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Rule 09, Shop for price before service when you can

Most care is not emergency care. For elective procedures, imaging, lab work, and prescriptions, you can find the price before you commit. The variation is large enough to matter, a CT scan can cost $300 at an independent imaging center and $6,000 at a hospital outpatient department, with identical clinical quality.

The rule

For any planned service:

  1. Identify the CPT or HCPCS code your doctor is ordering.
  2. Look it up in your area using the tools below.
  3. Choose the lowest-cost facility that meets quality criteria (see [[08_avoid_unneeded_care]] for the volume-and-outcomes question).
  4. For prescriptions: check GoodRx and compare to your insurance copay before filling.

Tools by service type

Procedures and surgeries

  • Turquoise Health (turquoise.health), derived from hospital machine-readable files mandated by the CMS Hospital Price Transparency Rule. Searchable by CPT and zip.
  • Healthcare Bluebook (healthcarebluebook.com), gives a "fair price" range; older but still widely used.
  • FAIR Health Consumer (fairhealthconsumer.org), uses commercial-claims data; useful for out-of-network reasonable-and-customary disputes.
  • Surgery Center of Oklahoma (surgerycenterok.com), publishes all-inclusive cash prices for common procedures. Use as a benchmark even if you're not going there.
  • Hospital's own machine-readable file, every US hospital is required to post one under 45 CFR § 180. Search "[hospital name] price transparency machine readable file" or check the hospital's website.

Imaging (MRI, CT, X-ray, ultrasound)

Independent imaging centers are almost always cheaper than hospital outpatient imaging. Ask your doctor for an order written in a way that allows you to choose the facility, not "go to [hospital] for the MRI."

Lab work

Independent labs (Labcorp, Quest, regional independent labs) are usually cheaper than hospital lab departments. The same caveat applies: ask for the order written so you can choose the lab.

Prescriptions

  • GoodRx (goodrx.com), shows cash price at multiple pharmacies in your zip code, plus a coupon code if applicable. For many generics, GoodRx + cash is cheaper than your insurance copay.
  • Cost Plus Drugs (costplusdrugs.com), Mark Cuban's transparent-pricing pharmacy; cost-plus-15% pricing on many generics.
  • Good Shepherd Pharmacy (Memphis-based, mail-order), membership pharmacy charging a flat fee per generic per month.
  • For brand-name drugs: ask the manufacturer about patient assistance programs (PAPs); many cover the cost entirely for income-qualified patients.

Direct primary care (DPC) and health-sharing plans

These are alternatives to traditional insurance for routine care. Direct primary care: $50-$200/month flat fee for unlimited access to a primary care doctor, no insurance billing. Health-sharing ministries: members pay each other's medical bills outside the insurance system; lower premiums, no contractual obligation to pay (which is the risk).

Allen recommended these as a combination for healthy individuals in the individual market. Both have real downsides:

  • DPC doesn't cover specialists, surgery, or hospitalization.
  • Health-sharing plans are not insurance; there is no legal obligation for them to pay your claims. Some are scams.

If considering, read multiple independent reviews and confirm specifics with the plan's contract.

How to actually use the prices you find

When you find an order-of-magnitude price difference, two things matter:

  1. Get the order written portable. Ask the ordering physician for an order on letterhead (or a portal-printable order) that doesn't pre-specify the facility. With that order, you can take it to the cheapest facility.
  2. Confirm the price before the service. Call the facility, give them the CPT code, ask for the all-inclusive cash price. Get the name of the person you spoke to and the date. Get it in writing if possible.

If you have insurance, also confirm:

  • That the facility is in-network for your plan
  • The total amount the plan would pay (so you know your actual out-of-pocket)
  • Sometimes the in-network price is higher than the cash price; in that case, paying cash and submitting for out-of-network reimbursement can be cheaper

When this rule does not apply

Emergencies. You don't shop the ER. The No Surprises Act exists in part because shopping in emergency conditions is impossible.

Related rules

  • [[00_principles]], Principle 1: prices vary enormously
  • [[05_negotiate_fair_price]], for bills already received
  • [[08_avoid_unneeded_care]], the highest-leverage form of "shopping" is not buying