How to Find the Most Affordable Hospital for Your Procedure

Emergency care leaves little room to shop — you go where the ambulance takes you. But for the majority of medical care — scheduled surgeries, imaging, lab work, specialist visits, and elective procedures — you have time to compare prices. And the differences are staggering: the same MRI might cost $300 at one facility and $3,000 at another, a mile apart.

A 2019 RAND Corporation study found that privately insured patients paid 247% of Medicare rates on average at US hospitals, with enormous variation across facilities. Using price transparency data to find a more affordable option for a scheduled procedure is one of the highest-leverage financial decisions many Americans can make.

Ask your ordering doctor or surgeon for the specific CPT code(s) for your procedure. This is the foundation of meaningful price comparison. "Knee surgery" is too vague — CPT 27447 (total knee arthroplasty) and CPT 29881 (knee arthroscopy with meniscectomy) are completely different procedures at very different price points.

If your doctor can't provide the code, ask their billing coordinator. Your insurance company's prior authorization letter will also typically list CPT codes. Once you have the code, you can search My Health Price to compare prices across hospitals in your area.

Before comparing prices, verify which hospitals are in-network with your insurance plan. Going out of network can cost significantly more, even if the hospital's published price is lower — your deductible may be higher, coinsurance may be worse, and your insurer may pay a smaller share.

Use your insurer's online provider directory or call member services. Confirm that both the facility AND the key providers (surgeon, anesthesiologist, assistant surgeon) are in-network — they're often contracted separately. Also confirm your specific plan, not just the insurance company, since many carriers have multiple network tiers.

Look at the procedure's cash (self-pay) price at each in-network hospital using My Health Price. Then estimate your actual out-of-pocket cost with insurance: take the insurer-negotiated rate and subtract what you've already paid toward your deductible and out-of-pocket maximum.

Sometimes the cash price at a cheaper facility beats your insurance cost at a more expensive one — especially if you haven't met your deductible. The comparison requires a little arithmetic, but it's worth doing for any procedure with a significant price tag.

Ambulatory Surgery Centers (ASCs) are outpatient facilities that specialize in planned surgical procedures. They typically charge 40–60% less than hospital outpatient departments for the same procedure, with comparable safety outcomes for appropriate cases. For cataract surgery, colonoscopy, hernia repair, carpal tunnel release, and many orthopedic procedures, an ASC is often the most cost-effective option.

Ask your surgeon whether they operate at any ASCs and whether your procedure is appropriate for an outpatient setting. Many surgeons have hospital privileges and ASC privileges simultaneously and can accommodate your preference.

Never rely solely on published prices. Call the hospital's patient financial services department, provide the CPT code(s), and ask for the estimated cost for your specific situation — including your insurance plan. Ask whether there are any facility fees, assistant surgeon fees, or other charges that won't be covered by the published price.

If you're paying cash, ask: "Is this the lowest price available?" and "Do you price-match other facilities?" Be specific and calm. Financial counselors field these calls constantly and generally respond well to prepared, direct patients. Getting a written estimate before scheduling is always a good idea.