By Natalie Burg
Sometimes answering one question leads to a landslide of new inquiries. That's exactly what happened in June when Castlight Health released data showing wild variations in how much in-network healthcare providers charge for four common procedures – lipid panel, preventive primary care visit, head/brain CT scan, and lower back MRI.
"These 4 maps show the insanity of U.S. health care prices," read a Vox headline.
"How much does an MRI cost?" asked The Wall Street Journal. "The question with a thousand answers."
"And the reason for such a wide disparity in prices?" asked the Washington Post.
To answer these questions, it's important to begin with what the data uncovered. Prices for preventive primary care, head/brain CT scans, and MRIs of the lower back vary substantially across the country. While there is much variation for services within a city—in Richmond, VA, a CT scan can range from $218 to $2,009—several cities stood out as having higher average costs across the board.
10 Most Expensive Cities for Healthcare
1. Sacramento, CA Sacramento is the most expensive city for CT scans at $1,404 and MRIs at $2,635—just three hours away from a $676 MRI in Fresno. California's capital also comes in second for preventive primary care at $219. The good news? Lipid panels average just $24, not even breaking into the top ten cities for that procedure.
2. San Francisco, CA With an average cost of $251, San Francisco is the most expensive place to find preventive primary care in the U.S. It also falls right behind Sacramento for MRIs and ranks fifth for CT scans at $1,203. Like Sacramento, lipid panels are a bargain at $24.
3. Dallas, TX Dallas is the fourth most expensive city for CT scans, fifth for MRIs, and eleventh for preventive primary care. At $47, lipid panels are nearly twice the California cities' cost.
4. St. Louis, MO One of two Missouri cities with notably high healthcare costs, St. Louis is the eighth costliest place for MRIs, tenth for CT scans and thirteenth in preventive care. It's one of the cheapest places for a lipid panel at just $20.
5. Kansas City, MO Whether or not Kansas City is technically more expensive than St. Louis depends largely on one's healthcare needs. The third most expensive city in the country for both CT scans and MRIs, it falls to eighteenth when it comes to preventive primary care at just $138. On the other hand, Kansas City is the fourth most expensive city to get a lipid panel at $79.
6. Charlotte, NC Seventh for MRIs at $1,813 and fifth for primary care at $199, Charlotte is barely on the charts for CT scans, ranking twenty-ninth at $619.
7. Denver, CO Denver scores a pair of sixth place rankings for CT scans and MRIs, but falls to nineteenth in preventive care at $134.
8. Miami, FL Miami ranks notably high for the cost of an MRI. It's the fourth most expensive place for one at $1,968, but falls to ninth for CT scans and ranks thirtieth for preventive care at just $95.
9. Boston, MA The sixth most expensive city for preventive primary care, Boston is also number 10 when it comes to MRIs at $1,737. When it comes to CT scans, however, Boston drops to nineteenth on the list at $853.
10. Portland, OR With one of the widest variations between procedures, Portland is the third most expensive city for preventive primary care at $216, but drops to fourteenth for MRIs and seventeenth for CT scans.
This interactive map offers more detail on how these and other major US cities stack up on pricing for the four common healthcare procedures.
More Questions than Answers
How can one procedure in Portland be so expensive while others are so comparatively cheap? Why would a city like Austin, which doesn't even rank in the top 30 for the more expensive procedures, be the costliest place to get a lipid panel in the U.S.?
One potential factor is cost of living. San Francisco and Boston are both among the most expensive cities in the nation. But that doesn't explain high costs in St. Louis, Kansas City, and other less expensive cities. Dallas and Miami were ranked among the 20 sickest cities in the US, and it's easy to make a connection between sicker, older populations and increased demand for healthcare services, which drives up prices. However, Boston, Portland, OR, Denver, Sacramento and San Francisco are all among the healthiest cities in the nation.
What gives?
"It’s all about what providers can negotiate with insurance companies," Castlight's Jennifer Schneider told the Washington Post. "Those with the biggest market share have the most clout."
Transparency as a Solution
Of all the questions raised by Castlight's data, the one most people want answered—particularly those living in cities with inexplicably high healthcare costs—is how to achieve fair pricing from city to city. As Vox senior editor Sarah Kliff explained, this disparity is relatively unique to the U.S., because in most other countries, the government negotiates a standard pricing for healthcare services.
Transparency may be the cure.
"By exposing such pricing data to consumers," Castlight Health CEO Giovanni Colella told the Wall Street Journal, "it can help them make more informed choices that could save money for employers and employees."
"We can chip away at the cost of care," Colella added.
Given the nearly 400 percent difference in the cost of an MRI between Sacramento and Fresno, there's certainly a lot of chipping to be done.
A former downtown development professional, Natalie Burg is a freelancer who writes about growth, entrepreneurialism and innovation.
