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Medical costs comparison

Compare medical costs to reduce out-of-pocket expenses.

Updated

Unknown out-of-pocket medical expenses are one of the most frustrating parts of health care in Australia. However, by learning how medical costs work, you can reduce or eliminate out-of-pocket expenses. We've identified what you need to look for.

How do medical costs work?

If you receive medical treatment in a hospital as a private patient, Medicare will pay 75% of the Medical Benefits Schedule (MBS) fee. The MBS fee is the amount the government defines as fair. The fee for each service differs and you can usually find it online if you get the MBS fee number from your doctor. If you have private health insurance, this will ordinarily cover the remaining 25%.

However, you still might have out-of-pocket expenses, also known as the gap. This is when the doctor treating you charges more than the MBS fee. Medical professionals in Australia are under no obligation to adhere to the MBS fee, meaning you still might have out-of-pocket expenses even if you have private health insurance.

Compare medical costs across Australia

The costs outlined in the below table come from the Medical Costs Finder. They're based on the most recent, publicly available government data on what people paid for medical procedures. To get an idea of what you're likely to pay for a procedure in your state, use the doctor's fee (the typical fee that is charged for the procedure) and the patient's fee (the typical amount that is paid by the patient) to see what the average costs are like. If you've already received a cost estimate from a doctor, you can use that to see if you're paying more than others in your state.

For specific services, such as weight loss surgery or treatment for your tonsils or your kidneys, it's often the case that the recommended MBS fee is far less than what most doctors charge, meaning you're more likely to have out-of-pocket expenses. For example, with weight loss surgery, the typical amount that is paid by a patient is $7,000 in NSW. Across all states, the MBS figure comes to $2,553.

On the other end of things, you're less likely to have large out-of-pocket expenses for services to address heart and vascular issues, pregnancy and birth, or sleep studies. For example, across all states, the average a patient will pay is $447. Generally, you're likely to pay more in states such as NSW and Victoria, but each service fee differs slightly, so that's not always the case.

ProcedureAverage Procedure costAverage Patient's pay
Acromioplasty (remove some shoulder bone surface)$500$560
Adenoid removal$350$630
Ankle replacement$1,400$2,700
Anterior cruciate ligament repair (knee)$700$2,600
Apronectomy (remove excess abdominal skin and fat)$5,000$7,000
Arthroscopy (knee)$400$850
Breast biopsy$450$600
Breast reduction$3,600$4,300
Caesarean section major complexity$420$500
Caesarean section minor/intermediate complexity$420$500
Cataract$400$650
Colonoscopy with or without biopsy$150$220
Coronary artery bypass graft (CABG)$340$520
Curette (uterus)$220$280
Cystoscopy (examine bladder)$200$300
Dialysis$0$10
Ectropion (repair outward turned lower eyelid)$400$500
Endarterectomy (remove artery lining blockage)$500$920
Female contraception (fallopian tube procedures)$420$490
Gall bladder removal$360$500
Gastric band$750$2,700
Gastric bypass$560$750
Gastroscopy (or upper gastrointestinal endoscopy)$140$160
Grommets insertion$360$650
Heart-related angiogram (examine blood vessels)$10$10
Heart valve replacement (not TAVI)$300$430
Hemicolectomy (remove part of colon)$500$770
Hip replacement (bilateral)$3,300$5,100
Hip replacement (single)$550$1,800
Hysterectomy (removal of the uterus)$580$850
Hysteroscopy with biopsy (examine uterus)$230$320
Inguinal or femoral hernia$360$580
IVF$160$180
Knee replacement$550$1,300
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$500
Lumpectomy (remove breast lump)$400$500
Male contraception (e.g. vasectomy)$260$480
Mastectomy (remove breast)$500$830
Pacemaker$50$50
Patella stabilisation (stabilise the kneecap)$570$2,200
Prolapse uterus$440$720
Prostatectomy (endoscopic)$460$840
Pterygium (remove abnormal tissue from eye)$400$300
Radical prostatectomy$4,700$7,600
Removal of skin lesion (abnormal tissue)$350$500
Retinal detachment$350$410
Rotator cuff repair (tendons around the shoulder joint)$720$2,000
Septoplasty (deviated nasal septum)$510$1,300
Shoulder replacement$570$1,600
Sinus surgery$500$830
Sleep studies$110$20
Sleeve gastrectomy (partial stomach removal)$850$810
Stenting blocked heart artery$30$40
Stress incontinence$400$880
Tonsillectomy with or without adenoidectomy$500$1,100
Turbinectomy (remove small nasal bones)$430$870
Umbilical hernia$300$590
Vaginal delivery major complexity$300$450
Vaginal delivery minor/intermediate complexity$350$450
Vaginal repair$490$670
Varicose veins$330$450
Wound debridement (remove tissue or material)$270$380
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500$500
Adenoid removal$350$280
Ankle replacement$1,400$1,100
Anterior cruciate ligament repair (knee)$700$500
Apronectomy (remove excess abdominal skin and fat)$5,000$6,300
Arthroscopy (knee)$400$290
Breast biopsy$450$360
Breast reduction$3,600$4,100
Caesarean section major complexity$420$380
Caesarean section minor/intermediate complexity$420$350
Cataract$400$300
Colonoscopy with or without biopsy$150$110
Coronary artery bypass graft (CABG)$340$350
Curette (uterus)$220$150
Cystoscopy (examine bladder)$200$150
Dialysis$0$30
Ectropion (repair outward turned lower eyelid)$400$330
Endarterectomy (remove artery lining blockage)$500$450
Female contraception (fallopian tube procedures)$420$250
Gall bladder removal$360$300
Gastric band$750$500
Gastric bypass$560$960
Gastroscopy (or upper gastrointestinal endoscopy)$140$100
Grommets insertion$360$290
Heart related angiogram (examine blood vessels)$10$20
Heart valve replacement (not TAVI)$300$420
Hemicolectomy (remove part of colon)$500$500
Hip replacement (bilateral)$3,300$4,500
Hip replacement (single)$550$640
Hysterectomy (removal of the uterus)$580$500
Hysteroscopy with biopsy (examine uterus)$230$180
Inguinal or femoral hernia$360$220
IVF$160$100
Knee replacement$550$510
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$350
Lumpectomy (remove breast lump)$400$350
Male contraception (e.g. vasectomy)$260$170
Mastectomy (remove breast)$500$410
Pacemaker$50$50
Patella stabilisation (stabilise the kneecap)$570$390
Prolapse uterus$440$300
Prostatectomy (endoscopic)$460$290
Pterygium (remove abnormal tissue from eye)$400$300
Radical prostatectomy$4,700$1,200
Removal of skin lesion (abnormal tissue)$350$200
Retinal detachment$350$250
Rotator cuff repair (tendons around the shoulder joint)$720$780
Septoplasty (deviated nasal septum)$510$470
Shoulder replacement$570$560
Sinus surgery$500$400
Sleep studies$110$190
Sleeve gastrectomy (partial stomach removal)$850$1,000
Stenting blocked heart artery$30$30
Stress incontinence$400$250
Tonsillectomy with or without adenoidectomy$500$380
Turbinectomy (remove small nasal bones)$430$360
Umbilical hernia$300$210
Vaginal delivery major complexity$300$350
Vaginal delivery minor/intermediate complexity$350$330
Vaginal repair$490$350
Varicose veins$330$300
Wound debridement (remove tissue or material)$270$190
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500$1,000
Adenoid removal$350$330
Ankle replacement$1,400$990
Anterior cruciate ligament repair (knee)$700$780
Apronectomy (remove excess abdominal skin and fat)$5,000$1,500
Arthroscopy (knee)$400$570
Breast biopsy$450$500
Breast reduction$3,600$3,600
Caesarean section major complexity$420$420
Caesarean section minor/intermediate complexity$420$460
Cataract$400$500
Colonoscopy with or without biopsy$150$150
Coronary artery bypass graft (CABG)$340$230
Curette (uterus)$220$250
Cystoscopy (examine bladder)$200$200
Dialysis$0$0
Ectropion (repair outward turned lower eyelid)$400$500
Endarterectomy (remove artery lining blockage)$500$500
Female contraception (fallopian tube procedures)$420$570
Gall bladder removal$360$500
Gastric band$750$1,000
Gastric bypass$560$630
Gastroscopy (or upper gastrointestinal endoscopy)$140$100
Grommets insertion$360$300
Heart related angiogram (examine blood vessels)$10$10
Heart valve replacement (not TAVI)$300$260
Hemicolectomy (remove part of colon)$500$690
Hip replacement (bilateral)$3,300$3,600
Hip replacement (single)$550$780
Hysterectomy (removal of the uterus)$580$970
Hysteroscopy with biopsy (examine uterus)$230$320
Inguinal or femoral hernia$360$500
IVF$160$240
Knee replacement$550$750
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$660
Lumpectomy (remove breast lump)$400$500
Male contraception (e.g. vasectomy)$260$320
Mastectomy (remove breast)$500$500
Pacemaker$50$50
Patella stabilisation (stabilise the kneecap)$570$850
Prolapse uterus$440$400
Prostatectomy (endoscopic)$460$540
Pterygium (remove abnormal tissue from eye)$400$400
Radical prostatectomy$4,700$4,900
Removal of skin lesion (abnormal tissue)$350$350
Retinal detachment$350$200
Rotator cuff repair (tendons around the shoulder joint)$720$950
Septoplasty (deviated nasal septum)$510$500
Shoulder replacement$570$720
Sinus surgery$500$500
Sleep studies$110$10
Sleeve gastrectomy (partial stomach removal)$850$850
Stenting blocked heart artery$30$40
Stress incontinence$400$410
Tonsillectomy with or without adenoidectomy$500$420
Turbinectomy (remove small nasal bones)$430$380
Umbilical hernia$300$380
Vaginal delivery major complexity$300$240
Vaginal delivery minor/intermediate complexity$350$300
Vaginal repair$490$510
Varicose veins$330$780
Wound debridement (remove tissue or material)$270$500
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500$200
Adenoid removal$350$260
Ankle replacement$1,400N/A
Anterior cruciate ligament repair (knee)$700$250
Apronectomy (remove excess abdominal skin and fat)$5,000$3,900
Arthroscopy (knee)$400$150
Breast biopsy$450$80
Breast reduction$3,600$780
Caesarean section major complexity$420$200
Caesarean section minor/intermediate complexity$420$200
Cataract$400$300
Colonoscopy with or without biopsy$150$50
Coronary artery bypass graft (CABG)$340$300
Curette (uterus)$220$190
Cystoscopy (examine bladder)$200$150
Dialysis$0N/A
Ectropion (repair outward turned lower eyelid)$400$250
Endarterectomy (remove artery lining blockage)$500N/A
Female contraception (fallopian tube procedures)$420$250
Gall bladder removal$360$180
Gastric band$750N/A
Gastric bypass$560$500
Gastroscopy (or upper gastrointestinal endoscopy)$140$50
Grommets insertion$360$190
Heart related angiogram (examine blood vessels)$10$10
Heart valve replacement (not TAVI)$300$330
Hemicolectomy (remove part of colon)$500$200
Hip replacement (bilateral)$3,300N/A
Hip replacement (single)$550$250
Hysterectomy (removal of the uterus)$580$350
Hysteroscopy with biopsy (examine uterus)$230$150
Inguinal or femoral hernia$360$140
IVF$160N/A
Knee replacement$550$230
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$300
Lumpectomy (remove breast lump)$400$120
Male contraception (e.g. vasectomy)$260$150
Mastectomy (remove breast)$500$150
Pacemaker$50$30
Patella stabilisation (stabilise the kneecap)$570$220
Prolapse uterus$440$300
Prostatectomy (endoscopic)$460$200
Pterygium (remove abnormal tissue from eye)$400$370
Radical prostatectomy$4,700$910
Removal of skin lesion (abnormal tissue)$350$200
Retinal detachment$350$500
Rotator cuff repair (tendons around the shoulder joint)$720$200
Septoplasty (deviated nasal septum)$510$480
Shoulder replacement$570$230
Sinus surgery$500$410
Sleep studies$110N/A
Sleeve gastrectomy (partial stomach removal)$850$400
Stenting blocked heart artery$30$20
Stress incontinence$400$500
Tonsillectomy with or without adenoidectomy$500$320
Turbinectomy (remove small nasal bones)$430$340
Umbilical hernia$300$150
Vaginal delivery major complexity$300$250
Vaginal delivery minor/intermediate complexity$350$200
Vaginal repair$490$280
Varicose veins$330N/A
Wound debridement (remove tissue or material)$270$150
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500$330
Adenoid removal$350$330
Ankle replacement$1,400$1,800
Anterior cruciate ligament repair (knee)$700$410
Apronectomy (remove excess abdominal skin and fat)$5,000$7,000
Arthroscopy (knee)$400$390
Breast biopsy$450$510
Breast reduction$3,600$2,900
Caesarean section major complexity$420$160
Caesarean section minor/intermediate complexity$420$150
Cataract$400$130
Colonoscopy with or without biopsy$150$100
Coronary artery bypass graft (CABG)$340N/A
Curette (uterus)$220$150
Cystoscopy (examine bladder)$200$220
Dialysis$0N/A
Ectropion (repair outward turned lower eyelid)$400$200
Endarterectomy (remove artery lining blockage)$500$300
Female contraception (fallopian tube procedures)$420N/A
Gall bladder removal$360$250
Gastric band$750N/A
Gastric bypass$560$500
Gastroscopy (or upper gastrointestinal endoscopy)$140$160
Grommets insertion$360$380
Heart related angiogram (examine blood vessels)$10$10
Heart valve replacement (not TAVI)$300N/A
Hemicolectomy (remove part of colon)$500$460
Hip replacement (bilateral)$3,300$150
Hip replacement (single)$550$170
Hysterectomy (removal of the uterus)$580$640
Hysteroscopy with biopsy (examine uterus)$230$200
Inguinal or femoral hernia$360$400
IVF$160$290
Knee replacement$550$180
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$420
Lumpectomy (remove breast lump)$400$360
Male contraception (e.g. vasectomy)$260$360
Mastectomy (remove breast)$500$460
Pacemaker$50$40
Patella stabilisation (stabilise the kneecap)$570$260
Prolapse uterus$440$330
Prostatectomy (endoscopic)$460$550
Pterygium (remove abnormal tissue from eye)$400$160
Radical prostatectomy$4,700$6,100
Removal of skin lesion (abnormal tissue)$350$320
Retinal detachment$350N/A
Rotator cuff repair (tendons around the shoulder joint)$720$400
Septoplasty (deviated nasal septum)$510$510
Shoulder replacement$570$220
Sinus surgery$500$500
Sleep studies$110N/A
Sleeve gastrectomy (partial stomach removal)$850$3,900
Stenting blocked heart artery$30$30
Stress incontinence$400$360
Tonsillectomy with or without adenoidectomy$500$500
Turbinectomy (remove small nasal bones)$430$420
Umbilical hernia$300$200
Vaginal delivery major complexity$300$150
Vaginal delivery minor/intermediate complexity$350$180
Vaginal repair$490$560
Varicose veins$330$200
Wound debridement (remove tissue or material)$270$320
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500$430
Adenoid removal$350N/A
Ankle replacement$1,400N/A
Anterior cruciate ligament repair (knee)$700N/A
Apronectomy (remove excess abdominal skin and fat)$5,000N/A
Arthroscopy (knee)$400N/A
Breast biopsy$450N/A
Breast reduction$3,600$2,100
Caesarean section major complexity$420N/A
Caesarean section minor/intermediate complexity$420N/A
Cataract$400$30
Colonoscopy with or without biopsy$150$40
Coronary artery bypass graft (CABG)$340N/A
Curette (uterus)$220N/A
Cystoscopy (examine bladder)$200$120
Dialysis$0N/A
Ectropion (repair outward turned lower eyelid)$400N/A
Endarterectomy (remove artery lining blockage)$500N/A
Female contraception (fallopian tube procedures)$420N/A
Gall bladder removal$360$350
Gastric band$750N/A
Gastric bypass$560N/A
Gastroscopy (or upper gastrointestinal endoscopy)$140$30
Grommets insertion$360$300
Heart related angiogram (examine blood vessels)$10$10
Heart valve replacement (not TAVI)$300N/A
Hemicolectomy (remove part of colon)$500$820
Hip replacement (bilateral)$3,300N/A
Hip replacement (single)$550N/A
Hysterectomy (removal of the uterus)$580$310
Hysteroscopy with biopsy (examine uterus)$230$160
Inguinal or femoral hernia$360$270
IVF$160N/A
Knee replacement$550$280
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$230
Lumpectomy (remove breast lump)$400$310
Male contraception (e.g. vasectomy)$260N/A
Mastectomy (remove breast)$500N/A
Pacemaker$50$50
Patella stabilisation (stabilise the kneecap)$570N/A
Prolapse uterus$440N/A
Prostatectomy (endoscopic)$460$300
Pterygium (remove abnormal tissue from eye)$400N/A
Radical prostatectomy$4,700N/A
Removal of skin lesion (abnormal tissue)$350$210
Retinal detachment$350N/A
Rotator cuff repair (tendons around the shoulder joint)$720N/A
Septoplasty (deviated nasal septum)$510N/A
Shoulder replacement$570$400
Sinus surgery$500N/A
Sleep studies$110N/A
Sleeve gastrectomy (partial stomach removal)$850N/A
Stenting blocked heart artery$30$10
Stress incontinence$400N/A
Tonsillectomy with or without adenoidectomy$500N/A
Turbinectomy (remove small nasal bones)$430N/A
Umbilical hernia$300$230
Vaginal delivery major complexity$300N/A
Vaginal delivery minor/intermediate complexity$350N/A
Vaginal repair$490$250
Varicose veins$330$240
Wound debridement (remove tissue or material)$270N/A
ProcedureProcedure costPatient's pay
Acromioplasty (remove some shoulder bone surface)$500N/A
Adenoid removal$350N/A
Ankle replacement$1,400N/A
Anterior cruciate ligament repair (knee)$700$2,900
Apronectomy (remove excess abdominal skin and fat)$5,000$11,000
Arthroscopy (knee)$400$2,000
Breast biopsy$450$850
Breast reduction$3,600$4,300
Caesarean section major complexity$420N/A
Caesarean section minor/intermediate complexity$420N/A
Cataract$400$1,100
Colonoscopy with or without biopsy$150$320
Coronary artery bypass graft (CABG)$340N/A
Curette (uterus)$220$280
Cystoscopy (examine bladder)$200N/A
Dialysis$0N/A
Ectropion (repair outward turned lower eyelid)$400N/A
Endarterectomy (remove artery lining blockage)$500N/A
Female contraception (fallopian tube procedures)$420N/A
Gall bladder removal$360$1,600
Gastric band$750N/A
Gastric bypass$560N/A
Gastroscopy (or upper gastrointestinal endoscopy)$140$180
Grommets insertion$360N/A
Heart related angiogram (examine blood vessels)$10N/A
Heart valve replacement (not TAVI)$300N/A
Hemicolectomy (remove part of colon)$500$1,800
Hip replacement (bilateral)$3,300$3,200
Hip replacement (single)$550$3,200
Hysterectomy (removal of the uterus)$580N/A
Hysteroscopy with biopsy (examine uterus)$230$340
Inguinal or femoral hernia$360$810
IVF$160N/A
Knee replacement$550$3,800
Laparoscopy (keyhole surgery to examine abdomen or pelvis)$450$660
Lumpectomy (remove breast lump)$400$500
Male contraception (e.g. vasectomy)$260N/A
Mastectomy (remove breast)$500$820
Pacemaker$50N/A
Patella stabilisation (stabilise the kneecap)$570$2,300
Prolapse uterus$440N/A
Prostatectomy (endoscopic)$460N/A
Pterygium (remove abnormal tissue from eye)$400N/A
Radical prostatectomy$4,700N/A
Removal of skin lesion (abnormal tissue)$350$550
Retinal detachment$350N/A
Rotator cuff repair (tendons around the shoulder joint)$720$3,000
Septoplasty (deviated nasal septum)$510$1,700
Shoulder replacement$570$4,600
Sinus surgery$500N/A
Sleep studies$110N/A
Sleeve gastrectomy (partial stomach removal)$850$5,200
Stenting blocked heart artery$30N/A
Stress incontinence$400N/A
Tonsillectomy with or without adenoidectomy$500N/A
Turbinectomy (remove small nasal bones)$430N/A
Umbilical hernia$300$590
Vaginal delivery major complexity$300N/A
Vaginal delivery minor/intermediate complexity$350N/A
Vaginal repair$490N/A
Varicose veins$330N/A
Wound debridement (remove tissue or material)$270$290
Source: https://www.health.gov.au/

What factors impact medical costs?

Ever wonder why medical costs can differ so much. Here are some of the main reasons:

  • Location. Doctors charge differently depending on the area. Sometimes, this has a lot to do with patient load. Other times, it might be because you live in an expensive city like Sydney or in a rural area.
  • Procedures. Some procedures cost more than others, partly due to their complexity and the technology involved.
  • Skill shortages. If there aren't as many doctors who specialise in a specific field, you might have to pay more for treatment.
  • Quality of service. Australia attracts some of the best medical professionals in the world. As a result, some doctors and medical specialists charge considerably more than others – and more than the MBS fee – because they claim to offer better services than others. This may well be the case and some people are happy to pay more for their treatment.
  • A lack of accountability. The fact is, private health care is a business built upon profits. If doctors can charge more, many probably will since there's no obligation to adhere to the MBS fee.
  • Efficiency. In principle, you pay for what you get. Private health care generally has shorter waiting times when compared to public care.

How to compare medical costs if I need treatment

There are a number of things you can do to figure out if you will have out-of-pocket expenses.

  • Call around to different doctors to get a few different quotes. This ensures you don't just go with the first person and potentially pay much more than if you went elsewhere.
  • Get a Medicare MBS code. This is so you know how much Medicare and private health insurance will cover. Get this code from your doctor and give it to your private healthcare provider.
  • Look on the Medical Costs Finder to see how much you are likely to pay. Alternatively, look at the table above for a breakdown of the costs for services by state. This shows what the average out-of-pocket expenses are, which you can then compare with the quotes you have received.
  • Find out if your surgeon is in your private health insurer's preferred list. Sometimes, your health provider will only cover certain doctors, so be sure to confirm this with your insurer beforehand.

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