A 2025 Health Affairs study found that commercial insurers pay an average of $1,489 (78%) more for the same outpatient procedures when performed in hospital outpatient departments (HOPDs) instead of ambulatory surgical centers (ASCs). The difference isn’t about outcomes — it’s about billing structures and negotiating power. For most orthopedic and sports procedures, ASCs deliver the same quality care at far lower cost and with greater efficiency.
Top 3 Reasons for the Differential
Facility Fees: The average commercial price for a hospital outpatient procedure was $3,060–$3,572, compared with just $1,660–$2,011 in ASCs. These higher “facility fees” account for most of the $1,489 price gap.
Negotiated Rates: Large hospital systems leverage market power to secure higher reimbursement, while selective contracting (like Cigna’s narrow ASC-focused network) can reduce costs by over $1,000 per procedure.
Case Complexity Claims: Hospitals justify higher prices by citing more complex patients, but for routine orthopedic and pain procedures, the case mix and outcomes are nearly identical across sites.
📊 Source: Maughan MP, Ryan AM, Whaley CM, Radhakrishnan N. Health Affairs. 2025;44(10):1291–1297. doi:10.1377/hlthaff.2025.00297.