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Published Plastic Surgery Prince Ranges and Averages

Published Pricing—What is usual and customary?


Health insurance companies collect the published prices of most non-elective procedures. This is done through the bill or claim form. An array of prices, fees and costs are developed for physicians practicing in a geographic area. This distribution of physician prices results in a percentile ranking by the insurance companies of the highest priced service/physician to the lowest usually by zip-code or other geographic area.

The insurance company, according to policy, may then determine what price they are willing to pay for each service in a geographic area. For example, your policy may read: “we will pay at the 75 percentile of what is usual and customary”.

This makes pricing, coverage and payment very easy to understand in the world of traditional health insurance.

---- This is not the case in elective procedures. ----

A physician working in our market economy establishes prices, fees, and costs. This is based on what the consumer or patient is willing to pay, or what competitors are charging. What the consumer is willing to pay may be driven by what they can afford, or if there is some service or outcome the physician provides that the patient will be willing to pay a premium. Ultimately, the price or fee the physician may charge may be due to his own capacity to provide the service and the demand that the public has for this very scarce resource - his time.

In our market economy prices must be the same for all, or there may be a question of price discrimination. These prices may of course be discounted for individuals or group purchasers if a certain volume is offered or other concession is made, or if there is a special promotion or offer given to the public at large.

Many physicians are true artists and their services are so in demand that they can command high prices or fees. Their services become exclusive, and expensive. However, some physicians may price their services at the highest rate in order to position their services in the minds of the consumer as being “premium”.

It is essential to ask about their credentials, time in practice, number of procedures performed to learn if this premium price is warranted or if they are just positioning themselves to appeal to the upscale mind.

Additionally, a lower priced physician may not be signaling a lower quality to the consumer. They may not have updated their prices to be in keeping with the demand for their services or the “going rate” in their community. Therefore price is not always a signal for quality.

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