Founder of the Month November 2026
Keith Smith has posted his surgery center's prices online since 2009
The Oklahoma City anesthesiologist co-founded a surgery center that quotes one price covering the surgeon, anesthesia and facility, and he says some hospitals now match its prices.
Dr. G. Keith Smith is an anesthesiologist and the medical director of the Surgery Center of Oklahoma, a physician-owned4 outpatient surgery center in Oklahoma City that he co-founded in May 1997, according to his published profile5 and Senate testimony1. In 2009 he put the center's prices on its website, one figure per procedure that covers the surgeon, the anesthesiologist and the facility. That was more than a decade before federal rules6 began requiring hospitals across the United States to post their prices, starting January 1, 2021.
Smith described the model's origins to the U.S. Senate Special Committee on Aging on October 22, 2025. The center was excluded from insurance from the start, he said, so it quoted each patient a single all-inclusive price built from three parts: the fee the surgeon thought was fair, a fair anesthesia charge and a facility charge based on time and materials. The center gave those quotes by phone until the website went up.
How the prices work
The center's price list2 runs from ear tubes to hip and knee replacements. On November 3, 2026, it showed $6,836 for laparoscopic gallbladder removal and $17,679 for a total knee replacement. Under the center's pricing disclaimer3, a posted price includes the facility fee, the surgeon's fee, the anesthesiologist's fee and uncomplicated follow-up care.
The disclaimer also lists what sits outside that number. A $250 consultation fee is added, and diagnostic tests, overnight stays, travel and the costs of complications after discharge are excluded. Implants and hardware are quoted after the consultation, and the center says it sells them at invoice cost with no markup.
The prices are not negotiable and apply to patients who pay the full amount in advance, though the disclaimer allows other arrangements through employers and self-insured groups. The center also says it has raised its prices only once since 1997, to adjust for inflation.
What posting changed
Smith told the committee that the center's total charges are one-sixth to one-tenth of what large hospital systems nearby charge for the same procedure, and about half of what Medicare pays hospitals. He described a child's tonsillectomy performed for $3,875, the amount the center lists for one today, after a Dallas-area hospital had quoted the family $72,000. He said roughly half of the center's patients come from other states or countries, and some self-funded employers waive all out-of-pocket costs for employees who travel there.
In his account, the bigger effect has been on other providers. Price matching began after the 2009 posting, he said, as patients carried the center's prices to their local hospitals; in one case he cited, a Georgia patient quoted $40,000 for a urologic procedure got the local hospital to match the center's $4,000 online price. Asked how many facilities now follow some version of the model, he said the number is "in the hundreds. It's not in the thousands."
Smith also runs Atlas Billing Company, which arranges bundled payments for the center and builds surgical bundles for other facilities. He co-founded the Free Market Medical Association, which works to connect buyers and sellers of care and, he said, now has 37 state chapters.
The hearing also heard about the limits of shopping. Don Moulds, chief health director of the California Public Employees' Retirement System, said a 2011 program that set a fixed price for hip and knee replacements pushed prices down, but that few members used a price tool the system introduced in 2014. He said fixed prices suit elective, non-emergency procedures with large price differences, and that many health services are not shoppable.