Why the same test costs twice as much across town

Reason one

Hospitals choose very different self-pay discounts

A hospital's file carries its list price and its discounted cash price, so you can measure the discount policy directly: what fraction of its own list price does each hospital charge someone paying cash? The answer is a policy choice, and the range is startling.

Across the files we read, Montclair Hospital Medical Center in the San Bernardino metro prices self-pay patients at roughly a tenth of its list price, averaged over 40 procedures. Valleywise Health Medical Center in Phoenix charges self-pay patients its full list price, and on average slightly above it. Both policies are applied nearly file-wide, so this is not a few odd rows. It is how each hospital has decided to treat people paying for themselves.

That one choice lands on every procedure at once. It is why a plain blood test can vary as much between two hospitals as a surgery does, and why the cheapest hospital for one scan is very often the cheapest for the next one too.

Reason two

Sometimes the code does not name the same thing

The other source of huge gaps is less honest-looking but equally real: two hospitals can bill the same procedure code for different amounts of work. One publishes a single operating-room line, the other publishes the whole admission, and the code cannot tell you which is which. We measured a shoulder arthroscopy published at $776 at one Columbus hospital and $55,317 at another for exactly this reason. Neither number is wrong. The comparison is.

This is why the rankings on this site compare hospitals only on imaging, lab work and the CMS-defined DRG bundles, where a code names a fixed unit of work. The full measurement, including the case that taught us this, is on what we found reading these files.

Worked example

An echocardiogram in Columbus, all published prices

Among Columbus hospitals publishing exactly one self-pay price for a standard echocardiogram (CPT 93306), read 28 August 2026:

Mount Carmel East also publishes prices for this code, and the lowest of them is $143. We leave it out of the comparison, and you should too: the hospital lists three different self-pay prices for the one code, and nothing in its file says which one a given patient gets. Reading its cheapest number against Diley Ridge's single figure would produce an 18× headline that no one could actually collect on. When a hospital publishes several prices for a code, the honest reading is a range, not a bargain.

A two-view chest X-ray shows the ordinary case: nine Columbus hospitals each publish one price, running from $199.55 to $442. A 2.2× spread on one of medicine's most standardized tests, purely from pricing policy.

What to do with this

Treat a big gap as information, and a huge one as a question

A 2× gap between hospitals on an imaging or lab code is normal and worth acting on; on the examples above it is a phone call worth a hundred dollars or more. A 50× gap usually means the code is not naming the same unit of work, and the "cheap" price may be one line of a bill that has other lines.

Either way the move is the same: get the code, look up who publishes an unambiguous price for it in your metro, and call the cheapest hospital's billing office first. The step-by-step version, including the exact phrases to use, is in how to find a hospital's self-pay price before you go.