Hip replacement surgery may seem fairly standard – but the cost is most certainly not according to a new study, which found that prices quoted for the surgery can vary by more than $100,000 and many hospitals can’t even put a price tag on the procedure at all.

“It was really surprising that only a little over half of hospitals could give us a price – and the range was surprising,” says the study’s lead author Jaime A. Rosenthal, a senior at Washington University in St. Louis who worked on this study with Peter Cram, MD, the director of the division of general internal medicine at the University of Iowa Carver College of Medicine, and Xin Lu, a data analyst at the Iowa City Veterans Administration Medical Center.

Rosenthal made calls between May 2011 and July 2012 to the top 20 orthopaedic hospitals in the U.S. (as ranked by US News & World Report) as well as to two hospitals randomly selected from each state and the District of Columbia. Following the same script each time, she asked for the lowest complete price (including hospital and doctors’ fees) for an elective total hip replacement for her fictitious 62-year-old grandmother who had no insurance but could pay out of pocket.

The study’s findings, published online recently in JAMA Internal Medicine show only nine of the top-20 hospitals and 10 of the 102 unranked hospitals could put a total price tag on the procedure. When Rosenthal made additional calls, she was able to get hospital and doctors’ fees separately from three other top-20 hospitals and 54 unranked ones.

But even though she made as many as five calls to each hospital in search of the data, three top-20 hospitals and 16 unranked ones did not provide any price at all – saying they either had “no way to provide such an estimate,”  didn’t offer those numbers over the phone or required a patient to see a doctor first.

“Some seemed like they were prepared to answer this question and others seemed like they had never received the question before and it took multiple phone calls to get a price,” Rosenthal explains.

Quoted prices ranged from $12,500 to $105,000 at top-20 hospitals that responded and from $11,100 to $125,798 at the unranked hospitals that responded.

Rosenthal says there was no rhyme or reason to the differences. “It wasn’t like the most expensive was the top ranked hospital. It wasn’t that you were paying more to go to the best hospital,” she says. In fact, the average estimate at a top-20 hospital ($53,140) was statistically similar to the average estimate for an unranked hospital ($41,666).

Dr. Cram, a study co-author, says it’s not all bad news. “Sixty percent were able to give us a price estimate. That is really good,” he says. “The other glass-half-full view is, we found some very highly-ranked orthopaedic hospitals – who are national leaders in orthopaedics – that gave us very competitive price estimates.”

Dr. Cram acknowledges these were just estimates given over the phone for a hypothetical patient, and this study didn’t assess information about quality of care, although he says there is a lot of that data available on the Internet.

But he says the message to patients is, you can and should shop around at the various hospitals in your area before having this surgery. “Even in rural parts of America, if you look within 60 miles most people have access to a couple of hospitals,” Dr. Cram says. “I think our results suggest if you ask around you might be able to save some real money and get some good care at the same time.”

It may be daunting to think about making all these calls and searching for this information, but Dr. Cram says, you are likely doing this kind of legwork for other major purchases like buying a car or doing big repairs on your home. “People use consumer reports and shop around …  you should do the same thing when you pick a hospital,” he says. “Considering most people don’t ask about the price at all, starting to ask is the first step. And I think the hospitals will get better the more that we ask and the more we demand of them.”

According to the Census Bureau, there are an estimated 48.6 million uninsured people in the country and, Dr. Cram points out, even those who do have insurance are likely to have to pay some of the cost of a big surgery like this. “There is robust data that in an effort to slow spiraling health care costs, consumers are sharing in a larger and larger percentage of the costs. Very few of us [have] a health care plan [that] picks up 100 percent of our doctor visits, pharmacy prescriptions, surgeries or hospitalizations,” Dr. Cram explains. “If you have a co-pay it is in your interest to try and minimize the cost.”

But Benjamin C. Bengs, MD, an orthopaedic surgeon at Ronald Reagan UCLA Medical Center in Santa Monica, Calif. and an assistant professor of orthopaedic surgery at the David Geffen School of Medicine at UCLA says while this study is intellectually interesting, he doesn’t think it adds up to much for the average patient. He says he teaches his residents that while a full price joint replacement could cost anywhere from $50,000 to $100,000 for someone paying out of pocket, it is exceedingly unusual for someone to actually do that, unless they are so wealthy that money is no object.

“It would be extremely rare to pay out of pocket. The rarity of the situation makes it difficult for hospitals to have that price right away,” Dr. Bengs says.

Dr. Bengs explains that the vast majority of people go through their private insurer or Medicare/Medicaid when getting a major surgery, and there are separate, privately-negotiated, contracted prices between the hospital and the insurer.

“The prices that were given in this article were not negotiated prices and aren’t reflective of the contracts,” Dr. Bengs says. “The reality is, this scenario of calling a hospital to say how much does it cost for joint replacement isn’t realistic for the vast majority of us. The patient needs to know what it will cost with my insurer.”

Dr. Bengs says when it comes to doing research before undergoing surgery, you should ask your insurer what you will have to pay over and above your co-payments, and compare and contrast the quality of hospitals and surgeons.