If you've had surgery in a hospital and gone to the mailbox afterward, you know the drill. A bill from the surgeon. A separate bill from the anesthesiologist. A facility bill from the hospital. A bill from pathology for the biopsy they did in the OR. Maybe another from the assistant surgeon. Maybe another from radiology for the intraoperative fluoroscopy. Six bills for one operation.

There is a better way. It's called bundled pricing, and it has been operating in plain sight since 2009 at facilities like the Surgery Center of Oklahoma. Let's talk about why it's rare, why it's cheaper, and how to find it.

1. Why Hospitals Send You Four Bills for One Surgery

Hospital billing is fragmented by design. The facility, the surgeon, the anesthesiologist, the pathologist, the radiologist, and any consulting specialists all operate under separate billing entities — sometimes different tax IDs, sometimes different contracts with your insurer, sometimes different network status. Each files its own claim. Each generates its own EOB. Each sends its own bill.

The problem for you: any one of these providers can be out-of-networkOut-of-NetworkOut-of-network means a provider has no contract with your health plan. The plan will typically pay something toward the bill (usually at a lower allowed amount and higher coinsuranceCoinsuranceCoinsurance is the percentage of the allowed amount you pay after your deductibleDeductibleA deductible is the dollar amount you pay out of pocket for covered services each plan year before your health plan starts sharing the cost. If your deductible is $3,000, you pay the first $3,000 of allowed charges yours… Read the full definition → is met, up until you hit your out-of-pocket maximum. If your plan is "80/20 after deductible," the plan pays 80% and you pay 20% of every … Read the full definition →), and the provider is generally free … Read the full definition → even if the hospital is in-networkIn-NetworkIn-network means a provider or facility has a written contract with your health plan's network. That contract locks in a negotiated rate, requires the provider to accept the allowed amount as payment in full, and prohibi… Read the full definition →. A patient going to an in-network hospital for an in-network surgeon might get a surprise bill from an OON anesthesiologist they never chose and never met. The No Surprises ActNo Surprises ActThe No Surprises Act is federal legislation that took effect January 2022 to protect patients from balance billingBalance BillingBalance billing is when a provider bills you for the difference between what they charged and what your plan allowed. If the hospital billed $6,000, the plan allowed $2,000 and paid $1,600, an out-of-network provider mig… Read the full definition → in emergency situations and at in-network facilities. If you go to an in-network hospital for surgery and… Read the full definition → (2022) largely eliminated this specific abuse for facility-based providers, but the underlying billing fragmentation remains.

The problem for the system: no one owns the total price. The surgeon optimizes their fee. The hospital optimizes the facility fee. The anesthesiologist optimizes their time-based charge. No one has an incentive to say "the whole procedure should cost $X and we'll figure out how to split it." So costs drift upward, unchecked.

2. What a Bundled Price Actually Covers

A bundled price (also called an "all-in" price or "global fee") is a single price that covers the entire episode of careEpisode of CareAn episode of care is a defined bundle of services related to a single medical event — from initial diagnosis through treatment and follow-up — treated as a single unit for pricing, quality measurement, or payment purpos… Read the full definition →. For a knee arthroscopy at a transparent-pricing surgery center, a bundled price typically includes:

What's usually NOT included:

The key: you get one price before you schedule. No surprises. No mystery bills.

3. Surgery Center of Oklahoma: The Model

The Surgery Center of Oklahoma (SCO), founded by anesthesiologists Keith Smith and Steven Lantier, published their full price list on the internet in 2009. It was a radical act. Almost no one else in American healthcare had done that publicly. They still list every procedure they perform, with an all-in bundled price, no asterisks.

Some SCO prices for comparison (as of 2026):

Compare to typical U.S. commercial rates for the same procedures:

SCO isn't magic. They have the same surgeons, the same accreditation (AAAHC), the same infection rates and outcomes as any high-quality hospital-based OR. What they don't have: a bloated hospital administrative overhead, cross-subsidization of unprofitable service lines, or leverage-based pricing negotiations. They know their cost, add a margin, and post the price.

4. Why Bundled Pricing Is 35-65% Less Than Hospital Billing

Three reasons:

  1. No facility fee inflation. Hospitals charge facility fees that can be 3–5x higher than ASCs for identical OR time. This is the single largest cost driver. Removing hospital facility fees alone typically cuts the total by 40–50%.
  2. No cross-subsidization. ASCs perform outpatient procedures only. They don't run money-losing service lines (obstetrics, behavioral health, unfunded ER care) that hospitals cross-subsidize with profitable outpatient surgery revenue.
  3. Skin in the game. A published bundled price means the facility owns the total cost. If they blow past their target, they lose money. This creates powerful internal pressure to run efficient ORs, standardize supplies, and negotiate hard with implant vendors. Hospital billing has no such pressure — every additional charge is additional revenue.

5. How to Find Facilities With Bundled Pricing

There are three growing directories:

State-level networks are growing rapidly. Texas alone now has 15+ transparent-pricing surgery centers. Oklahoma, Kansas, Missouri, Indiana, and Florida all have multiple. If you're within a 3–4 hour drive of any of them, the savings on a major procedure will often pay for the trip plus a hotel stay plus your recovery time — with money left over.

6. Questions to Ask Before Scheduling Any Procedure

Whether or not you end up at a bundled-price facility, these five questions apply to any scheduled procedure:

  1. "What CPT code(s) will be billed for this procedure?" (Get them in writing before you show up.)
  2. "What is your all-in cash priceCash PriceA cash price is what a facility charges when a patient pays directly at the time of service, with no insurance claim filed. It bypasses the entire billing, coding, denial, and collections machine — which is expensive to … Read the full definition → for those CPTs?" (Compare to your negotiated rateNegotiated RateA negotiated rate is the price a health plan and a provider have agreed to in a written contract. It sits between the hospital's chargemasterChargemasterA chargemaster is the master price list a hospital keeps for every single item and service it can bill for — from a Tylenol tablet to a heart valve replacement. It's the sticker price, not the price anyone actually pays.… Read the full definition → (the sticker price) and the cash price (what someone pays with no insurance at… Read the full definition →.)
  3. "Will there be separate bills from other providers — anesthesia, pathology, assistant surgeon, radiology — or is your price all-inclusive?"
  4. "If a complication requires additional care within 30 days, is it covered by this price?" (Some bundles include a warranty. Ask.)
  5. "Are you an Ambulatory Surgery CenterASC (Ambulatory Surgery Center)An ASC is a freestanding facility that performs same-day outpatient surgical procedures — colonoscopies, cataract surgery, arthroscopies, hernia repairs, many orthopedic and ENT procedures. Patients arrive, have surgery,… Read the full definition → (ASC) or a Hospital Outpatient Department (HOPD)?" (POS 24 vs. POS 22 on the claim — determines whether facility fees are hospital-scale or ASC-scale.)

If you get a run-around on any of these questions, that's a signal. A facility that owns its pricing will answer plainly. A facility that inflates its bills will hedge, transfer you to different departments, and eventually say something like "we don't know until it's submitted to your insurance." That's the answer that costs you $18,000 instead of $4,395.

7. CMS Bundled Payment Programs

Medicare has run bundled paymentBundled PriceA bundled price is a single all-inclusive fee for a defined episode of care — surgeon, anesthesia, facility, implants, and typical follow-up rolled into one number. Instead of the patient getting four separate bills (fac… Read the full definition → pilots for over a decade. The current active program is BPCI Advanced (Bundled Payments for Care Improvement Advanced), which bundles payments for 37 clinical episodes including joint replacement, cardiac procedures, spine surgery, and sepsis.

Results from CMS evaluations: BPCI participants reduced Medicare payments per episode by an average of $423 for joint replacement without measurable harm to quality (readmission rates, mortality, complications all statistically unchanged). Total Medicare savings from the program exceeded $75 million in the first two years.

Commercial insurers are slowly adopting similar models — some Blue Cross plans, Cigna, and UHC have limited bundled-payment products for orthopedic episodes. These are typically negotiated by employers as "Centers of ExcellenceCenters of ExcellenceA Center of Excellence is a facility a health plan designates as preferred for a specific high-cost, high-complexity procedure — spine surgery, joint replacement, bariatric surgery, transplant, cardiac surgery, complex c… Read the full definition →" (COE) programs, where the employer covers travel costs to a designated bundled-price facility (Cleveland Clinic, Mayo, HCA COE hospitals) in exchangeACA MarketplaceThe ACA Marketplace (also called the Health Insurance Marketplace, the Exchange, or by state-specific names like Covered California and Access Health CT) is the federal or state-run online platform where individuals and … Read the full definition → for the volume discount.

8. What About Insurance Coverage at Bundled-Price Facilities?

A common question: can I use my insurance at a Surgery Center of Oklahoma or similar transparent-pricing facility? Answer: depends on the facility and your plan.

9. The Employer Angle: Direct Contracting with ASCs

Self-funded employers increasingly contract directly with bundled-price surgery centers, bypassing the traditional payer network. Structure:

  1. Employer negotiates a bundled price for defined procedures with the ASC (often a small premium over the facility's cash price).
  2. Employee cost-sharing is waived or reduced when they use the direct- contracted facility.
  3. Employer captures the difference between hospital-based negotiated rates and the bundled price — often $10K-$40K per procedure.

This model is gaining traction quickly. Direct-contract arrangements now cover 15%+ of orthopedic and general surgery procedures for large self-funded employers, up from under 3% in 2019. Employers see 40-60% facility cost reductions on directed procedures.

10. The Broker's Recommendation

If you have a scheduled procedure — orthopedic, general surgery, imaging, GI, urology, gynecology — do this before you accept the hospital's first quote:

  1. Get the CPT code(s) from the ordering physician.
  2. Search TruePrice Care or a similar tool for cash-price options within driving distance.
  3. Call the top 3 cash-price facilities and confirm the all-in price for your specific case.
  4. Compare to your negotiated rate through your insurance (which you can usually see in your plan's pricing tool or on the hospital's MRF).
  5. Do the math: cash price vs. (deductible + coinsurance to OOP maxOut-of-Pocket MaximumThe out-of-pocket maximum is the most you'll pay for covered, in-network care in a plan year. Once you hit it, the plan pays 100% of allowed charges for the rest of the year. Deductible, copays, and coinsurance all count… Read the full definition →). For most people who haven't met their deductible, cash at a good ASC will win by thousands.

A knee arthroscopy for $4,395 versus $14,000 through insurance isn't a close call. And you'll get one price, one bill, one email confirmation — not six mystery envelopes over three months.