Healthcare Insights
Medical specialties with the highest average charges
Health insurance plans negotiate reimbursement and coverage with healthcare provider organizations. As hospitals have moved to value-based care models, and concerns grow over unmanageable healthcare costs, understanding service line revenue, charges, and expenses is crucial to measuring hospital financial performance.
Which types of services cost the most?
As additional healthcare reforms, like hospital price transparency, take off in the industry, knowing which services and specialties run up the highest charges is insightful information for both healthcare organizations and patient consumers.
Using data from the Definitive Healthcare Atlas All-Payor Claims dataset, we analyzed claims for medical specialties containing more than 100 providers in the platform. The data in the chart below is representative of claims filed in 2023 through October.
| Rank | Medical specialty | Number of providers | Average charges per provider | Explore dataset |
|---|---|---|---|---|
| 1 | Cardiac Surgery | 946 | $34,757 | Explore |
| 2 | Nephrology | 13453 | $24,646 | Explore |
| 3 | Thoracic Surgery | 2689 | $23,101 | Explore |
| 4 | Critical Care | 2118 | $13,674 | Explore |
| 5 | Pediatric Critical Care | 2626 | $12,884 | Explore |
| 6 | Neonatal-Perinatal Medicine | 7722 | $12,752 | Explore |
| 7 | Neurosurgery | 5609 | $11,807 | Explore |
| 8 | Hematology | 488 | $10,592 | Explore |
| 9 | Gynecological Oncology | 814 | $9,520 | Explore |
| 10 | Surgical Oncology | 492 | $9,296 | Explore |
| 11 | Hospital Medicine | 43266 | $9,178 | Explore |
| 12 | General Surgery | 25077 | $8,681 | Explore |
| 13 | Pediatric Surgery | 1059 | $8,181 | Explore |
| 14 | Plastic and Reconstructive Surgery | 5979 | $7,602 | Explore |
| 15 | Pediatric Oncology | 2272 | $7,505 | Explore |
| 16 | Medical Oncology | 2015 | $7,121 | Explore |
| 17 | Colorectal Surgery | 1800 | $6,438 | Explore |
| 18 | Interventional Cardiology | 282 | $6,274 | Explore |
| 19 | Cardiac Electrophysiology | 2450 | $5,430 | Explore |
| 20 | Oncology | 13157 | $5,028 | Explore |
| 21 | Orthopedic Surgery | 25112 | $4,451 | Explore |
| 22 | Vascular Surgery | 4260 | $4,338 | Explore |
| 23 | Radiation Oncology | 5424 | $3,920 | Explore |
| 24 | Oral and Maxillofacial Surgery | 1568 | $3,883 | Explore |
| 25 | Internal Medicine | 87558 | $3,602 | Explore |
Fig. 1 Data is from the Definitive Healthcare Atlas All-Payor Claims dataset. Data represents claims filed in 2023 through October. Data accessed November 2023.
Which providers charge the most?
Healthcare providers in the cardiac surgery specialty had the highest average charge per provider at $34,757. Cardiac surgery is a subspecialty of the broader cardiology field. Because heart disease is the leading cause of death in the U.S., it is no surprise that cardiac surgery has become such a lucrative medical specialty. Cardiac surgeries tend to be high-risk, often involving open chest procedures. The highly skilled care team, as well as the long procedure and recovery times required, likely contribute to the high cost of the medical specialty.
The second top medical specialty with the highest average charges per provider was nephrology at $24,646. Not only does nephrology care require regular ongoing treatment, such as dialysis, but it also requires drug and supply orders for patients to continue care at home. One drug used for chronic kidney disease-related anemia, called Mircera, carries an average charge of $14,000 and is the eleventh most commonly billed CPT code for this specialty. The regular treatments along with drug and supply costs likely drive the high charges for this specialty.
Thoracic surgery is the third top medical specialty by average charges, with an average charge of $23,101 per provider. Thoracic surgery is a subspecialty of the broader surgery field. Because thoracic services involve treating many issues with the chest, including the heart, lungs, and throat, the procedures tend to involve a mix of high-risk open and non-invasive surgeries, likely contributing to thoracic surgery being a high-cost specialty.
Why are physician specialties important?
Physician specialties are a critical component in providing high-quality, focused care for various health-related concerns. With the health system broken down into many medical specialties and subspecialties, providers can focus their expertise on one or a few types of diseases, organs, body systems, or patient populations.
Learn more
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.
You might also be interested in...
