Find average costs for common procedures and estimate your out-of-pocket costs
This tool shows the national average "allowed amount" for procedures, which is what insurance companies typically negotiate with providers.
Key Points:
Estimated Total Charge
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What provider typically charges
Estimated Insurance Payment
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What insurance covers
Your Out-of-Pocket Cost
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What you'll pay
Cash Pay Discount
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If paying without insurance
Total Charge (Billed Amount): The price the healthcare provider charges. This is typically much higher than what insurance actually pays.
Insurance Payment (Allowed Amount): The negotiated rate between insurance and the provider. You're protected from balance billing (the difference).
Your Out-of-Pocket: What you pay based on your plan terms (deductible, copay, coinsurance). This counts toward your deductible and out-of-pocket maximum.
Uninsured/Cash Pay: Uninsured patients often negotiate discounts or use payment plans. Many providers will discount 20-40% for cash payment.
Medical procedure costs vary dramatically due to geographic location, hospital type, provider negotiations, and facility overhead. Rural hospitals may charge less than urban academic medical centers. A knee replacement might cost $30,000 in one location and $60,000 in another, even within the same state. Insurance companies negotiate different 'allowed amounts' with each provider. Hospitals with newer equipment or specialized services charge more. Additionally, some hospitals operate as non-profit while others are for-profit. Using healthcare price transparency tools to compare costs before surgery can save thousands of dollars.
To estimate out-of-pocket costs, first find the procedure's typical cost using this calculator or hospital price transparency pages. Next, determine how much of your deductible you've met this year. You'll pay the full cost up to your remaining deductible, then your coinsurance percentage (typically 20-30%) on amounts above the deductible. Finally, cap it at your remaining out-of-pocket maximum. For example, if you have a $1,500 deductible remaining and a $3,000 procedure with 20% coinsurance, you'd pay $1,500 (deductible) + $300 (20% of remaining $1,500) = $1,800 total.
The Hospital Price Transparency Rule, effective since 2021, requires hospitals to publicly display standard charges (negotiated rates) for common procedures and services. This allows patients to compare prices before scheduling elective procedures. You can typically find price lists on hospital websites, often searchable by procedure. CMS (Centers for Medicare & Medicaid Services) also maintains a database of hospital charges. While these prices show 'negotiated rates' rather than what you'll personally owe, they give a baseline for comparison and help you identify which facilities offer better value for planned procedures.
This depends on your specific situation. Use insurance if your deductible is nearly met or you're close to your out-of-pocket maximum, as costs then count toward these limits and may be covered quickly. Pay cash if your deductible is high and far from being met - many providers offer 20-40% discounts for upfront cash payment, making it cheaper than insurance coinsurance. Ask the provider for their cash price upfront. Never use a discount card (like GoodRx) for procedures since those don't go toward your deductible. For major surgeries, always use insurance. For minor procedures, compare the negotiated rate your insurance would pay versus the cash discount offered.
Contact the hospital's billing department within 30 days of receiving your bill and request an itemized statement. Review it for errors or duplicate charges. If you received unexpected out-of-network care, you can dispute those charges. Many hospitals have financial assistance programs for low-income patients that can reduce or forgive bills. You can also request a discount for paying upfront or in full. If you received care from an out-of-network provider without consent, you may be protected from balance billing. Some facilities use third-party advocates to negotiate on your behalf. Payment plans with zero interest are often available even after billing.
Yes, your privacy is fully protected. This calculator runs entirely in your browser and performs all cost calculations locally on your device. No personal information, medical data, or financial information is sent to our servers or any third party. We do not collect, store, or track any data you enter. No cookies or analytics are used to identify you. Your usage is completely anonymous. This is an educational tool only - for actual medical consultations or billing questions, consult with your healthcare provider or hospital directly.