The price files on this site come from hospitals, because hospitals are who the federal rule covers. But for many of the procedures people shop for, a hospital is not the only place to have them done, and it is usually the most expensive. The same colonoscopy, MRI or hernia repair, by the same doctor, often costs a third to a half less at a facility that is not a hospital.
The three settings
Hospital outpatient department (HOPD). Part of a hospital, either in the main building or in a clinic or imaging center the hospital owns, sometimes miles away. It bills a hospital facility fee, which is what the price files show. Medicare and most insurers pay HOPDs more than other settings for the identical service, and hospitals price accordingly.
Ambulatory surgery center (ASC). A licensed facility for same-day surgery and procedures: endoscopy, cataracts, arthroscopy, hernia repair, pain injections. Often owned by the physicians who practice there, sometimes jointly with a hospital. ASCs are paid less than HOPDs by Medicare (roughly 55 to 60 percent of the hospital rate) and typically charge cash-pay patients far less. Many publish all-inclusive cash prices.
Freestanding imaging center or laboratory. Independent MRI, CT, ultrasound and mammography centers, and independent laboratories, are the cheapest setting for imaging and blood tests, frequently a quarter of the hospital price for the same scan on the same kind of machine.
Why the price is different
Hospitals argue that they carry costs the others do not: 24-hour emergency capacity, intensive care, uncompensated care, teaching. Those costs are real, and they are spread across every service the hospital bills, including your outpatient MRI. A surgery center or imaging center carries none of them. Whether that justifies the difference is a policy question; for a patient it is simply a fact of the price list.
What the files do not show
ASCs and imaging centers are not covered by the hospital transparency rule, so their prices are not in the files and not on this site. Some publish prices voluntarily; many will quote a cash price by phone. When you compare hospitals here and find a range from $600 to $3,000 for a knee MRI, the freestanding imaging center down the road may be $400, and it is worth one call to find out.
Hospital-owned outpatient centers are in the files, under the hospital's name, sometimes at a lower price than the main campus. Where a hospital lists several locations, we show the file as the hospital's; ask which location the price applies to.
When the hospital is the right choice
For anything with a real chance of complications, for patients with serious conditions, and for procedures that may need to convert to something bigger, a hospital's capabilities matter more than the price. Surgeons choose the setting partly on that basis, and a good one will tell you whether you are a candidate for a surgery center.
What to ask
- "Can this be done at an ambulatory surgery center or an imaging center instead of the hospital?"
- "Do you practice at one, and what is the cash price there?"
- "Is the hospital's outpatient location priced differently from the main campus?"
- "Is there a clinical reason it should be done in the hospital?"
If the answer to the last question is no, the price difference is yours to keep.