Cash vs Insurance
58% of the time, the insurance price is higher than cash.
Hospitals publish both "cash/self‑pay" prices and insurer‑negotiated rates. We compared the two across 2,134 hospitals using official price‑transparency files.
When insurance costs more, the median overcharge is $767. When insurance saves you money, the median savings is just $99.
20,822,928
price records analyzed
2,134
hospitals in the dataset
110
procedures compared
18%
average procedure markup (median‑based)
Where cash tends to save the most
Big-ticket procedures where the median gap (insurance minus cash) is at least $1,000.
Pacemaker Insertion
+83%Cash (median)
$9,603
Insurance (median)
$17,537
Median difference
$7,934
Spinal Fusion (Lumbar)
+113%Cash (median)
$5,418
Insurance (median)
$11,543
Median difference
$6,125
Shoulder Replacement
+120%Cash (median)
$3,866
Insurance (median)
$8,503
Median difference
$4,637
Where insurance tends to save the most
Procedures where the median insurance‑negotiated rate is lower than cash — sometimes by $500 or more.
CTA Head
-27%Cash (median)
$1,677
Insurance (median)
$1,223
Insurance saves you
$454
CT Pulmonary Angiography (CTPA)
-25%Cash (median)
$1,723
Insurance (median)
$1,288
Insurance saves you
$435
CT Spine (Cervical)
-13%Cash (median)
$1,256
Insurance (median)
$1,089
Insurance saves you
$166
Real examples from individual hospitals
A curated set of extreme gaps (unique hospitals) to show how large the spread can be.
#1
Adventhealth North Pinellas
Tarpon Springs, FL
Total Knee Replacement
Cash
$34,243
Insurance
$225,698
Extra cost: $191,455
#2
Adventhealth Durand
Durand, WI
Pacemaker Insertion
Cash
$5,304
Insurance
$40,699
Extra cost: $35,395
#3
St. Clare Hospital
Lakewood, WA
Pacemaker Insertion
Cash
$5,738
Insurance
$40,072
Extra cost: $34,334
#4
St. Anthony Hospital
Gig Harbor, WA
Pacemaker Insertion
Cash
$6,054
Insurance
$40,158
Extra cost: $34,104
How to pay less
Practical steps that work regardless of whether you have insurance.
1
Ask for the cash/self‑pay price
Before scheduling, ask for the self‑pay or "prompt pay" amount. It's often dramatically lower.
2
Request an itemized estimate
Ask for the CPT/HCPCS codes and line items so you can compare apples‑to‑apples.
3
Shop around first
Use our procedure comparison tool
to see the range before you book.
Cash vs insurance, by procedure
Each row shows median cash and insurance‑negotiated prices across hospitals that report both.
All procedures
110 rows
| Procedure | Hospitals | Cash | Insurance | Markup |
|---|---|---|---|---|
| IV Hydration/Infusion | 1,062 | $98 | $254 | +158% |
| Radiofrequency Ablation (Spine) | 631 | $853 | $1,976 | +132% |
| Tubal Ligation | 359 | $1,479 | $3,250 | +120% |
| Shoulder Replacement | 279 | $3,866 | $8,503 | +120% |
| Spinal Fusion (Lumbar) | 180 | $5,418 | $11,543 | +113% |
| Shoulder Arthroscopy | 330 | $1,793 | $3,688 | +106% |
| Myomectomy (Fibroid Removal) | 220 | $1,866 | $3,828 | +105% |
| Chemotherapy Infusion | 908 | $183 | $358 | +96% |
| Umbilical Hernia Repair | 158 | $1,803 | $3,533 | +96% |
| Facet Joint Injection | 682 | $464 | $902 | +94% |
| Thyroid Panel (TSH, T4, T3) | 1,090 | $31 | $57 | +88% |
| Appendectomy | 392 | $2,146 | $3,980 | +85% |
| Transforaminal Epidural Injection | 783 | $686 | $1,254 | +83% |
| Pacemaker Insertion | 633 | $9,603 | $17,537 | +83% |
| Tonsillectomy | 304 | $2,093 | $3,644 | +74% |
| Inguinal Hernia Repair | 470 | $2,392 | $4,066 | +70% |
| Echocardiogram | 1,072 | $527 | $893 | +69% |
| Skin Lesion Excision | 798 | $445 | $745 | +68% |
| IUD Insertion | 802 | $261 | $433 | +66% |
| Lumpectomy | 342 | $2,130 | $3,369 | +58% |
| Ventral/Incisional Hernia Repair | 144 | $2,277 | $3,479 | +53% |
| Gallbladder Removal (Cholecystectomy) | 444 | $3,028 | $4,470 | +48% |
| Cardiac Catheterization | 652 | $4,590 | $6,719 | +46% |
| Knee Arthroscopy | 374 | $2,134 | $3,104 | +45% |
| Bunion Surgery (Bunionectomy) | 343 | $3,180 | $4,512 | +42% |
| Rotator Cuff Repair | 327 | $3,851 | $5,352 | +39% |
| Vasectomy | 397 | $1,371 | $1,906 | +39% |
| Vaginal Delivery | 657 | $2,100 | $2,923 | +39% |
| Breast Biopsy | 929 | $1,546 | $2,128 | +38% |
| Trigger Point Injection | 937 | $335 | $460 | +38% |
| Total Hip Replacement | 285 | $4,338 | $5,896 | +36% |
| Total Knee Replacement | 340 | $6,760 | $9,024 | +33% |
| ERCP | 407 | $3,011 | $3,971 | +32% |
| Coagulation Panel (PT/INR, PTT) | 1,098 | $24 | $32 | +31% |
| Hysterectomy (Laparoscopic) | 287 | $5,035 | $6,613 | +31% |
| Event Monitor (30-Day) | 697 | $192 | $249 | +30% |
| Upper Endoscopy (EGD) | 699 | $1,059 | $1,380 | +30% |
| Epidural Steroid Injection (Lumbar) | 837 | $904 | $1,162 | +29% |
| Low-Dose CT Lung Cancer Screening | 919 | $286 | $370 | +29% |
| Cardioversion | 1,021 | $819 | $1,052 | +28% |
| Sacroiliac Joint Injection | 658 | $750 | $960 | +28% |
| Physical Therapy Session | 1,066 | $76 | $98 | +28% |
| Iron Studies | 1,082 | $37 | $47 | +27% |
| Ultrasound OB (Pregnancy) | 1,059 | $290 | $369 | +27% |
| Medial Branch Block | 772 | $1,092 | $1,366 | +25% |
| Epidural Steroid Injection (Cervical) | 773 | $938 | $1,165 | +24% |
| Ultrasound Pelvis | 1,102 | $302 | $367 | +22% |
| EKG/ECG | 1,062 | $138 | $168 | +22% |
| Glaucoma Surgery (Trabeculectomy) | 125 | $2,918 | $3,543 | +21% |
| Holter Monitor (24-Hour) | 928 | $275 | $329 | +20% |
| X-Ray Chest | 1,099 | $175 | $210 | +20% |
| Flexible Sigmoidoscopy | 615 | $924 | $1,094 | +18% |
| Physical Therapy Evaluation | 1,047 | $178 | $209 | +18% |
| DEXA Bone Density | 983 | $204 | $238 | +16% |
| Esophageal Dilation | 571 | $1,728 | $1,988 | +15% |
| C-Section | 273 | $2,354 | $2,718 | +15% |
| Endometrial Ablation | 365 | $3,849 | $4,378 | +14% |
| Carpal Tunnel Release | 456 | $2,010 | $2,296 | +14% |
| Hysterectomy (Vaginal) | 242 | $3,181 | $3,597 | +13% |
| Glucose (Fasting) | 1,089 | $26 | $29 | +13% |
| Capsule Endoscopy | 475 | $1,557 | $1,743 | +12% |
| Nuclear Stress Test (Myocardial Perfusion) | 949 | $1,830 | $2,038 | +11% |
| X-Ray Knee | 1,049 | $206 | $228 | +10% |
| Venous Doppler (Lower Extremity) | 1,094 | $562 | $610 | +9% |
| Intravitreal Injection | 219 | $560 | $610 | +9% |
| Cardiac Stress Test | 980 | $521 | $564 | +8% |
| Cataract Surgery | 262 | $2,751 | $2,964 | +8% |
| ACL Reconstruction | 297 | $5,565 | $5,967 | +7% |
| Mammogram | 955 | $210 | $223 | +6% |
| Bone Scan (Nuclear) | 985 | $848 | $896 | +6% |
| Hysteroscopy | 453 | $2,915 | $3,095 | +6% |
| PET Scan (Whole Body) | 702 | $3,213 | $3,362 | +5% |
| PSA (Prostate Cancer Screen) | 1,069 | $65 | $68 | +5% |
| MRI Wrist/Hand | 1,031 | $1,585 | $1,627 | +3% |
| Retinal Detachment Repair | 112 | $4,794 | $4,896 | +2% |
| MRI Ankle/Foot | 1,032 | $1,590 | $1,608 | +1% |
| Stress Echocardiogram | 871 | $1,031 | $1,039 | +1% |
| X-Ray Spine (Lumbar) | 1,089 | $275 | $274 | 0% |
| Trigger Finger Release | 441 | $1,854 | $1,859 | +0% |
| MRI Orbit/Face/Neck | 1,060 | $1,511 | $1,498 | -1% |
| Hysterectomy (Abdominal) | 206 | $1,925 | $1,898 | -1% |
| MRI Abdomen | 1,074 | $1,600 | $1,552 | -3% |
| Ultrasound Breast | 1,009 | $295 | $287 | -3% |
| CT Sinuses | 1,101 | $1,011 | $970 | -4% |
| Lumbar Discectomy/Laminectomy | 207 | $6,779 | $6,526 | -4% |
| CT Chest | 1,107 | $1,103 | $1,062 | -4% |
| Ultrasound Abdomen | 1,102 | $451 | $431 | -4% |
| MRI Pelvis | 1,068 | $1,582 | $1,495 | -5% |
| CT Neck (Soft Tissue) | 1,099 | $1,072 | $1,013 | -5% |
| MRI Brain | 1,082 | $1,648 | $1,561 | -5% |
| MRI Spine (Thoracic) | 1,079 | $1,653 | $1,566 | -5% |
| MRI Spine (Cervical) | 1,076 | $1,674 | $1,578 | -6% |
| Complete Blood Count (CBC) | 1,089 | $44 | $40 | -7% |
| MRI Spine (Lumbar) | 1,080 | $1,693 | $1,567 | -7% |
| CT Pelvis | 1,102 | $1,130 | $1,036 | -8% |
| MRA Neck | 1,042 | $1,530 | $1,411 | -8% |
| Lipid Panel | 1,084 | $70 | $64 | -8% |
| Hemoglobin A1C | 1,088 | $48 | $45 | -8% |
| MRA Brain | 1,074 | $1,561 | $1,416 | -9% |
| CT Head | 1,107 | $1,109 | $1,003 | -10% |
| CT Abdomen & Pelvis | 1,109 | $1,906 | $1,700 | -11% |
| CT Spine (Lumbar) | 1,099 | $1,251 | $1,104 | -12% |
| CT Spine (Cervical) | 1,108 | $1,256 | $1,089 | -13% |
| Vitamin D Level | 1,075 | $110 | $95 | -14% |
| Ultrasound Thyroid | 1,082 | $476 | $390 | -18% |
| CT Pulmonary Angiography (CTPA) | 1,097 | $1,723 | $1,288 | -25% |
| CTA Head | 1,089 | $1,677 | $1,223 | -27% |
| Basic Metabolic Panel (BMP) | 1,082 | $84 | $61 | -28% |
| Liver Function Panel | 1,080 | $93 | $65 | -30% |
| Comprehensive Metabolic Panel (CMP) | 1,084 | $115 | $80 | -31% |
Methodology
Source: official CMS hospital price transparency files.
- We compare each hospital's minimum cash price to its average negotiated (insurance) rate for the same procedure.
- Procedure medians reduce the impact of outliers.
- Included procedures have 50+ hospitals with both price types.