Price Comparison
How to Compare Hospital Prices Before Surgery
The same procedure can cost 2-10x more at one hospital than another — even in the same city. With 5,426 hospitals and 25 procedures tracked on HospitalCostData, here is how to use price and quality data to make an informed choice.
Step 1: Find Your Procedure
Hospital pricing is organized by DRG (Diagnosis Related Group). Each DRG represents a specific type of hospital stay. Search for your procedure on HospitalCostData to see which DRG applies and how prices compare across hospitals.
Common high-volume procedures with the most price variation include:
- Major joint replacement (hip/knee) — DRG 470
- Spinal fusion — DRG 460
- Cardiac stent placement — DRG 247
- Cesarean section — DRG 783/785
- Appendectomy — DRG 343
Step 2: Compare Prices at Nearby Hospitals
Look at the average Medicare payment for your DRG at each hospital. This figure reflects what Medicare actually pays — not the inflated chargemaster price. While your commercial insurance will likely pay more than Medicare, the relative differences between hospitals are similar.
A hospital that receives $15,000 from Medicare for a hip replacement while a nearby hospital receives $25,000 for the same DRG is genuinely more expensive — and your out-of-pocket costs will likely be proportionally higher.
Step 3: Check Quality Ratings
Price alone is not enough. Check each hospital's CMS star rating, readmission rate, and mortality rate for your specific condition. A hospital with lower prices but higher complication rates may cost more in the long run through readmissions, extended recovery, and lost work time.
Step 4: Look at the Value Score
HospitalCostData's Value Score combines price (40%), quality rating (40%), and patient outcomes (20%) into a single A-F grade. Hospitals with an "A" grade offer the best combination of quality and affordability. This is the most practical metric for comparing hospitals because it balances cost against the quality of care you'll receive.
Step 5: Contact the Hospital for a Price Estimate
Once you've narrowed your choices, call each hospital's billing department and ask for a Good Faith Estimate for your specific procedure. If you're uninsured, you have a legal right to this estimate under the No Surprises Act. If you're insured, ask both the hospital and your insurance company what your out-of-pocket cost will be after your deductible and coinsurance.
Related Resources
Frequently Asked Questions
Yes. Since 2021, hospitals are required to publish their prices under the Hospital Price Transparency rule. HospitalCostData uses CMS Medicare IPPS data to compare what hospitals are paid for the same procedures. You can compare hospitals by procedure, location, and quality ratings. The key metric is the average Medicare payment per DRG — this reflects what hospitals actually receive, not the inflated chargemaster price.
No. Price is important, but quality matters more for complex procedures. A hospital with slightly higher prices but significantly better mortality and readmission rates may be the better value. HospitalCostData's Value Score combines price, quality, and outcomes to identify hospitals that deliver good care at a fair price.
Enormously. For common procedures like hip replacement, the average Medicare payment can vary 2-3x between hospitals in the same city. For commercially insured patients, the variation is even larger — 5-10x differences are common. This variation exists even after adjusting for patient complexity.