2021 Update: How much do common surgeries cost?

We’ve updated our list of 30 hospital surgeries using the latest government data to give you an accurate snapshot of how much health funds and members typically pay for hospital.

The figures are for private hospitals using the government’s Medical Cost Finder tool to show you the median cost (the middle) that health funds covered in the year to 1 July 2020. After all, a lot of the value you get is what folks like us pay when you need to use your cover.

How to read this table

The first column row is key. It shows the percentage of health fund members who paid no out-of-pocket costs for their hospital treatment. For instance, 53% of health fund patients paid nothing for cataract surgery. In the second row, of the remaining 47% of members who had an out-of-pocket cost for cataract surgery, the median cost was $400.

The figures in the third last and second last columns show how much health funds paid on average for surgeries and the final column totals the health fund benefit average per surgery.

Note. The final column shows what you’d pay if you didn’t have hospital cover and you wanted to enter private hospital as a self-funded patient (spoiler: not fun for your pocket!).

Remember that half the surgeries cost more than the figures quoted. Hospital doesn’t come cheaply!

Surgery type   Health fund
  No gap % Patient out-of-pocket costs  Specialist fees  Medicare specialist benefit  Specialist benefit  Accomm, theatre and device benefit  Total health fund payment
Cataract 53 $400 $2,000 $750 $780 $2,300 $3,080
Colonoscopy 81 $170 $1,300 $590 $480 $690 $1,170
Gall bladder 30 $350 $2,700 $1,200 $1,100 $4,600 $5,700
Heart surgery (Coronary artery bypass graft) 23 $390 $15,000 $7,400 $6,800 $32,000 $38,800
Heart surgery (Stenting blocked heart surgery) 33 $10 $3,100 $1,600 $1,400 $16,000 $17,400
Heart valve replacement 22 $410 $14,000 $7,000 $6,300 $39,000 $45,300
Pacemaker procedure 45 $50 $2,600 $1,300 $1,100 $18,000 $19,100
Varicose veins 36 $300 $1,900 $730 $700 $3,000 $3,700
Hernia (inguinal or femoral) 40 $370 $1,900 $680 $660 $3,600 $4,260
Thyroid tumor removal 28 $560 $3,700 $1,500 $1,200 $5,000 $6,200
ACL repair 20 $600 $3,900 $1,400 $1,500 $5,000 $6,500
Single hip replacement 19 $560 $5,000 $1,900 $1,9000 $21,000 $22,900
Double hip replacement 9 $3,800 $8,900 $3,100 $2,200 $33,000 $35,200
Knee replacement 22 $560 $4,700 $1,800 $1,800 $19,000 $20,800
Shoulder replacement 23 $590 $5,600 $2,100 $2,200 $19,000 $21,200
Bladder tumour removal 49 $280 $1,700 $680 $590 $1,500 $2,090
Kidney stone removal 33 $310 $3,100 $1,300 $1,300 $2,300 $3,600
Prostate removal (endoscopic) 36 $460 $3,000 $1,200 $1,200 $4,600 $5,800
Radical prostate removal 9 $4,400 $8,600 $2,600 $1,600 $11,000 $12,600
Caesarean: major complexity 40 $400 $4,400 $2,000 $1,900 $8,600 $10,500
Caesarean: minor/intermediate complexity 43 $410 $3,800 $1,700 $1,900 $8,000 $9,900
Vaginal delivery major complexity 58 $300 $3,100 $880 $1,700 $6,000 $7,700
Vaginal delivery minor/intermediate complexity 69 $350 $2,900 $810 $1,700 $5,800 $7,500
Adenoids 22 $400 $1,200 $370 $420 $1,200 $1,620
Grommets 26 $400 $1,300 $430 $500 $1,100 $1,600
Tonsil removal 18 $500 $1,500 $420 $490 $2,100 $2,590
Apronectomy (removal of excess abdominal skin and fat) 9 $4,600 $6,700 $1,300 $730 $7,500 $8,230
Gastric band 37 $590 $3,500 $1,200 $1,100 $8,900 $10,000
Gastric bypass 23 $620 $4,400 $1,600 $1,300 $9,900 $11,200
Sleeve gastrectomy (partial stomach removal) 26 $850 $3,400 $1,300 $1,000 $9,700 $10,700

*All Australia, median data 2020 FY 

These figures come directly from the Australian Government Department of Health and reflect health funds overall, not just Peoplecare.

Want more help with your planned surgery?

You can get a much more accurate estimate of planned surgery costs (if any) by asking your specialist for an itemised quote called Informed Financial Consent.

After more info? Check out our Going to Hospital Guide.

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