Frequently asked questions

What is the Price Tool?

The Price Tool offers a way to price-compare healthcare providers in your area. Whether you’re looking for a hospital, urgent care, doctor’s office, the Price Tool can be used to find high-quality care at a fair cost.

For each provider, we compare the amount that they’re charging for different healthcare services to the average costs in the surrounding area. Each provider has an overall cost percentage, which represents how expensive the provider is compared to similar providers in the area.

To use the Price Tool, enter your zip code and search for healthcare providers by type, medical specialty, or by specific procedures.

What type of healthcare providers are included in the Price Tool?

The Price Tool contains pricing information for over 1 million providers in the U.S., which includes the majority of hospitals and primary-care providers.

We include pricing information for hospitals, urgent care facilities, medical practices, and individual physicians. We also include information for some other medical needs such as flu shot providers, nutritionists, and therapists.

How are the cost percentages calculated?

There are two types of cost percentages used in the Price Tool - an overall cost percentage that is unique to each provider, and procedure cost percentages that show the price difference for individual procedures.

Overall cost percentages

Each provider in the Price Tool has a single overall cost percentage, which represents how expensive the provider is compared to similar providers in the area. For example, if a hospital has an overall cost percentage of +30%, this means that, on average, procedures at this hospital are 30% more expensive than other hospitals in the area.

The overall cost percentage is calculated by looking at all of the procedures offered by a provider, and comparing them individually to the average procedure costs in that area.

So, if a hospital offers 3 procedures (procedures A, B, and C below), we compare the amount that this hospital charges for each of these procedures to the average cost of these procedures across all hospitals in the surrounding area.

Procedures A and B are more expensive at this hospital compared to other hospitals in the area, and procedure C is less expensive at this hospital.

Since some procedures are performed more often than others, the overall cost percentage is calculated as a weighted average of the price differences - so procedures that are performed more often contribute more to the overall cost percentage than procedures performed less often.

The overall cost percentage will be calculated using (Procedure Count / Total Procedure Count) x Price Difference. Since there were 67 total procedures performed at this hospital (47 + 15 + 5), the overall cost percentage can be calculated as:

Procedure cost percentage

Procedure cost percentages display the price difference for a single procedure. For example, if one hospital charges $500 for a procedure (Procedure A below) and the average cost of this procedure is $377.89 across all hospitals in the surrounding area, then the procedure cost percentage would be +32%, since Procedure A is 32% more expensive at this hospital than other hospitals in the area.

How do I access quality of care information and patient reviews for each provider?

Patient reviews and quality of care information are available through Healthgrades. For each provider, click on the Healthgrades icon to search for the provider’s patient reviews and quality score.

How can I look up procedure volumes for each provider?

Procedure volumes (the number of times a provider performs a specific procedure) are available in each providers popup window.

In the popup window, below each procedure name will be an estimate of how commonly each procedure is performed by that provider (labelled as more common, somewhat common, or less common). The number of patient bills included under each procedure represents the number of patients that were billed for that procedure by the provider in a given calendar year.

The procedure volumes listed in the Price Tool are not comprehensive and do not represent a provider’s entire practice. The number of patient bills and relative frequencies of each procedure only reflect the billing information that we have on file for each provider. The procedure volumes in the Price Tool should be used as a rough estimate of how often each procedure is performed relative to others.

How should I know what procedure to search for?

There are many different procedures offered by hospitals and medical providers. Every operation or service that’s performed by a healthcare provider has a specific procedure code and description associated with it.

To find out what procedures may be relevant to your healthcare needs, contact your primary-care provider or community hospital.

Which procedures will I get billed for when I visit a provider?

Many patient visits will include a bill for multiple procedures. The procedures administered during your patient visit are at the discretion of the physician or medical specialist that’s treating you.

To find out what procedures may be relevant to your healthcare needs, contact your primary-care provider or community hospital.

How can I sort providers by price or distance?

At the top of search results list you should see two sorting buttons - one for price and one for distance. Click on either button to sort the list of providers. Clicking the sorting button again will reverse the order of the search results.

Will my health insurance affect these prices?

The prices displayed in the Price Tool represent the out-of-network or ‘sticker’ price for each procedure. These are the prices you would pay if you did not have health insurance or went to a provider that was out-of-network.

These prices are usually discounted when you visit a provider that is in-network with your health insurance. The amount that each procedure is discounted for in-network providers depends on your specific insurance plan and the provider you visit.

If you have insurance, we recommend using the Price Tool to find providers that are a good match for affordability and quality of care, and then checking to see which providers are covered by your insurance so that you get the in-network discount. Read below for more information on how to check if a provider is in-network with your insurance plan.

If you have health insurance, some providers (hospitals, urgent cares, doctors, etc) will be considered in-network with your insurance plan and some will be considered out-of-network.

A provider that’s in-network means that there is a contracted relationship between that provider and your insurance company. Usually, the provider has agreed to offer a discounted rate for their services to everyone with your insurance plan.

It’s important to know ahead of time whether a healthcare provider is in-network or out-of-network with your insurance plan before you go in for a patient visit. Read below for more information on how to check if a provider is in-network with your insurance plan.

If you have health insurance, it’s important to do your due diligence and check ahead of time if a provider is in-network with your insurance plan before going in for a patient visit.

Even though the in-network providers with your insurance plan will charge different prices, it will usually save you money overall to go with a provider that offers an in-network discount versus a provider that’s out-of-network.

Many insurance providers offer online tools to find providers that are in-network:

• Aetna

• Anthem

• Cigna

• Humana

• Kaiser Permanente

• Molina Healthcare

• Oscar

• United HealthCare

• WellCare

However, it’s best to call and verify that a provider is in-network directly with your insurance company. Insurance networks change frequently and the provider information from the online tool may not be up to date.

To check if a provider is in-network, call the provider’s office and ask for their tax ID number, then call your insurance company and ask if the provider is in-network with your specific plan.

It’s also important to verify with the hospital or doctor’s office that all of the procedures for your visit will be billed through the same tax ID number. Many healthcare providers will contract out-of-network providers for different services. Even if all of the services for your patient visit are performed in the same building or hospital, some of the services may be considered out-of-network. It’s best to verify directly with the healthcare provider that all of the services you need for your visit will be in-network with your plan.

Where does the pricing data come from?

Every time you visit a healthcare provider (hospital, urgent care, doctor’s office, etc) a bill is sent from that provider to your insurance company - this bill is called a claim. The insurance claim contains a list of all the procedures that were administered to you during your patient visit and the amount charged for each procedure.

We aggregate insurance claims data at scale - across all 50 states and from over 1 million providers to populate the Price Tool. The prices displayed in the Price Tool represent the average charges from these patient bills.

These prices represent the out-of-network or ‘sticker’ price for each procedure. This is the amount you would pay if you did not have health insurance or went to a provider that was out-of-network. If you have health insurance and visit a provider that’s in-network you will usually pay a discounted rate. Read more here.

How accurate is the pricing data?

The prices displayed in the Price Tool are pulled from real patient bills, and represent the average amounts that patients were charged from each provider.

Healthcare providers are allowed to update their prices as they see fit. The pricing information in the Price Tool represents the most recent data available but may not reflect the current prices that each provider is charging.

These prices represent the out-of-network or ‘sticker’ price for each procedure. If you have health insurance and visit a provider that’s in-network you will usually pay a discounted rate. Read more here.

How can I contact customer support?

If you have additional questions about the Price Tool or anything else, please feel to reach out to us through our contact page or by sending us a message at help@healthcarepricetool.com and we’ll get back to you as soon as possible.