Standards & Criteria

About the Listings

In the USA, there are more than 59,000 unique surgical procedures that have been described by the official guide to Current Procedural Terminology (CPT®) developed, maintained, and copyrighted by the American Medical Association. 

For each package price you submit for inclusion in our database, all we ask that you give us the courtesy to update our files with fifteen (15) days advance notice if you must modify a price or delete a service. We also ask that for anyone who has booked a surgery through our service and prepaid or agreed to pay on the day of surgery, that you honor that price according to the terms and conditions upon which it was booked.  We will never alter or debase your transparent prices. The price you list is the price that is charged to the individual consumer or group health purchaser that agrees to your terms and conditions.  The consumer or group health plan pays you your fee directly. We don’t insert commission fees, brokerage fees, or mark your prices up or down. verifies codes submitted by providers on our site are a correct for the procedures and prices advertised before we publish them. We also verify that the package prices are transparent and comparable to others using the same procedure code listed in our directory.  If your package is so different from the majority of the packages listed in our database, we may elect to decline one or more of your package prices from inclusion in the website. 

About the Facilities and Providers

Before we list your prices in our database or allow your hospital or ASC to participate in our service, we verify that you meet or exceed our rigid internal standards. pre qualifies each hospital, freestanding surgery center (ASC) and the surgeons, anesthesiologists and allied health providers who participate in the surgical cases at the facilities by initially and periodically verifying license and accreditation status, professional liability insurance coverage, and a few other key data such as physician and surgeon Board-Certification.

  • Vetting of all providers includes primary source verification. That means, we check with the state in which they are licensed to verify the license status and history.
  • We have carefully reviewed the accreditation standards of the prestigious healthcare accrediting bodies that meet our criteria.
  • We verify each providers’ current accreditation status and renewal dates with that accrediting body.  Some accrediting bodies don’t meet our criteria for inclusion, so while the facility may advertise that it is accredited, if the accreditor is one we don’t recognize, the hospital, clinic or free-standing surgery will not be among those listed on our site.
  • We also verify transfer agreements between freestanding surgery centers and full service hospitals.  A written hospital agreement between two health care institutions for the transfer of patients from one to another and the orderly exchange of pertinent clinical information on the patients transferred in the event of a complication or an emergency.
  • We verify professional liability coverage amounts and form with insurers to compare with information you’ve supplied. We also request  and maintain a Certificate of Insurance in our files.
  • We verify that the surgeons and anesthesiologists have given authority to bill on their behalf under the bundled price supplied to us. That eliminates erroneous billing and surprise bills.
  • Finally, we review infection and complications rates of each facility.

We also follow updates and alerts and if a provider listed in our database is implicated in any alert, and reserve the right to immediately place the provider on pended status until the matter is cleared up to our satisfaction.

Complication rate for hip/knee replacement patients

The hip/knee replacement complication rate is an estimate of complications within an applicable time period, for scheduled surgery  for primary total hip and/or knee replacement.

We monitor for certain indicators related to 1 of 8 complications that occurs within a specified time period:

  • Heart attack (acute myocardial infarction [AMI]), pneumonia, or sepsis/septicemia/shock during the index admission or within 7 days of admission;
  • Surgical site bleeding, pulmonary embolism, or death during the index admission or within 30 days of admission; or
  • Mechanical complications or peri-prosthetic joint infection (PJI) and surgical wound infection within 90 days of the procedure.

Due to recent reports shared at the American Academy of Orthopedic Surgeons meeting in 2019, we now also include consideration and note the altitude of the surgery facility and recovery location if they are located at or above 4000′ ASL.
Phone: (800) 209.7263
Hours: 0800-1800 MDT