How Melivaro computes a fair price.

Hospital chargemaster prices are list prices, not what the procedure actually costs to deliver. We translate chargemaster to estimated cost using each hospital's cost-to-charge ratio (CCR) from the CMS Provider Specific File:

estimated_cost = chargemaster_price * hospital_CCR

The fair price range for a procedure in a region is the interquartile spread of estimated costs across all hospitals in the same Hospital Referral Region (HRR):

fair_price_range = { p25, median, p75 } of regional cost distribution
markup_ratio    = chargemaster_price / estimated_cost

A markup ratio above 4.0× flags the facility as "significantly above fair" — a signal to negotiate or shop elsewhere. National average markup is roughly 3.5×; the range is 1.5× to 12×+.

Same procedure, different city: prices vary 2–5×. We model this with three signals:

regional_price_index = median_price_HRR / national_median_price
GPCI                 = Medicare Geographic Practice Cost Index (CMS)
COLA_adjusted_price  = raw_price / state_COLA_index

For ASC-eligible procedures we surface the ambulatory surgery center alternative (typically 40–60% of hospital outpatient pricing per MedPAC):

asc_savings = hospital_outpatient_price * (1 - 0.48)

Cross-state arbitrage: when an adjacent metro is materially cheaper, we surface it with travel cost netted out:

cross_state_savings = price_home_HRR - (price_destination_HRR + travel_cost)

Insurance path total cost folds in premium, deductible, coinsurance, and out-of-pocket maximum cap:

insurance_total =
    annual_premium
  + min(remaining_deductible, procedure_cost)
  + coinsurance_rate * max(0, procedure_cost - deductible)
oop_capped      = min(insurance_total, oop_max_remaining + premium)

Cash-pay path applies the negotiated self-pay discount off chargemaster. Many facilities offer 20–50% off when you ask:

cash_pay_total = chargemaster_price * (1 - self_pay_discount)

Hybrid path: pay cash at the cheapest facility but use insurance for pre-op imaging and post-op follow-up. Recommendation is whichever total NPV is lowest, with a plan-year timing note when the procedure is elective.

International procedure cost is only the headline number. Real comparison adds travel, recovery, and risk:

medical_tourism_total =
    procedure_cost_abroad
  + airfare + (hotel_per_night * recovery_days)
  + travel_insurance + companion_costs
  + (lost_wages_per_day * extra_recovery_days)
  + follow_up_care_us
  + risk_premium  // probability-weighted complication cost

We only recommend a destination when net savings clear the break-even threshold (default $5,000) and the procedure is non-emergent. Risk premium accounts for medical evacuation cost (Mexico ~$25K, Thailand ~$80K) weighted by the destination's published complication rates.

We rank payment instruments by NPV at a 5% discount rate, surfacing risks alongside cost:

NPV_option = procedure_cost + total_interest - tax_savings
monthly    = procedure_cost / term_months  (for 0% promo or provider plans)

CareCredit deferred-interest worst case:
  procedure_cost * (1 + 0.2699 * promo_months / 12)

HSA tax savings:
  withdrawal_amount * marginal_federal_tax_rate

HELOC interest (NOT tax-deductible for medical):
  procedure_cost * heloc_rate * repayment_years / 2

Provider 0% payment plans usually beat CareCredit because they have no deferred-interest trap. We always surface that risk explicitly when CareCredit is in the option set.

The user types "knee replacement"; we map it to CPT 27447, MS-DRG 469/470, and the appropriate APC for outpatient eligibility. Mapping uses a curated catalog of 70+ elective procedures with common-name aliases for fuzzy lookup. Direct CPT entry is supported.

Each procedure record carries: CPT code(s), DRG, APC, ASC-eligibility flag, typical recovery days (used in tourism analysis), and the procedure category that drives tourism destination matching.

• Medicare Physician Fee Schedule — the procedure cost baseline, public.
• Geographic practice cost index — the area adjustment applied to that baseline.
• IRS Revenue Procedures — annual HSA limits and tax brackets.

All sources are public. No paid feeds, no medical-board certifications inferred, no insurance contracts assumed.

We do not currently ingest hospital price transparency machine-readable files, CMS Hospital Compare quality metrics, or a facility directory, so we do not publish facility-level prices or quality scores and we do not claim a refresh cadence we do not run. Every scraper in this repository is invoked manually.