Estimates Don’t Work
When hospitals and insurance companies don’t post their upfront prices, they can charge you whatever they want. That’s why medical debt is the leading cause of personal bankruptcy in America.
Estimates are not binding, do not hold hospitals accountable, and leave patients vulnerable to overcharges, errors, and fraud.
88% of registered voters believe that hospitals should be required to post all actual prices, not estimates, in advance of planned care, according to an April 2023 poll. That’s because millions of Americans have been impacted by surprise bills.
A Colorado patient faces $75,116 in medical debt after a hysterectomy at Avista Adventist Hospital, whose estimator tool displays an estimate of only $8,088 for the procedure.
A South Carolina patient was billed $8,424 for a breast biopsy after receiving a $1,400 estimate.
Real prices — not estimates — protect patients and lower costs.
Rush University Medical Center in Chicago, Illinois clearly posts its upfront prices so consumers can spot the wide price variation.
| CODE CPT/HCPCS | CODE DESCRIPTION | GROSS CHARGE | DE-IDENTIFIED MINIMUM NEGOTIATED | DE-IDENTIFIED MAXIMUM NEGOTIATED | DISCOUNTED CASH PRICE | AETNA INTERNATIONAL (501036) | AETNA SIGNATURE ADMINISTRATOR | CIGNA HEALTH - HMO (517030) |
|---|---|---|---|---|---|---|---|---|
| J9030 | BCG LIVE INTRA VAC INSTAL 1VAC | $959.75 | $188.38 | $873.37 | $479.88 | $633.44 | $537.46 | $188.38 |
| J9040 | BLEOMYCIN SULFATE INJ 15J | $546.00 | $180.18 | $496.86 | $273.00 | $360.36 | $305.76 | $449.37 |
| J9065 | CLADRIBINE INJECTION 1MG | $277.75 | $91.66 | $334.27 | $138.88 | $183.32 | $155.54 | $334.27 |
| J9190 | FLUOROURACIL INJECTION 500MG | $22.25 | $7.34 | $86.52 | $11.13 | $14.69 | $12.46 | $86.52 |
| J9214 | INTERFERON ALFA/2B INJ 1 MILL U | $94.25 | $31.10 | $329.86 | $47.13 | $62.21 | $52.78 | $329.86 |
| J9209 | MESNA INJECTION 200MG | $76.50 | $25.25 | $69.62 | $38.25 | $50.49 | $42.84 | $26.10 |
| J9280 | MITOMYCIN INJECTION 5MG | $282.75 | $93.31 | $316.52 | $141.38 | $186.62 | $158.34 | $316.52 |
| J2405 | ONDANSETRON INJ 1 MG | $21.50 | $7.10 | $19.57 | $10.75 | $14.19 | $12.04 | $18.52 |
| J2430 | PAMIDRONATE INJ 30 MG | $486.25 | $48.30 | $442.49 | $243.13 | $320.93 | $272.30 | $48.30 |
| J9310 | RITUXIMAB INJECTION 100 MG | $2,725.25 | $899.33 | $9,260.13 | $21,362.63 | $1,798.67 | $1,526.14 | $9,260.13 |
Transparent facilities like Walmart Health Clinics offer upfront, guaranteed prices.
Walmart Health Services Summary Price List
| Primary & Urgent Care | |
|---|---|
| Office visit | $40 |
| Annual checkup | $30 |
| Annual checkup - youth | $20 |
| Add-ons | |
| Lipid test | $10 |
| A1C test | $10 |
| Dental | ||
|---|---|---|
| Patient exam (including X-Rays) | $40 | |
| Teeth cleaning - adult | starting at | $25 |
| Teeth cleaning - youth | starting at | $15 |
| Porcelain crown | $675* | |
| Teeth whitening | $225 | |
| Deep Cleaning (per quad) | $75 |
| Optometry | |
|---|---|
| Routine vision exam | $45 |
| Contact lens fitting | $55 |
| Hearing | |
|---|---|
| Hearing Exam | Free |
Several price transparent surgical centers, such as the Surgery Center of Oklahoma and Texas Free Market Surgery have long published their guaranteed, all-in surgery prices, which are small fractions of what the big hospital systems charge.
| Procedure/Surgery | Cost |
|---|---|
| Bone Marrow Biopsy (includes pathology)i | $6,330* |
| Fluoroscopic Hip Injection with Anesthesiai | $3,040* |
| Hip Arthroplasty (hip replacement)i | $17,579* |
