Hysterectomy charges: geographic variations United States, 1994

During 1994 Metropolitan Life Insurance Company claims by group health insureds and their dependents for a vaginal hysterectomy averaged $10,500, for an abdominal hysterectomy (laparotomy), $12,440, and for a laparoscopically assisted vaginal hysterectomy (LAVH), $13,840. The distributions of the three surgeries varied by geographic area and state. The East South Central states had the lowest average total charge for each procedure whereas the highest charge for a laparotomy was reported in the Middle Atlantic states; the highest vaginal hysterectomy charge was in the Pacific area, and LAVH average total charge was the highest in New England. Of the three surgeries, the vaginal hysterectomy charges varied the most by state-the average charge in Florida was almost twice that in Oklahoma. Laparotomy charges differed by 59 percent between California and Tennessee, where they were 30 percent above and 19 percent below the U.S. norm, respectively. The total charge for the LAVHs varied by 42 percent and was the highest in California and lowest in North Carolina. Three study states, California, Florida and Illinois, were among the four states with the highest average total charges for each form of hysterectomy. Physicians' fees accounted for 41 percent of vaginal hysterectomy charges, 37 percent of the laparotomy total charges, and 34 percent of the LAVH charges. Of the laparotomies, the physicians' fees differed by 132 percent between the highest in New York and the lowest in Tennessee. For the country as a whole, the average length of stay was 2.17 days for the LAVHs, 2.54 days for a vaginal hysterectomy and 3.43 days for an abdominal hysterectomy.