NOTE: This spoiler was submitted by Jeremy

The film opens with John Kramer/Jigsaw (Tobin Bell) undergoing treatment for his cancer. He attends a support group and is told by his doctor to retire his work as he has roughly a year left to live.

John witnesses a custodian (Isam Beomhyun Lee) going through the belongings of an elderly patient. John then envisions a trap for the custodian, having two vacuums attached to his eyes while another device is on his right hand connected to his fingers. The custodian must stop the trap from sucking his eyes out, but each move he makes breaks a finger from his hand. He appears to give up and has his eyes sucked out. In reality, the custodian sees John watching him and he leaves the patient’s belongings alone.

John later finds a man named Henry Kessler (Michael Beach), a member of his support group. Previously, Henry said he had stage four pancreatic cancer, but he shows John a surgical scar and says he underwent an experimental procedure that cured him of his disease. Henry tells John about Dr. Finn Pederson (Donagh Gordon), who started the procedure. John later gets in touch with Pederson’s daughter Cecilia (Synnove Macody Lund), who refers him to her clinic setting up shop in Mexico.

John travels to Mexico and meets a cab driver named Diego (Joshua Okamoto). A van stops the cab, and two armed men step out and force John out. He tells them who he is, and they bring him to the clinic, which appears to be in a large mansion. He meets a young woman named Gabriela (Renata Vaca), who claims to have been cured by Cecilia’s treatment. John then personally meets Cecilia, who guides him through the process of the operation. She introduces John to her assistants, Mateo (Octavio Hinojosa) and Valentina (Paulette Hernandez).

The night before the operation, John gets up in the middle of the night and sees a neighbor boy, Carlos (Jorge Briseño), trying to fix his bike. John helps him out and is friendly toward the boy.

John later undergoes the procedure, which Cecilia says will have him slipping in and out of consciousness. The surgery is apparently a success, and John tells Cecilia he will give her the rest of her payment later.

Before leaving, John stops by a liquor store to buy a bottle of tequila as a thank-you gift for Gabriela. He returns to the clinic and finds it abandoned. He walks down to the room where the surgery took place, only for John to find evidence that the group faked the procedure and robbed him of his money, and they never even operated on him. He then angrily smashes the bottle and proceeds to contact one of his resources as he begins to plan his revenge.

John locates Diego, who was in disguise as the doctor performing the “surgery”. He puts him in a trap where he must cut out two pipe bombs that have been wired into his arms. Diego reluctantly begins cutting into his arms and painfully tears his flesh off, but he succeeds in removing the bombs before they detonate, and he survives. John congratulates him and then makes Diego give up the rest of the information he needs.

Outside of their scam, Valentina works as a prostitute. She tries to scam a guy out of money, and he nearly rapes her until Amanda Young (Shawnee Smith), wearing her pig mask, shows up to knock out the rapist and kidnap Valentina. Gabriela is then shown as being a drug addict, and Mateo is her dealer. They are both knocked out and kidnapped. Finally, Cecilia is in her home and sees an intruder on the roof through her security cameras, and although she tries to run, she is taken as well.

The four con artists wake up chained in a room. John and Amanda step out to confront them over their sham operation, wherein they have scammed dozens of dying people out of everything they own. Cecilia tries to weasel her way out of it by pretending to say that John’s case was different, but he knows she’s still lying. He then begins his game.

Valentina is stuck in a trap where a wire saw is placed in front of her neck, while there is a box with a gigli saw next to her. She is told to cut her right leg off and extract enough bone marrow to free herself. Given three minutes, Valentina begins to cut through her leg despite the pain, and she begins to take out her marrow, but the cup doesn’t fill up in time, and she is decapitated.

The remaining three notice a phone on a cart in the middle of the room. Cecilia cuts into Valentina’s corpse and pulls out her intestines to use as a rope and pull the cart toward them. When Cecilia attempts to call for help, Amanda hits her and takes the phone.

Outside, another patient named Parker Sears (Steven Brand) that John had met earlier after another fake operation, comes with a gun demanding Cecilia give him back his money. Amanda knocks him out and takes his gun. John explains that he can help Parker get his money back as long as he plays by their rules.

Despite John wanting Gabriela to be next, Amanda has sympathy for her since she was also a recovering drug addict. Mateo ends up going next. His trap is to force him to cut brain matter out of his head and drop it into a jar of enzymes. Once the matter is fully dissolved, a key will come out to free him. Mateo cuts his head open and tries to work through the pain. Unfortunately, he also fails to complete his task on time, and a mask shuts around his head, burning him to death.

Gabriela’s trap begins next. She is hung up from the ceiling by one arm and one leg. She is told that she must use a sledgehammer to break her limbs to free herself, or a radiation machine will burn her alive. Gabriela reluctantly smashes the bones in her hand and foot, freeing herself but suffering burns to her face.

John and Amanda free Parker before moving onto Cecilia, only to discover too late that Parker is working with Cecilia and is her lover. She called him on the phone to get him to rescue her. Parker holds John and Amanda at gunpoint and forces them to chain themselves up. When John says Gabriela needs to be taken to the hospital, Cecilia steps on her neck and breaks it, saying she doesn’t want any loose ends. She also tells John she knew he was Jigsaw and finds it ironic that a serial killer is trying to punish her.

Outside, Carlos is heard kicking a soccer ball. Cecilia brings him in and forces the boy to be chained up on a seesaw trap with John, but John tells him in Spanish to not pull the lever. Cecilia and Parker activate the trap, which waterboards John and Carlos with blood. John pulls his lever so that the blood will only start to drown him. Meanwhile, Cecilia and Parker go back to the office to get their money. However, when Cecilia pulls on a bag where the money supposedly is, she activates a timer set for ten minutes…and then “Hello Zepp” begins to play as John and Carlos’s trap is deactivated.

Flashbacks show that John knew all along that Parker was in on the con, so he and Amanda prepared for him to show up and do what he did. The bag contains documents showing withdrawals from Cecilia’s accounts, just as poison gas starts to fill the room while Cecilia and Parker are locked in. They both fight for an opening to breathe while the gas also burns their skin. Cecilia stabs Parker to death to save herself, just as John and Amanda warned him that she would. Cecilia sticks her head out and survives as the countdown runs out, but she can only call out to John in futility while she remains locked in the room with no way to call for help.

John and Amanda guide Carlos outside as it is now morning. John then gives Carlos all the money recovered from Cecilia’s scam.

Midway through the credits, John has tracked down Henry with help from Detective Mark Hoffman (Costas Mandylor). John figured that Henry was in on the scam, as he no longer has his fake surgical scar. John tells him “I want to play a game” and activates a trap on Henry’s body that will cut into his stomach. Henry can only scream in terror.

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The film takes place between the first two “Saw” movies, where John Kramer/Jigsaw travels to Mexico for what he is led to believe is an experimental operation that can remove his brain tumor. He meets the head of the procedure, Dr. Cecilia Pederson, but although she claims to have successfully cured John, he later discovers that he and countless others have been scammed out of their money with no actual work done to them.

John teams up with his apprentice Amanda Young and kidnaps Cecilia, along with her cohorts - Diego, Valentina, Mateo, and Gabriela. Diego survives his trap after cutting two pipe bombs out of his arms. Valentina cuts her leg off to extract bone marrow but doesn’t get enough out before her trap decapitates her. Mateo has to cut brain matter out of his head but runs out of time before a mask closes on his head and burns him to death. Gabriela must break her hand and foot to free herself or be burned by radiation. She succeeds in freeing herself. Also, the eye vacuum trap seen in the marketing was just a fantasy from John for a potential victim before changing his mind.

John and Amanda end up trapped when a man named Parker Sears, who was allegedly another victim of the scam, shows up to free Cecilia since they are lovers. Cecilia kills Gabriela to cut loose ends, and she leaves John and a neighbor boy named Carlos in a trap where they will be drowned by blood. Cecilia and Parker attempt to reclaim the money they stole, only for them to fall into one last trap. John already knew Parker was working with Cecilia and has them locked in the office as it begins to fill with poison gas. Cecilia kills Parker to save herself as John and Amanda warned him. Cecilia survives the gas but is still left imprisoned and will likely die of starvation. John and Amanda free Carlos, and John gives him the stolen money.

John and Detective Mark Hoffman then play one more Jigsaw game with a man named Henry Kessler, a member of John’s cancer support group that tricked him into believing Cecilia cured him.