You are scheduling a surgery. The surgeon's office hands you a date, a prep sheet, and — if you ask directly, and sometimes only then — a vague assurance that "we'll bill your insurance." What they do not hand you is a price.
That is absurd, and it is also fixable. The federal price transparency rule means the data exists. Using it takes about an hour and a specific sequence of steps. Here is the playbook, in order.
Step 1: Get the shoppable services list — and the CPT codes
Every hospital must publish a consumer-friendly list of 300 shoppable services: plain-language descriptions with prices. Find it on the hospital's website — search the hospital name plus "price transparency" or "standard charges." It is usually a downloadable spreadsheet or a searchable web tool.
But the shoppable list alone is not enough. Call the surgeon's office and ask for the CPT codes for your procedure — the five-digit codes that define exactly what will be billed. A "knee replacement" might be billed as one CPT code or five depending on what else happens in the OR. Without the codes, you are comparing descriptions. With them, you are comparing prices. Get the codes in writing, by email or patient portal message.
Then ask a second question most patients never ask: will this be billed as hospital outpatient, ambulatory surgery center, or office-based? As the price data shows, the facility designation can swing the total by multiples. If your surgeon operates at both a hospital and an ASC, ask for the price at each.
Step 2: Read the machine-readable file (or use a tool that does)
The hospital's machine-readable file — usually linked near the shoppable list, often a massive JSON or CSV — contains the payer-specific negotiated rates: what Aetna pays versus Cigna versus UnitedHealthcare versus cash. You do not need to parse raw JSON by hand. Turquoise Health's free tools and several nonprofit price-comparison sites ingest these files and present them in searchable form. Plug in your procedure and your insurer.
What you are looking for: the negotiated rate for your plan, the cash/self-pay price, and the spread between them. Do this for at least two competing facilities. The pattern you will often find — cash cheaper than your insurer's rate — is the single most valuable discovery in this whole exercise.
One caution: the file shows contracted rates, not your out-of-pocket cost. Your deductible, coinsurance, and out-of-pocket maximum determine what you actually owe. A $20,000 negotiated rate means little if you've already hit your $4,000 out-of-pocket max — but it means everything if you're on a high-deductible plan and paying the first $7,000 yourself.
Step 3: Negotiate — yes, really — and ask the right questions
Hospitals negotiate. They do it with insurers every year, and they will do it with you. The script:
- "What is your self-pay cash price for CPT [codes]?" Get it in writing before the procedure. Many hospitals offer 20–40% prompt-pay discounts off billed charges; some match their posted cash price only if you ask.
- "Can you provide a good-faith estimate?" The No Surprises Act entitles uninsured and self-pay patients to a written good-faith estimate before scheduled care. If the final bill exceeds the estimate by $400 or more, you can dispute it through the federal patient-provider dispute process.
- "Is the anesthesiologist / assistant surgeon / pathologist in my network?" Facility price is only part of the bill. Out-of-network ancillary providers were the classic surprise-billing trap; the No Surprises Act now protects against most of it, but verify anyway.
- "What is bundled in this price, and what is billed separately?" Implant, facility fee, surgeon fee, anesthesia — get the itemization. Two quotes that look $5,000 apart may be identical once you learn one excludes anesthesia.
Then call your insurer with the CPT codes and the facility's tax ID and ask for your estimated out-of-pocket. Write down the representative's name, the date, and the reference number. Insurer phone quotes are wrong often enough that the paper trail matters.
The questions that separate informed patients from surprised ones
- If I pay cash instead of running this through insurance, what is the total — and will it count toward my deductible? (Usually not. Do the math both ways.)
- Is there a less expensive site of service where my surgeon also operates?
- What is your financial assistance policy, and what income threshold qualifies? (Nonprofit hospitals must have one. Many patients who qualify never apply.)
- Can I get the estimate and the cash price in writing before I schedule?
An hour of this work routinely saves patients thousands of dollars. The system was not designed to make it easy. It was designed, for a century, to make it impossible. The data changed that — but only for patients who use it.
The price of your surgery is knowable before the incision. SurgeryRates.com compiles facility-level pricing so you can compare before you schedule — not after the bill arrives.