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)
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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%
633 hospitals compared
Cash (median)
$9,603
Insurance (median)
$17,537
Cash saves you
$7,934

Spinal Fusion (Lumbar)

+113%
180 hospitals compared
Cash (median)
$5,418
Insurance (median)
$11,543
Cash saves you
$6,125

Shoulder Replacement

+120%
279 hospitals compared
Cash (median)
$3,866
Insurance (median)
$8,503
Cash saves you
$4,637
View full table →

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%
1,089 hospitals compared
Cash (median)
$1,677
Insurance (median)
$1,223
Insurance saves you
$454

CT Pulmonary Angiography (CTPA)

-25%
1,097 hospitals compared
Cash (median)
$1,723
Insurance (median)
$1,288
Insurance saves you
$435

CT Spine (Cervical)

-13%
1,108 hospitals compared
Cash (median)
$1,256
Insurance (median)
$1,089
Insurance saves you
$166
View full table →

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
6.6×
Total Knee Replacement
Cash
$34,243
Insurance
$225,698
Extra cost: $191,455
#2

Adventhealth Durand

Durand, WI
7.7×
Pacemaker Insertion
Cash
$5,304
Insurance
$40,699
Extra cost: $35,395
#3

St. Clare Hospital

Lakewood, WA
7.0×
Pacemaker Insertion
Cash
$5,738
Insurance
$40,072
Extra cost: $34,334

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.