Because US hospital prices are negotiated, not set: the chargemaster is an opening bid, each insurer cuts its own deal with each hospital, Medicare and Medicaid pay set rates, and facility fees, region, and market power stack on top - so the same scan can price several-fold apart.
Since 2021 hospitals must post their prices, and CMS requires good faith estimates for uninsured patients who ask - so non-urgent care (imaging, scheduled procedures) is now genuinely shoppable by phone.
What to do
Common questions
Why do two hospitals charge different prices?
Because in the US system, hospital prices are not prices in any normal sense - they are negotiated artifacts. The mechanics: every hospital keeps a chargemaster, a list price for every item and service - an opening bid almost nobody pays. Each insurer negotiates its own discounted rates with each hospital, so the same MRI carries a different real price at every insurer-hospital pair; Medicare and Medicaid pay their own set rates, usually the lowest; and uninsured patients historically got billed the full chargemaster - the reason hospital financial assistance policies matter so much. On top: facility type (a hospital outpatient department can bill a facility fee an independent center cannot), regional labor and real-estate costs, teaching-hospital status, and market power - a hospital that dominates its region negotiates from strength. Since 2021, federal rules require hospitals to post their prices, and CMS requires good faith estimates for uninsured patients who ask - so the prices are now knowable before you go, and shopping non-urgent care (imaging, scheduled procedures) by phone genuinely works. Pymander, a free AI doctor available 24/7 by text, can help you compare options for a specific service.