Orms&d optimizer smart ipg
Price distribution
Each bar = number of hospitals charging in that price range. Emerald bar contains the median. Amber dots = entries we flagged as likely partial-cost line items (excluded from the table below).
Why some prices look unrealistically low or high
Hospitals publish their machine-readable files (MRFs) the way they choose. A single procedure code can appear with very different prices depending on what's being charged:
- Global price — facility + implant + anesthesia + surgeon. This is what you'd actually be billed.
- Professional fee only — surgeon's portion. Often $500–$2,500 for a major procedure that costs $20K+ globally.
- Facility fee only — operating room and recovery, no implant or surgeon.
- Per-unit / per-minute charges — e.g. anesthesia time billed at $0.68/min appearing under a CPT code.
- Rate multipliers — values like 0.85 meaning "85% of Medicare" rather than dollars.
We filter the most obvious artifacts (under $50, or 25× above the median), but rows in the $500–$2K range for a major procedure are typically professional-only and we can't always tell. Use the median and high-end as the realistic range; treat very low rows as partial-cost line items, not full bills.
| Hospital | State | Gross | Cash price | Min negotiated | Max negotiated | Your insurer |
|---|---|---|---|---|---|---|
| CHSLI ST JOSEPH HOSPITAL | NY | $132,250 | — | $23,805 | $132,250 | 5 insurers |
Data straight from each hospital's federally-mandated machine-readable file (45 CFR § 180). Prices reflect what the hospital published; what you actually pay depends on your specific plan, deductible, and other factors. "Cash price" is the discounted self-pay rate hospitals are required to publish for uninsured patients.