List prices at 4 hospitals vs. Medicare: 2026 study
Read this first: these are list (gross) prices from 4 hospitals' own files, not what patients or insurers actually pay, and 4 hospitals are not a national sample. A price far above Medicare is not by itself a billing error or an unlawful price.
We compared the list prices four U.S. hospitals publish in their federally required price-transparency files with what Medicare pays a hospital for the same outpatient service in 2026. Across 797 hospital-service pairs (209 services), the median list price was 8.0× the Medicare rate.
Key findings (4 hospitals, list prices)
- Median list price: 8.0× Medicare across 797 price pairs.
- 88% of list prices were at least 3× the Medicare rate; 38% were at least 10×.
- The hospitals' own posted discounted cash prices were a median 3.3× Medicare.
- Largest single-line gap: Simple stitches on the face, small wound (12011) at NYU Langone Tisch: list price $13,538 vs. $205 Medicare hospital outpatient rate (66.0×).
- Highest-level ER visit (99285, hospital facility charge) list prices ranged from $3,156 to $4,428, vs. a $608 Medicare hospital outpatient payment.
Correction, Oct 14, 2026: the first version compared four blood-bank tests (such as ABO blood typing, 86900) with the lab fee schedule ($2.99). Hospitals are paid for these under the outpatient system instead ($135.93 for 86900), so we re-ran the study. The overall median moved from 8.2× to 8.0×. We also stopped ranking "largest" examples where a hospital lists several different-priced items under one code.
Median list price ÷ Medicare, by hospital
NYU Langone Tisch Hospital (New York, NY)file dated 2026-01-01
206 services · list 10.4× · cash 1.2×
Duke University Hospital (Durham, NC)file dated 2026-04-01
202 services · list 9.4× · cash 2.5×
Oregon Health & Science University Hospital (Portland, OR)file dated 2026-03-23
206 services · list 6.5× · cash 4.2×
UCHealth Yampa Valley Medical Center (Steamboat Springs, CO)file dated 2025-11-01
183 services · list 5.8× · cash 5.2×
By service type
Categories with at least 15 price pairs.
Common services: list price vs. Medicare
Emergency department visit, highest complexity (99285)Medicare $608 (OPPS, status J2)
NYU Langone Tisch: $4,428 (7.3×) · Duke University Hospital: $3,556 (5.8×) · OHSU Hospital: $3,156 (5.2×) · UCHealth Yampa Valley: $3,509 (5.8×)
Emergency department visit, high complexity (99284)Medicare $426 (OPPS, status J2)
NYU Langone Tisch: $3,739 (8.8×) · Duke University Hospital: $2,065 (4.8×) · OHSU Hospital: $2,067 (4.8×) · UCHealth Yampa Valley: $2,467 (5.8×)
CT scan of head, no contrast (70450)Medicare $107 (OPPS, status Q3)
NYU Langone Tisch: $3,297 (30.9×) · Duke University Hospital: $1,675 (15.7×) · OHSU Hospital: $1,537 (14.4×) · UCHealth Yampa Valley: $1,358 (12.7×)
CT scan of abdomen and pelvis, with contrast (74177)Medicare $356 (OPPS, status Q3)
NYU Langone Tisch: $8,252 (23.2×) · Duke University Hospital: $5,727 (16.1×) · OHSU Hospital: $4,138 (11.6×) · UCHealth Yampa Valley: $2,422 (6.8×)
MRI of lower back spine, no contrast (72148)Medicare $244 (OPPS, status Q3)
NYU Langone Tisch: $5,967 (24.5×) · Duke University Hospital: $3,245 (13.3×) · OHSU Hospital: $2,637 (10.8×) · UCHealth Yampa Valley: $1,045 (4.3×)
Chest X-ray, 2 views (71046)Medicare $88.91 (OPPS, status Q3)
NYU Langone Tisch: $245 (2.8×) · Duke University Hospital: $345 (3.9×) · OHSU Hospital: $512 (5.8×) · UCHealth Yampa Valley: $327 (3.7×)
Comprehensive metabolic panel (14 blood chemistry tests) (80053)Medicare $10.56 (CLFS, status Q4)
NYU Langone Tisch: $326 (30.8×) · Duke University Hospital: $400 (37.9×) · OHSU Hospital: $83 (7.9×) · UCHealth Yampa Valley: $85 (8.0×)
Complete blood count (CBC) with automated differential (85025)Medicare $7.77 (CLFS, status Q4)
NYU Langone Tisch: $139 (17.8×) · Duke University Hospital: $126 (16.2×) · OHSU Hospital: $104 (13.4×) · UCHealth Yampa Valley: $58 (7.5×)
Routine blood draw from a vein (36415)Medicare $9.34 (CLFS, status Q4)
NYU Langone Tisch: $45.93 (4.9×) · Duke University Hospital: $24 (2.6×) · OHSU Hospital: $39.5 (4.2×) · UCHealth Yampa Valley: $48 (5.1×)
The 10 largest single-line gaps
| Service | Hospital | List price | Medicare | Ratio |
|---|---|---|---|---|
| Simple stitches on the face, small wound (12011) | NYU Langone Tisch | $13,538 | $205 OPPS | 66.0× |
| CT scan of chest, with contrast (71260) | NYU Langone Tisch | $8,496 | $179 OPPS | 47.4× |
| Urinalysis, automated, no microscope (81003) | NYU Langone Tisch | $105 | $2.25 CLFS | 46.4× |
| CT angiogram of neck (70498) | NYU Langone Tisch | $7,396 | $179 OPPS | 41.3× |
| Ultrasound of neck arteries (93880) | NYU Langone Tisch | $10,000 | $244 OPPS | 41.0× |
| CT angiogram of head (70496) | NYU Langone Tisch | $7,210 | $179 OPPS | 40.2× |
| Prothrombin time (PT/INR clotting test) (85610) | NYU Langone Tisch | $172 | $4.29 CLFS | 40.2× |
| Kidney function panel (80069) | Duke University Hospital | $347 | $8.68 CLFS | 40.0× |
| CT scan of neck soft tissue, no contrast (70490) | NYU Langone Tisch | $4,259 | $107 OPPS | 39.9× |
| CT scan of chest, no contrast (71250) | NYU Langone Tisch | $4,227 | $107 OPPS | 39.6× |
Each value was re-checked against the hospital's raw file on Oct 14, 2026.
Methodology and data
- Hospital files. Each hospital's machine-readable standard-charges file (CMS template v3), found via its
cms-hpt.txt: NYU Langone Tisch (file dated 2026-01-01), Duke (2026-04-01), OHSU (2026-03-23), UCHealth Yampa Valley (2025-11-01). Downloaded October 13, 2026. - Matching. Outpatient or "both" rows, CPT/HCPCS code in our 252-code CMS dataset, no modifier, positive gross charge; professional-fee rows excluded; exact duplicate rows dropped. Several lines for one code: median gross charge (flagged as "mixed" in the data if lines differ by more than 1.5×; mixed pairs are kept in medians but not used as headline examples).
- Medicare benchmark (rule v2). If the code has a separately payable rate in the CMS OPPS Addendum B, October 2026 (status J1, J2, Q1, Q2, Q3, S, T or V): that national unadjusted APC rate. Otherwise, lab tests use the CMS Clinical Laboratory Fee Schedule 2026 Q4 national limit. Codes Medicare packages with no separate payment (status N) or doesn't pay under OPPS are excluded and listed in the exclusions file.
- Packaged services. Status Q1/Q2/Q4/J1 services are often packaged into another service the same day, so Medicare may pay nothing separately for them in practice. We compare to the rate Medicare pays when they are paid separately.
- Calculation. Ratio = hospital median gross charge ÷ benchmark. We report medians, not averages. Rates are national and not adjusted for local wages.
- Limits. Four hospitals, not a national sample. Gross charges are list prices; insured patients usually pay a negotiated rate, and many hospitals discount for uninsured patients. Vanderbilt was tried but had no gross charges on matching outpatient rows.
Download: cleaned rows (CSV) · excluded codes (CSV). Built by scripts/study.py (row extraction) and scripts/study-build.py (benchmarks and stats).
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