1. Getting Started
PriceCheckMD helps you find and compare healthcare prices before you receive care. Our database contains real negotiated rates from insurance companies, giving you accurate pricing information.
To start searching, simply enter a procedure name (like "MRI" or "blood test") or a billing code (like "99213" or "J1055") in the search box on the home page.
2. Understanding Billing Codes
Healthcare services are identified by standardized billing codes. The most common types are:
- CPT Codes: Five-digit codes for medical procedures (e.g., 99213 for an office visit)
- HCPCS Codes: Alphanumeric codes often starting with a letter (e.g., J1055 for injectable medications)
If you don't know the billing code, you can search by description (e.g., "knee replacement" or "colonoscopy").
3. Reading Search Results
Each search result shows:
- Billing Code: The CPT or HCPCS code for the service
- Description: A brief description of the procedure
- Negotiated Rate: The price the insurance company has agreed to pay
- Payer Name: The insurance company
- Plan Name: The specific insurance plan
- Billing Class: Whether it's a professional or institutional fee
4. Professional vs. Institutional Fees
Healthcare billing often has two components:
- Professional fees: Payment to the doctor or clinician for their services
- Institutional/Facility fees: Payment to the hospital or facility for use of equipment, rooms, etc.
For a complete picture of costs, you may need to add both fees together.
5. What These Prices Mean for You
The negotiated rates shown are what insurance companies pay providers. Your actual out-of-pocket cost depends on:
- Your deductible (how much you pay before insurance kicks in)
- Your coinsurance (your percentage of costs after deductible)
- Your copay (fixed amount per visit)
- Your out-of-pocket maximum
Check your insurance plan details or contact your insurer for specific coverage information.
6. Tips for Saving Money
- Compare prices across different providers for the same service
- Ask your doctor if a procedure can be done at an outpatient facility instead of a hospital
- Request a cost estimate from your provider before scheduling
- Check if there are generic or alternative treatments available
- Review your bill carefully and dispute any errors
7. Bill Reconciliation
After receiving care, you can use PriceCheckMD to verify your bill:
- Find the billing codes on your Explanation of Benefits (EOB) or medical bill
- Search for those codes in PriceCheckMD
- Compare the negotiated rate shown to what was charged
- If there's a significant discrepancy, contact your insurance company or the billing department