10 states of shocking appendectomy price range data

The analysts treated one big city — New York City — as if it were a state.

For appendectomies, for example, the range of prices for insured, in-network patients was just 1 to 1. All of the hospitals charged roughly the same price.

In another state, the most expensive hospital charged 27 times more than the least expensive hospital.

For a look at the price ranges for appendectomies in 10 of the states analyzed, see the gallery accompanying this article.

What it means: Employers and benefits advisors who want to get good prices for a health plan's participants may still have a hard time getting the right price data, let alone using the price data to help patients get high-quality, reasonably priced care.

The backdrop: Federal regulators tried to make U.S. hospitals publish the "real," negotiated prices that insured, in-network patients pay by adopting the Transparency in Coverage Rule.

Hospitals are now supposed to put all of the rates they have negotiated with each payer in big, machine-readable files.

The hospital price files: So far, Patient Rights Advocate says, the hospital price transparency efforts have not worked very well: only 15.5% of the 2,000 hospital price files the group reviewed showed at least 50% of the prices in dollars and cents, and only 1% of the hospitals expressed all prices in dollars and cents.

In many cases, the health care price transparency group says, hospitals cripple efforts to analyze their prices by expressing the prices in terms of mathematical formulas or pricing rules that are difficult or impossible to translate into actual dollar prices, and 236 of the hospitals included failed to provide any prices expressed in dollars and cents.

The group found that 159 hospitals expressed their prices by simply stating, "Conditional payment logic at the claim level, including numerous contracting methods, hierarchical applications, and service utilization requirements."

Related: Many hospitals still fail to comply with price transparency rule

About 1,000 of the hospitals were somewhat less cryptic, but they "posted algorithms that are unquantifiable due to ambiguity or missing information," the group says. "Hospitals omitted full disclosure of actual reimbursement rates due to carve-outs, stop loss, and outlier contract terms, which substantially drive up prices."

The analysis: Patient Right Advocate analysts did their best to quantify hospital price variation, in spite of the problems with the price files, by looking at what the same hospital charges patients with different coverage for the same procedure.

At the University of Kansas Hospital, for example, a patient with one plan could pay $650 for a cervical spine fusion procedure. Another patient at the same hospital could pay $26,100.59 for that procedure, or 40.2 times more.