Colorado Hospital Price Report
From the Division of Insurance
Updated December 2019
- Use the gray slider on the right of the report box to scroll within the report itself
- Select inpatient or outpatient data using the gray boxes at the top of the report box.
- To find specific information, you can select MS DRG / Procedure, the type of insurance (coverage type), the year, and the hospital region.
- Data is available from 2013 through 2018. In the section "Average Allowed Cost and Utilization by Hospital" (bottom right quadrant), hospital names are specified for 2016, 2017 and 2018; for prior years, only region and a number for the hospital is provided.
Starting in 2019 the Colorado Division of Insurance changed the source of information for its Colorado Hospital Report. Before 2019, the Division obtained limited payment information directly from the insurance companies it regulates. This makes up approximately 20% of all insured lives for health insurance in Colorado. Beginning with the 2019 Hospital Price Report and going forward, the Division is making use of information reported to the Colorado All Payer Claim Database (APCD) maintained by the Center for Improving Value in Health Care (CIVHC), which has information for around 77% of the total number of insured Colorado lives.
This report now also has the ability to compare hospital costs to the base Medicare reimbursement rates for many outpatient and inpatient procedures.
Hosptials reported their average billed charges to the Colorado Hospital Association (CHA), and health insurers reported their claim payments to the Colorado APCD.
The Colorado Hospital Association (CHA) has a sister report that gathers information from hospitals rather than insurance companies that is more detailed from a hospital perspective, including all procedures and average length of stay for patients by facility. It can be accessed at Colorado Hospital Association Price Report.
Another change for this report is the ability to compare hospital costs to the Base Medicare reimbursement rates for many outpatient and inpatient procedures.
This report shows the average reimbursement rates and charged amounts for over 50 of the most common inpatient procedures. The common basis for reporting data for both hospitals and health insurers used in this report is the Medicare Severity Diagnosis Related Group or “MS-DRG” code developed by the federal Centers for Medicare and Medicaid Services (CMS). If you are unsure about a specific MS-DRG code, check with your physician or other health care provider.
Because of the different data sources used, there will be discrepancies between the Colorado Division of Insurance and the CHA reports, and it is important to consider all sources when making a decision on medical service providers. The charge information from the CHA report is a sum of all charges from the patient claim. The sum is taken from the charge per revenue code which is generated from the hospital charge master. This information is manually imported by a member of the hospital staff or the hospitals Electronic Health Record (EHR) vendor into the data file that is submitted to CHA.
This report can be broken down to show information by region, insurance company, and hospitals. However, due to privacy laws, the report does not show information when a search would return 10 or less procedures for a specific MS-DRG code. You can read more about the specifics of the data on the "Methodology" page, with information provided by CIVHC.
Each year the CHA and the Division of Insurance are required to publish hospital prices and carrier reimbursement information on a website in accordance with Colorado law (§25-3-705 and §10-16-134, C.R.S.). These laws require health care providers (hospitals, doctors and other providers) and health insurers to be more transparent about their prices and reimbursement rates, helping consumers make educated choices regarding their health care needs.