AJMC October 6, 2025
This article examines how prices, insurer payments, and patient payments for outpatient surgeries differ by site of care and network status.
ABSTRACT
Objective: To examine how site of care and insurance network contribute to price differences for common adult outpatient surgeries paid by commercial insurers.
Study Design: Observational study using a 50-state sample of commercial medical claims data.
Methods: We compared insurer-paid amounts, patient out-of-pocket payments, and balance billing amounts for 4 common adult outpatient surgeries (arthroscopy, cataract, colonoscopy, and upper gastrointestinal procedures) by site of care (ambulatory surgery center [ASC] vs hospital outpatient department [HOPD]) and insurance network status (in network vs out of network).
Results: Compared with a surgery occurring at an in-network ASC, insurers paid $306 (32%)...
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