Explanation of pricing:
“Medicare Pays“: This is an approximation of what Medicare would reimburse for a similar procedure. Medicare have a large variance in what they pay. The actual Medicare Reimbursement is based on many factors including things such as: The provider performing the procedure, the billing codes used, the state, whether it is rural or urban, whether it is done in a hospital or surgery center, whether the surgery center is owned by, or attached to the hospital, whether the hospital is a teaching facility, just to name a few. In short, the actual Medicare reimbursement, could be very different from the “price” we publish. If you want to know how much Medicare would reimburse for your procedure, we would need the provider ID number, and all of the billing codes.
The “Healthcare Blue Book ‘Fair Price(TM)‘” is the maximum “Fair Price”. The Fair Price can also vary by zip code, and any variance on the procedure. To find out what the current Healthcare Blue Book “Fair Price” is in your zip code, please visit Healthcare Blue Book and enter your zip, and the procedure. The “Fair Price” we show you is based on our zip code, and the day we look it up. This could vary.
What is the “Fair Price?”
The Fair Price is the price that a person can expect to pay by being a prudent healthcare consumer: someone who does basic research to determine which facilities offer the best price for a specific service. Bluebook Fair Prices are based on the actual amount paid on the claim, not the billed amount, and reflect the discounts that the health plan has negotiated with the facility.
Note: the fair price is most often between the 33rd and 55th percentile by price; it depends on local market price variations.
Our “Average Bid” is an average of bids placed over the last 6 months, with the top 2.5% and the bottom 2.5% of bids removed from the average. This number could change every day. These are not necessarily the “best prices”, they are simply the “trimmed mean”.