So, a few years ago I was diagnosed with Moyamoya. My angiogram indicated bilateral involvement. But only one side was bad enough to cause symptoms. Was told that I probably never have to have surgery on the other side. Had surgery on the affected side. All went well.
Now, naturally, my neurologist says there has been progressive involvement on the remaining side. Need surgery again. 
The delimma: Do I return to my original surgeon or stay local? One reason I went out of state the first time is because I know the ENTIRE surgical team. They are good, but I know them. Work with them. They do this surgery once every couple of months, but the surgeon is young. My insurance decided to approve out of network coverage as in-network, but it cost money. They may not this time. And my yearly out of pocket doubled. Right now, money is an issue for me.
Some family says stay here. Other, the ones with no financial worries, say go back to first surgeon. If I have it here, the operation would basically be free. (Employee discount!)
So, do I make a decision with money out of the equation?
And I shouldn't feel disloyal, but I do.  :-/

It is my daughter that has MM disease.  My thought is that you want the best neurosurgeon you can get.  I would be afraid to have this surgery based only on the money aspect.  If someone is going to operate on my brain, I only want the best if that is at all possible.  Good luck and keep us posted.   :)

Thanks. My local guy is a great surgeon, but the other has about 25 years experience over him. And I do trust him. Then I remembered when I consulted him first the last time. He walked into the exam room, saw it was me, and told me he would be happy to refer me to wherever I wanted to go.

I told my neurologist to refer me back to the original guy.

I just wanted to second the idea of going to the surgeon whom you think has the most experience and whom you have the greatest confidence in.  I had surgery on the right at Stanford, and now am in the same situation of having the left watched.  If it comes to having surgery on the left, which is likely, I'll go back to Stanford even though there are closer surgeons simply because I trust them to do an excellent job and that puts me at ease .