healthcosts.net

How it works

Why do two hospitals charge such different prices?

Hospitals negotiate rates separately with each insurer, use different pricing bases (fee schedule vs. case rate vs. per diem), and set their own cash and gross prices — there's no single "market price" for most procedures.

Example

A chest X-ray ranged from $145 to $53,000 across hospitals in one state — tracing the $53,000 outlier showed it wasn't an error, it was a case rate (a flat fee for a whole episode) published against the same code as everyone else's per-scan price.

Related terms

← Back to the help center