Maine HealthCost

Definitions

The following terms are used throughout the HealthCost site.

  • Average Facility Cost - The average amount of money paid to the health care facility or hospital for a service. An example of a facility cost is a charge for use of an X-ray machine or surgical room.

  • Average Professional Cost - The average amount of money paid to a professional (provider) for a service. An example of a professional cost is the cost associated with a provider conducting an annual physical.

  • Average Total Cost - The average combined cost (professional cost plus facility cost) for a service. The average total cost includes payments from an insurance company as well as co-pays, co-insurance, or deductible payments from the patient.

  • Common Procedural Terminology (CPT) - A five-digit code used by health care providers and facilities to identify medical procedures. CPT codes distinguish procedures from one another, such as a CT of abdomen with dye (CPT 74160) and a CT of abdomen without dye (CPT 74150). To get an accurate average cost, you can ask your provider for the CPT code for your procedure of interest. See the Procedures page for a list of procedures and their associated CPT codes.

  • Distance to Facility - The approximate distance from the zip code you entered to the Lead Facility.

  • Facility - A hospital, surgical center, diagnostic imaging center, health center, and/or any other entity required to file a claim, using a UB-04 claim form, for all non-professional services rendered.

  • Lead Facility - The primary facility where the services are provided. For example, a patient might be seen at her doctor’s office and have blood work done at another location. The lead facility would be the doctor’s office. See the Facilities page for a list of all facilities for which cost data were available.

  • Number Performed - The number of times a procedure was performed at the Lead Facility.

  • Patient Complexity - Some facilities treat sicker patients who are typically associated with more complex procedures and higher costs. The patient complexity column in HealthCost represents how sick the patients are that receive services at a certain facility compared to how sick patients are at all other facilities. The scale we use ranges from 1 to 5, where 5 represents a patient population with a 'Very High' complexity.

  • Professional - An individual physician or health care practitioner, such as a nurse or doctor, providing direct services to a patient.

  • Health Care Transparency - The availability of information to the public regarding the cost and quality of specific health care services and procedures. Transparency is essential in order for consumers to make informed decisions about their health care, for providers to evaluate their performance compared to others, and for insurers and policymakers to identify and reward quality and efficiency.