How to price a procedure without insurance: the worksheet

The worksheet at a glance

Step	What you end up holding	Where it comes from
1. The exact code	The CPT code and descriptor for your procedure	The order from your clinician, matched on a procedure page
2. The anchor	The published Medicare payment amount for that code, by setting	The procedure pages and the Price Anchor Explorer on this site
3. The cash price	Each facility's all-in cash price, in writing	The billing office, asked the same question at each facility
4. The estimate	That written price as a Good Faith Estimate	The provider or facility, under the No Surprises Act
5. The setting comparison	The same code priced in each setting that offers it	Your worksheet rows, side by side
6. The confirmation	The chosen price, confirmed in writing before service	The facility you book with

Run the steps in order. Each step produces the document the next step needs: the code makes the anchor lookup possible, the anchor tells you whether a cash price is in a plausible range, and the written estimate is what the final bill gets compared against.

Step 1: Get the exact code before you price anything

A price question without a code gets a vague answer. Ask the ordering clinician's office for the CPT code that will be billed, and write down the descriptor next to it. Then match the code against the procedure pages on this site: each page prints the code, the descriptor, and what the price includes and excludes, so a quote for one code is never mistaken for a quote for its neighbour. The CPT code guide walks through that matching step in full, including the paired codes, such as with contrast and without contrast, that change the price before any facility is involved.

Ask one more question at the same time: who else will bill? A facility, the clinician who performs the service, and separate anesthesia, pathology, or imaging groups can each send their own bill. The worksheet below has a row for each layer, because a price that covers only the facility layer is not the price of the procedure.

Step 2: Read the Medicare anchor for that code, in both settings

Before you call anyone, read the verified Medicare anchor for your code. The anchor is a published payment amount, not a price quote and not your bill. Its job on this worksheet is order of magnitude: it tells you the scale of the payment Medicare makes for the same code, so a cash price can be judged against something other than the first number a billing office says out loud.

Read the anchor for both settings, because setting is the lever that moves this price most. Take CPT 70551, magnetic resonance imaging of the brain without contrast, from the checked-in data on this site. In an office or imaging center, the Medicare Physician Fee Schedule global anchor is $192.65 (CY2026, Michigan Locality 01, verified 2026-10-18). In a hospital outpatient department, the same code is paid in two layers: an OPPS facility payment of $243.77 for 70551 billed alone (single-service APC 5523, CY2026 national unadjusted rate, verified 2026-10-22) plus a professional component of $69.04 billed separately. The $537.85 MRI composite (APC 8007) applies only when several qualifying MRI studies are on one claim (multi-study only, national unadjusted). The layers are printed separately here on purpose: no source publishes them as one total, and your worksheet keeps them separate for the same reason. Your own locality amount will differ from the Michigan Locality 01 figure. The MRI without contrast procedure page carries the full anchor block for this code, and the Price Anchor Explorer does the same lookup for all 30 procedures this site covers.

Step 3: Ask each facility for the all-in cash price, in writing

Now call the billing office or patient financial services at each facility you are considering, and ask the same question in the same words: the all-in cash price for that exact CPT code, in that exact setting, with the layers named. The cash-price guide is the script for this call, including the question most people forget: what happens to the price if the plan changes on the day. Ask what the figure includes and what it leaves out, ask what is due at check-in, and write down the figure, the date, and the name of the person who gave it.

Compare like with like as the answers come in. A facility-only figure and an all-in figure are not two prices for the same thing. If a facility quotes only its own layer, note the missing layers on the worksheet rather than treating the partial figure as the lower price.

Step 4: Have the written price issued as your Good Faith Estimate

If you are uninsured, or you have insurance but choose not to use it for this service, CMS states that you can get a Good Faith Estimate of the expected charges before you receive care. Ask for the written cash price from Step 3 in that form. The estimate should list the expected charges for the primary item or service and the items and services reasonably expected in connection with it, with co-providers and co-facilities reflected through the convening provider or facility that coordinates the estimate. The Good Faith Estimate guide covers what the estimate must list and how updates work.

Your situation	When the estimate is due
You schedule the service at least 3 business days in advance	No later than 1 business day after the date of scheduling
You schedule the service at least 10 business days in advance	No later than 3 business days after the date of scheduling
You ask for an estimate without scheduling	No later than 3 business days after the date of your request

The timing table is why the worksheet runs before booking, not after. Scheduling inside 3 business days can leave no room for the estimate to arrive before the service. People enrolled in federal health care programs, including Medicare and Medicaid, are not entitled to a Good Faith Estimate under the CMS rules, even when a service is not covered or they do not intend to use their coverage. For everyone the right covers, the estimate is also a shopping document: CMS describes it as something you can request before you schedule, to compare providers before you choose one.

Recurring care compresses the paperwork rather than repeating it. A provider may issue a single Good Faith Estimate for recurring items or services, such as a series of physical therapy visits, covering a scope of no more than 12 months, with the frequency and the total number of services stated. If your procedure comes with a series attached, ask whether the series sits inside the same estimate or needs its own, and write the 12 month limit next to the estimate's start date so the scope can be checked later without guessing.

What the estimate does not do

Three limits keep the worksheet honest. First, the estimate is not a cap. It is a good faith listing of expected items, codes, and charges, and a bill below the $400 dispute threshold, or a bill changed by a documented change in the plan, is settled by explanation rather than by the dispute process. Second, the estimate covers the providers it lists. Anesthesia, pathology, or a clinician group that was never reflected through the convening provider is a gap to raise before service, because a biller who never appeared in the estimate is harder to challenge after it. Third, the estimate right belongs to scheduled, shoppable care. CMS notes that you will not get a Good Faith Estimate during emergency care, where the protections work differently; the urgent care and ER guide covers the emergency side of the line. None of these limits weakens the worksheet. They mark where it stops, which is what makes the part inside the line worth holding firmly.

Step 5: Compare the settings, not just the totals

Lay the worksheet rows side by side, one column per facility. The same CPT code is paid under two different systems in the two settings, which is why the hospital outpatient column usually carries a facility layer the imaging center column does not. The setting comparison guide explains that split with verified anchors for 11 procedures, and the facility types pages describe what each setting is. Compare the all-in written figure for each setting, then check the inclusions row by row: a lower figure that excludes a layer the other figure includes is not yet a lower price.

Worksheet row	CPT code	Medicare anchor (setting and year)	Facility A written cash price	Facility B written cash price	Good Faith Estimate figure
Facility layer
Professional layer
Anesthesia, if it applies
Pathology, if it applies
What is due at check-in

The procedure quote worksheet on this site holds these rows in a form you can fill in as the calls come back. Fill in the anchor column from the procedure page first, so each cash price is read against its anchor as it arrives, not reconstructed later from memory.

Some procedures have a third column worth adding. An ambulatory surgery center is a facility built only for outpatient procedures, paid under its own Medicare payment system, separate from both the Physician Fee Schedule and OPPS. Colonoscopy is the standing example on this site: the professional fee is one layer, and the facility layer is priced differently at a hospital outpatient department, a surgery center, and an office endoscopy suite. If a surgery center is among your options, give it its own worksheet column rather than averaging it into the hospital column, and ask it the same all-in question, layers named, in writing.

The worksheet filled in, with made-up numbers

This illustration is hypothetical. The cash figures are invented for the arithmetic only and are not prices charged by any real facility. Suppose your code is CPT 70551, the brain MRI without contrast from Step 2. An imaging center gives you a written all-in cash price of $450, issued as your Good Faith Estimate, covering the facility and professional layers in one figure. A hospital outpatient department gives you a written estimate with two lines: a facility layer of $1,150 and a professional layer of $140. The hospital's listed layers total $1,150 plus $140, which is $1,290. The difference between the two written prices is $1,290 minus $450, which is $840. Read against the anchors from Step 2, the imaging center figure sits above the $192.65 PFS global anchor, and the hospital facility layer sits above the $243.77 single-service OPPS anchor: both are plausible orders of magnitude, and the worksheet, not the anchor, is what chooses between them. Now suppose you book at the hospital and the final bill from that facility totals $1,790 against its $1,290 estimate. The bill is $1,790 minus $1,290, which is $500 more than the estimate from that provider. That passes the federal dispute threshold in Step 6.

Step 6: Confirm in writing, then hold the bill against the estimate

Book only when the chosen facility has confirmed the price in writing, as the Good Faith Estimate, with the layers listed. Keep the estimate, any revised estimate, and the booking confirmation together. If the scope changes before the service, a new estimate must reach you no later than 1 business day before the service, with the changes explained: save both versions, with dates.

The paper trail this worksheet produces is short enough to keep in one folder: the order showing the CPT code; the anchor printout or note for that code in both settings; each facility's written cash price with the date and the name of the person who gave it; the Good Faith Estimate and any revision, each with the date received; and the booking confirmation naming what is due at check-in. That folder is the whole negotiation file if anything is later disputed, and it is assembled here, while the documents are arriving one at a time, rather than reconstructed from a portal and a memory after the bill lands. If a document on the list is missing, the missing one names the next call to make.

When the bill arrives, compare it provider by provider, not as one episode total. CMS states the dispute test this way: if the billed amount is at least $400 more than the Good Faith Estimate provided by that provider or facility, you may be able to dispute the bill through the federal patient-provider dispute resolution process, and the dispute is started within 120 days of the date on the initial bill. The Good Faith Estimate checker runs that comparison one provider at a time. If the bill matches the estimate but a line looks wrong on its own, the checking procedure is the itemized-bill check. If the bill is correct and the problem is paying it, the next step is the call in the negotiation guide.

Self-pay pricing errors to catch early

• Getting a verbal quote and treating it as the price, when nothing in writing carries the dispute protection.
• Comparing one facility's facility-only figure against another facility's all-in figure.
• Scheduling inside 3 business days, so the estimate timing in Step 4 cannot run before the service.
• Assuming one estimate covers every biller, when anesthesia, pathology, or a separate clinician group may bill on its own.
• Reading the Medicare anchor as a price to demand, instead of an order of magnitude check on the written figures.
• Letting the 120 day dispute window run from the date of the initial bill while waiting on a billing office reply.

If you are uninsured because coverage lapsed, two other guides may change the arithmetic: how far Medicaid can reach back to cover care already received, which shortens for applications from January 1, 2027, and the 2027 Marketplace cost worksheet for coverage going forward.

Self-pay pricing questions

Sources behind the worksheet

Centers for Medicare and Medicaid Services, No Surprises: Understand your rights against surprise medical bills, CMS fact sheet, checked October 21, 2026. Centers for Medicare and Medicaid Services, No Surprises Act Toolkit for Consumer Advocates, consumer sections on good faith estimates for the uninsured and self-pay, checked October 21, 2026. Centers for Medicare and Medicaid Services, medical bill rights guidance for people who do not have or do not use insurance, checked October 21, 2026. Anchor figures: CMS Physician Fee Schedule CY2026 via WPS GHA, Michigan Locality 01, and CMS OPPS CY2026 Final Rule CMS-1834-FC addenda, as recorded in this site's checked-in procedure data, verified 2026-10-18.