MRI, CT Scan and Colonoscopy Prices at 55 Major U.S. Hospitals

Ask a hospital what something costs and you will get a number. Ask the same hospital's federally mandated price file and you will get three, and they rarely agree. Since 2021, 45 CFR §180 has required every hospital in the country to publish a machine-readable list of its standard charges: the chargemaster sticker price, the discounted price offered to people paying cash, and the rate it negotiated with each insurance plan. The files are enormous, inconsistently formatted and effectively unread. We built a pipeline that reads them, and pointed it at 55 of the largest hospitals in the United States.

Jump to prices: MRI · CT scan · Colonoscopy · all 19 procedures

The headline most people expect from an exercise like this is that prices vary wildly between hospitals. They do. But the more useful finding sits inside a single hospital's own file, where no comparison between institutions is needed at all: the price these hospitals quote to a patient paying cash is, again and again, higher than the price they have already agreed to accept from insurers for the identical service.

Of the 55 hospitals in this study, 39 publish both a cash price and enough payer-negotiated rates to compare the two on at least one common service. At 36 of them, the cash price is the higher number somewhere in that list. At 30, it is higher on most of the services we checked. At 22, it is higher on every single one.

Why the Cash Price Runs High

The mechanism is not mysterious, and it is not really about hospitals gouging the uninsured, though the effect lands the same way. Most hospitals set the self-pay price as a flat percentage off the chargemaster. 49 of the 55 here do exactly that, at a rate that barely moves across tens of thousands of line items — from 81% off at NYU Langone Health - Tisch Hospital down to nothing at all. A percentage off an inflated number is still tied to that inflated number. Negotiated rates, by contrast, are bargained service by service against an insurer with leverage. The two prices are built by completely different processes, and there is no rule anywhere requiring the first to come out below the second.

At 10 of these hospitals the discount is not merely thin. It is zero: the published “discounted cash price” equals the gross charge, to the cent, across the file. The column exists because the regulation requires a column. The discount does not exist at all.

Another 4 publish no cash price whatsoever. Self-pay pricing there begins as a conversation with the billing office rather than a posted number, which is precisely the situation the transparency rule was written to end.

The Hospitals, and What Each One Posts

Each hospital below links to its financial assistance policy on this site — who qualifies for free or discounted care there, and how to apply. The cash column counts the services where that hospital's posted cash price exceeds its own median negotiated rate, out of the services where the two could be compared at all.

The Same Service, Hospital to Hospital

The variation between hospitals is real and it is large. For each service, the table below gives the lowest and highest median negotiated rate anywhere in the study, along with the median across all of them.

Single extremes make for better headlines than evidence, so it is worth reading the middle of the distribution too. Take CT scan, head (without contrast) (CPT 70450): the most expensive tenth of these hospitals negotiated roughly 16× what the cheapest tenth did — $126.27 against $1,974.05. The full range runs wider still, from $38.03 at Zuckerberg San Francisco General Hospital to $2,651.25 at Northwestern Memorial Hospital, though a gap that rests on two institutions says less than one that holds across 39.

The last column carries two figures. The second is how many hospitals publish a rate for that code at all. The first is how many the high and low were actually drawn from, because we bar a rate from being an extreme when it rests on fewer than three plan contracts, when it sits an order of magnitude above every other hospital's (the signature of a code pooling unrelated items rather than pricing one), or when it exceeds that hospital's own sticker price for the same code and setting, which is impossible for a genuine per-service rate. Nothing is deleted. Excluded rates still appear in the explorer below and still count toward each service's median; they are simply not allowed to become a headline.

Every Hospital, One Procedure at a Time

Pick a service to see what each hospital publishes for it: the gross charge, the discounted cash price, the median of its payer-negotiated dollar rates, and the number of plan rates that median rests on. A dash means the hospital's file does not publish that value. We never estimate one.

Prices are one thing; your bill is another. Upload it and, for any hospital whose file we have loaded, the analysis puts these same posted rates beside each line item. For a closer look at one procedure rather than one hospital, we go deeper on MRI costs, CT scan costs and colonoscopy costs.

How to Read the Three Prices

The gross charge is the chargemaster price, and almost nobody pays it. It still matters, because it is the number that appears on many bills before adjustments and it anchors out-of-network and uninsured billing. Our hospital price transparency guide explains how these lists are built.

The discounted cash price is what the hospital offers someone paying without insurance, and as the numbers above show, it deserves more scepticism than it usually gets. The negotiated rate is what an insurance plan actually pays. It varies plan to plan, which is why we show a median rather than a single figure, and your own share is computed from your plan's specific rate, not from the median.

The distance between the first and the third is the part worth internalising. Zuckerberg San Francisco General Hospital lists $4,403 for CPT 70450 and accepts a median of $38.03 from insurers, a gap of 116×. The sticker price is not a price. It is an opening position.

What to Do With This

If you are uninsured or on a high-deductible plan, these files are leverage, and the specific move is narrow enough to be useful. Do not accept a self-pay quote on the assumption that it is the discounted option. Ask the hospital what its negotiated rate is for the same CPT code, and ask to pay that instead. The rate is published, publishing it is federally required, and this page shows you where to find it. When a hospital bills $4,403 for a service its own file puts a median insurer rate of $38.03 on, “I would like to pay what insurers pay” is a documented and entirely reasonable request.

Financial assistance policies are the second lever, and they stack on top of the first — see Zuckerberg San Francisco General Hospital's and Northwestern Memorial Hospital's. If you are weighing cash against running a bill through a high deductible, we work through that arithmetic in cash price vs. insurance.

And when you upload a bill to Health Bill Central from a hospital whose price file we have loaded, the analysis puts that hospital's own posted rates beside each line item — the same numbers in this article, matched against what you were actually charged.

Methodology

Cite as: Health Bill Central analysis of 55 U.S. hospitals' CMS-mandated price-transparency files (45 CFR §180), August 2026. healthbillcentral.com/blog/what-hospitals-actually-charge

Every file here is the hospital's own machine-readable standard-charges file. We located each one through its federally required cms-hpt.txt discovery file where that resolved, and otherwise through the hospital's price-transparency page or a public index of those filings; many hospitals host the file itself with a vendor, which is what their own discovery file points to (CMS template version 2.0.0, 3.0.0, 3.0.1). For each CPT code we take the hospital's outpatient row, or its combined outpatient-and-inpatient row where that is what the file publishes, use that row's gross and discounted-cash values, and compute the median of the payer-specific negotiated dollar rates. Rates published only as percentages or algorithms, and the v3 “estimated allowed amount” percentiles, are excluded, because they describe different quantities. Where a hospital prints a gross or cash figure only on a sibling row for a different setting we show it, but we never compare it against a negotiated rate from another setting.

That discovery file is not always right. On 10 August 2026, Yale New Haven Hospital's cms-hpt.txt named a standard-charges file that returned a 404. The working file was published all along on the pricing page listed in the same entry, under the same name with a -1 added. Nothing in the rule requires anyone to check that the link still resolves, so a hospital can be fully compliant on paper and undiscoverable in practice.

The number of plan rates behind each median varies enormously by hospital and by service, from 1 to 2300 in this study, which is why the explorer shows it next to every figure. On some codes a hospital's median negotiated rate lands above its own gross charge for the same code and setting, which cannot be true of a genuine per-service price and usually means the code covers a different mix of services at that hospital than its description suggests. Those rates are shown as published and barred from being an extreme. Figures are exactly as published; where a file omits a value we print a dash rather than estimate. Data generated 2026-08-11.

One caveat belongs on every number here. 49.6% of these medians pool rates struck under more than one kind of contract — a per-service fee schedule, a case rate covering a whole episode, a percentage of billed charges. The federal format records which methodologies apply but does not separate the dollars, so a single median can mix them. That is a property of the format rather than a failing of any particular hospital, and it is the best reason to treat these figures as a range to argue from rather than a quote to hold someone to.