Here’s How to Find the Cost of a Medical Procedure Before You Get It

In a perfect world, your doctor would hand you a cost estimate right alongside your treatment plan. But that’s not how it works. Instead, patients generally undergo surgeries and tests without a clue as to what the bill will be. But have no doubt: Those procedures add up.

In 2019, the average American spent more than $11,500 on healthcare. Much of that was covered by insurance, but an unlucky patient can still be hit with thousands in billing.

But there’s a way to keep some of that money in your pocket. First, speak up. “We need to normalize conversations about the cost of healthcare,” says Caitlin Donovan, a healthcare policy expert with the National Patient Advocate Foundation. “Too often, patients get shy when talking about money—and then they find that they can’t adhere to their treatment plan because it’s too expensive. So always ask.”

But who exactly do you ask? And once you get an answer, what tools can you use to compare prices? Finding the exact cost of a surgery or test might not be as simple as scanning a price sheet, but it’s not impossible either. Here’s how to do it.

Ask your doctor

When a doctor tells you that you need a specific test or surgery, it’s perfectly reasonable to ask how much it will cost. And once you know the price, you have the info you need to shop around.

“That single question can be the difference between thousands of dollars or a surprise bill down the line,” says Touré McCluskey, chief product officer of ReduHealth, which compiles healthcare pricing information. “It can make a huge financial difference.”

If talking to your doctor about money feels uncomfortable, wait until the end of the conversation, after you’ve had a chance to learn more about the procedure. Then ask the front office billing staff about the financial details.

Ask for the billing code

In addition to asking about the price, ask about the billing code. “Make sure you get not just the name of the procedure but the CPT code as well—that’s healthcare-speak for the precise number that identifies the procedure or test your doctor has ordered,” says McCluskey. “So instead of just an x-ray of your knee, for example, you may need one with a four-part view, which is code 73564.”

The billing code allows you to compare apples to apples when price shopping. And if you forget to ask about the billing code at the doctor’s office, don’t sweat it. Just give the doctor a call or reach out through your patient portal.

Oh, and when you get the code, write it down. In fact, it’s a good idea to buy a dedicated notebook that fits in your pocket or purse to use for all medical appointments, says AnnMarie McIlwain, CEO of Patient Advocators, a firm that helps people navigate their healthcare needs.

Inside this notebook, you’ll capture details such as the names of the people you’re speaking to, the dates and times of calls, and any reference numbers you get. “Nobody wants to mislead you,” says McIlwain. “But these are very complex subjects, and it’s easy to make a mistake.”

Call your insurance rep

Grab your insurance card and call the number on the back. In addition to helping you find a doctor that’s in your plan’s network, your insurance agent can lay out what you should expect to pay based on several factors, including whether the doctor or service is in network or out of network, as well as the amount of your deductible and copay.

“Every plan—even within the same insurance company—is different, and your rep is a great starting point,” says McIlwain. “They’ll know exactly what your plan provides.”

Another great source: If you work for a large company, there might be a benefits expert on staff, says McIlwain. And if you buy your personal plan from a broker, they can assist you too.

Check your local hospital’s website

Legislation enacted in 2021 stipulates that every hospital in America is required to post pricing information for 300 common, shoppable services, such as x-rays, magnetic resonance imaging (MRI), bypass surgeries, and appendix removals.

In theory, this should make it very easy to check hospital prices. But there are two challenges:

• Many hospitals are dragging their feet. Only 15% are fully compliant with the law, according to a report from Patient Rights Advocates. To find out if your hospital is posting its prices, search the name of the hospital along with the term “transparency pricing.” Or you can look for the term “transparency pricing” on the hospital’s home page or billing services page.
• Hospital price sheets can be difficult to read. Some of them are thousands of pages long. That’s one place where the billing codes come in handy. If you know the number associated with your procedure, you can search for it in the document.

Once you locate your test or surgery on the price sheet, you’ll see the cash prices for people without insurance, plus the prices charged under various insurance plans. The numbers can vary widely, so make sure you’re looking at the price that applies to you.

And if you can’t find the hospital’s price sheet, call their finance office and ask how much your procedure costs.

Call your local imaging center

When you start digging into prices, you’ll probably find that local hospitals have higher prices than what you’d find at an independent clinic. The average cost for routine tests, for example, can be 165% higher at a hospital outpatient department than at a stand-alone imaging center or doctor’s office, according to a report from UnitedHealth Group.

“Imaging centers are almost always cheaper than the hospital,” says McCluskey. “The hospital might push back and say their tests are better, but for the most part, unless you get into higher-end specialized services, an x-ray is an x-ray, an MRI is an MRI, and an A1c lab test at the hospital is the same test you’d get somewhere else.”

So don’t limit your search to the big hospital systems. Find freestanding and ambulatory medical centers in your area—and check their websites too. If you don’t see the price you’re looking for, give them a call. (Again, having the right CPT code can help you make sure you’re getting the right price. You don’t have to have it, but it might help.)

Use a cost comparison tool

Many price-aggregation websites allow you to compare expected prices by ZIP code. These prices won’t be specific to your provider, but they can give you a solid baseline for shopping around. Some sites to try include:

• Turquoise Health
• FairHealth
• Guroo
• ClearHealthCosts

If your health insurance plan has a price tool for members, it can usually help you get the most accurate prices for providers in your network.

Remember: It’s OK to shop around for medical care. And doing so could help you save a ton of money.

Additional sources
Per capita healthcare costs: Centers for Medicare & Medicaid Services
Only 15% of hospitals are compliant with transparency rules: Patient Rights Advocate
Hospital outpatient departments cost 165% more: UnitedHealth Group