Find Out How Much Your Medical Care Should Cost

Updated July 17, 2014.

Need health care but don’t know how much it will cost? It’s no simple task to ferret out the best price for the health care you need. The price for even routine things like X-rays can vary by hundreds of dollars just across town. To make things worse, prices are rarely published and many providers tweak prices from person to person and from health insurance company to health insurance company.

Whether it’s a simple office visit, a complex surgery, or an imaging study like an MRI, you’re likely to have trouble finding out how much your medical care should cost, or what others are paying for the same service.

Here are some resources to help.

Your Health Insurance Company

If you have health insurance, check your health insurance company’s website. Many of them have cost calculators that will help you estimate your share of the cost for different types of medical care. Be aware that you may pay a different amount for different in-network providers, especially if the medical care you need requires you to pay coinsurance rather than a copay. Learn more about this in “Why Using an In-Network Provider Isn’t Always the Best Deal.”

If you’re uninsured, going out-of-network, or need to know a self-pay price for other reasons, try these resources.

Healthcare Bluebook

Healthcare Bluebook allows you to type in your zip code to look up what it deems to be a “Fair Price” for a myriad of health care services including:

• Hospitalization for specific ailments or specific surgical procedures.
• Physician services, further divided into office visits, tests, procedures, and more.
• X-rays and imaging tests like MRIs, ultrasounds, and mammograms.

• Laboratory services including hundreds of types of blood tests.
• Cosmetic procedures like face lifts, breast implants, and Botox injections.
• Medications.
• Dental procedures.
• Hearing aids.

This website also provides a pricing agreement you can print out and take with you to your doctor’s office, hospital, surgery center, or other health care provider. The print out explains what’s included in Healthcare Bluebook’s “Fair Price” estimate and is intended to be used as both a negotiating tool and a binding estimate when signed by your health care provider.

ClearHealthCosts.com

ClearHealthCosts.com allows you to look up what it thinks is the going rate for self-pay medical procedures and office visits. It also shows how much Medicare pays for the same procedure which can give you a starting point for negotiating prices.

While you’ll find a lot of information here, you won’t find detailed information for every geographic area and every procedure known to mankind. This is a problem if you don’t live in one of the areas ClearHealthCosts specializes in since health care prices vary significantly from one geographic area to another.

However, ClearHealthCosts.com provides another invaluable service: it allows you to type in the name of a procedure and get that procedure’s CPT or HCPCS code.

In the health care world, anything that can be paid for has an insurance code to describe it. You’re more likely to get an accurate cost estimate if you’re using the correct code to describe the procedure. Here, you’ll be able to retrieve the code you need by typing in the name of the procedure and choosing from a drop down menu.

Unable to find what you’re looking for at ClearHealthCosts.com or can’t find information about your geographic area? Try Fair Health.

GoodRx

GoodRx allows you to comparison shop for prescription drug costs. Enter the name of your medication and your zip code; GoodRx will show prices at several of your local pharmacies. Select one of several different dosage strengths to make your search more accurate, and choose the number of pills included in your prescription. If you’re not sure how to find this information on your prescription, read “Prescription Abbreviations: Understanding What Your Doctor Writes on a Prescription.”

Have an electronic prescription? Don’t worry. As long as you know the name, dosage, and number of pills, you can still use the GoodRx site. If your doctor sent the electronic prescription to a pharmacy that isn’t the best deal, you can request that pharmacy transfer the prescription to the pharmacy of your choice.

However, be careful about using multiple pharmacies. One of the services a good pharmacy provides is to check each new prescription against your current prescriptions to make sure there won’t be any potentially harmful medication interactions. If you have your blood pressure prescription filled at pharmacy A, your arthritis prescription filled at pharmacy B, and your antidepressant filled at pharmacy C, no single pharmacist will have the big picture. This makes it less likely that a potentially harmful drug interaction will be caught.

Caveat Emptor & Being a Savvy Consumer

Whenever you’re using a website, whether it be one of the websites above or another one you’ve discovered through your own research, be a savvy consumer. If you’re trying to find out how much your medical care should cost and the website you’re using suggests it can get you a discounted price with one of its “select” providers, don’t just take the bait. First, ask yourself what’s behind that offer.

Is the website earning money from this provider for shunting business to him or her? If so, is it providing open, honest disclosure about that relationship? Are the cost estimates it’s providing accurate or are they influenced by that financial relationship? Does the discounted provider have good quality ratings?

When looking at the cost of medical care, cost isn’t the only important factor. For example, consider one  surgeon who has performed the surgery you need hundreds of times and has a low complication rate versus another surgeon with less experience or one a higher complication rate. You might be willing to pay more for the more experienced surgeon.

Also, ask yourself if you really need the care, visit, or procedure you’re seeking pricing information for. Make sure it’s the most appropriate care option for you.  Learn more about this in "How To Decide if You Really Need a Test or Procedure."