lower back.

Hospital charge: $3,535 Private insurance: $577 Medicare: $588

Procedures:

(Usually these procedures are done in an office not a hospital. The amount billed varies substantially for different medical groups but it usually ranges from $1,000 to $8,000 for each).

Colonoscopy, Diagnostic: A screening test for colon cancer where the entire colon is examined through a fiber optic tube.

Private insurance: $504 Medicare: $464

Colonoscopy with Biopsy: If a lesion is found on screening colonoscopy a biopsy is needed.

Private insurance: $603 Medicare: $555

Upper endoscopy with Biopsy: Evaluates problems in the esophagus and stomach, again through a fiber optic tube.

Private insurance: $447 Medicare: $410

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