federal hospital – A federal transparency rule meant to make hospital billing easier to understand has largely fallen short, with new 2025 pricing data showing the same procedures can cost vastly different amounts depending on insurance and plan—leaving consumers to hunt for ans
On a quiet weekday in Park Ridge, five patients lined up for the same noninvasive cardiac test: a diagnostic echocardiogram at Advocate Lutheran General Hospital. They weren’t guaranteed the same price.
One patient could be billed as little as $973 for the echocardiogram under United Healthcare. Another could face $1,721 under Humana. For uninsured patients, the hospital lists a “discounted cash price” of $1,155—still hundreds of dollars less than some insured prices.
The spread isn’t an edge case. It’s the pattern Chicago-area consumers keep running into when they try to understand hospital bills: opaque pricing that varies by insurer and plan, even for the same CPT-coded procedure, and negotiations happening long before patients ever walk through the door.
“You have a bunch of insurers; you have a bunch of hospitals. They don’t all reach the same pricing deal,” economist and University of Chicago professor Joshua Gottlieb said. Gottlieb is also co-director of UChicago’s Becker-Friedman Institute’s Health Economics Initiative and consulted with the Mansueto data team. “Although the hospitals and the insurers have negotiated this. now it’s the consumer who sees that price and says. ‘Where did this come from?’”.
For Emily Kostecka, the shock came last year. The Logan Square resident has had several MRIs over the years for her epilepsy diagnosis. She says her portion of the bill is usually a few hundred dollars—until Northwestern Memorial Hospital called to warn her that an upcoming outpatient MRI appointment would cost about $6. 000 after her insurance handled the claim.
Kostecka, 29, has high-deductible insurance with Blue Cross Blue Shield. She briefly considered taking out a loan to pay for the test, then decided to shop around. She chose Humboldt Park Health, a small safety-net hospital, where her portion of the bill was $115.
It wasn’t seamless. She said she had to pick up the disc with her results in Humboldt Park and find the right place at Northwestern’s Streeterville campus to drop it off for her doctor. But she still described it as worth the hassle—because the experience forced her to confront a system that makes price-watching feel like her job.
“Why is this on me to look for a better price for this thing that I need?” she said.
That tension—between a federal promise of transparency and the reality of a pricing labyrinth—is central to new 2025 pricing data compiled by the Chicago Sun-Times and the University of Chicago’s Mansueto Institute for Urban Innovation. The study examines thousands of medical procedures that hospitals publish to comply with a federal transparency law.
The analysis finds large differences in procedure prices across the Chicago area. both when comparing between hospitals and when looking at different insurance plans within the same hospital. The discrepancies repeat across categories. from colonoscopies and hemodialysis to x-rays and ultrasounds—amounts that are inconsistent enough to make consumer comparison feel nearly impossible.
Gottlieb said the cause is baked into how the system is structured. Healthcare prices are negotiated between hospitals and insurers. with hospitals setting what’s essentially a starting “sticker price” for thousands of procedures. Those prices are then adjusted in negotiations with different insurers and plan types, such as HMOs or PPOs.
Hospitals also set discounted cash prices for people with no health insurance. Each procedure is classified using a Current Procedural Terminology, or CPT, code. Those CPT codes are used by private insurance companies and also by Medicare and Medicaid.
Even when the federal government requires hospitals to post their prices. the data often doesn’t behave like information consumers can use. In the Mansueto-Sun-Times dataset. the researchers say the presentation makes apples-to-apples comparisons difficult because insurers can have hundreds of plans under one company. and hospitals may label those plans differently in the published files.
To address that, the analysis typically relied on median prices.
In practice, that still leaves huge swings.
At Advocate Lutheran General Hospital in Park Ridge. a diagnostic echocardiogram shows the range starkly: the median price under United Healthcare is $973; under Aetna it is $1. 258; under Cigna it is $1. 524; under Blue Cross Blue Shield it is $1. 710; and under Humana it is $1. 721. The discounted cash price for uninsured patients is $1,155.
At Northwest Community Hospital in Arlington Heights, an uninsured patient receiving hemodialysis would be billed $741, according to hospital data. For privately insured patients. the median prices include $1. 715 under Blue Cross Blue Shield; $1. 970 with Humana; $2. 050 with Cigna; $2. 413 with United Healthcare; and $2. 769 with Aetna.
At Northwestern Medicine Palos Hospital, the numbers shift again. A colonoscopy across all Blue Cross Blue Shield plans has a median price of $980, but the median price under Aetna or United Healthcare plans jumps to $3,371.
Even something as simple as an x-ray of the foot shows wide variations at Advocate Lutheran General: the median price under Aetna is $97, $118 under Cigna, $167 under Blue Cross Blue Shield, $287 under United Healthcare, and $551 under Humana.
The study also finds that prices within the same hospital system can vary widely. A hand x-ray under Blue Cross Blue Shield’s Managed Care plan costs $330 at Advocate Christ Medical Center in Oak Lawn. $424 at Advocate Illinois Masonic in Lake View. $521 at Advocate Good Samaritan Hospital in Downers Grove. and $647 at Advocate South Suburban Hospital in Hazel Crest—even though all are owned by Advocate Health Care.
Those differences land hardest on consumers with high-deductible plans, including nearly half of privately insured Americans under age 65. A survey by the CDC’s National Center for Health Statistics found those plans made up about 42% of the private insurance market in 2023.
Ge Bai. a Johns Hopkins University professor who researches healthcare costs. described why it can feel different for people who do and don’t have “skin in the game.” “For people well-covered. the price — high or low — will not affect whether they go to the hospital or not. ” Bai said. “They don’t have skin in the game.”.
But for people who haven’t met a deductible, high procedure prices can quickly become a budget crisis. Healthcare can include some of the biggest purchases consumers make—on par with a car, rent, or mortgage payments—yet unlike other purchases, the price is largely beyond a patient’s control.
Christopher Whaley, an associate professor at Brown University’s School of Public Health, said the lack of transparency leaves room for profit. “Healthcare is certainly not a normal marketplace,” he said. “Where there’s a mystery, there’s a margin.”
The system’s mechanics also include insurer administrative rules. With fully-insured private commercial plans. insurers are allowed to keep 20% of the premiums they collect to spend on administrative. overhead and marketing costs. Bai said critics argue that slice can reduce insurers’ incentive to drive a hard bargain—because if healthcare costs rise. premiums may rise too.
What the public sees is only part of the story. The American Hospital Association’s Molly Smith said negotiations aim for fair reimbursement overall. not necessarily for the clean consumer comparisons people expect. Smith. group vice president for policy at the American Hospital Association. said hospitals have overhead that must be shared across services and that some services are underpaid.
Smith said services that hospitals often lose money on include maternity care, behavioral health, pediatrics, and infectious disease. “And so you have to then build in the overhead costs to maintain those services,” she said.
Smith also said most consumers never pay the price listed in the published data. “What a patient ultimately ends up getting billed is not going to be what you see in the [pricing] files,” she said.
Still, the Mansueto-Sun-Times study suggests that even when prices are posted, the federal transparency rule doesn’t deliver the clarity its supporters envisioned.
Hospitals have been required to publicly post their prices for the procedures and tests they offer using CPT codes under the Hospital Price Transparency Rule that took effect in 2021. The concept was to empower consumers and drive competition.
But compliance has been uneven. Since June 2022, the federal Centers for Medicare & Medicaid Services has notified 28 hospitals that they’re out of compliance. The agency has taken steps including a 2023 civil penalty of $847. 740 against Community First Medical Center in Portage Park and a $51. 615 fine against Pinnacle Hospital of Crown Point. Indiana. in February.
Even when data exists, researchers and consumer advocates say the format often makes it unhelpful. Insurers’ bundling and discounting can also change the final price a patient sees.
Jeanne Pinder, founder and CEO of ClearHealthCosts.com, said consumers struggle to use the published information. “The average consumer can’t access the data, can’t make heads or tails of it. You have to be able to compare one hospital to another. Without comparisons, you don’t have anything actionable,” she said.
Pinder added that the biggest beneficiaries of the 2021 rule appear to be insurers and hospitals, which can use the published files to track what competitors are doing.
There is another federal change coming, but it too carries delays and complexity. Smith said the American Hospital Association is looking ahead to the Advanced Explanation of Benefits provision mandated by the No Surprises Act. a federal law enacted in 2020 to prevent consumers from receiving unexpected medical bills.
Under the provision, patients will receive a good faith estimate of what they’ll owe ahead of any scheduled medical service. Smith said the reform was supposed to take effect in January 2022 but has been delayed while industry stakeholders worked through execution details.
“We think this is going to be kind of the gold standard for scheduled services. It’s just been complicated to figure out how exactly to make this happen,” she said.
Laura Minzer. president of the Illinois Life & Health Insurance Council. said the system is flawed and complex for both consumers and insurers. She pointed to network adequacy requirements. which are designed to ensure reasonable access to hospitals. doctors. and specialists for everyone under an insurer’s plans.
Minzer said in less-served areas of Illinois, those requirements can give hospitals an upper hand in price negotiations. She also said insurers worry that expected federal cuts to reduce Medicaid spending by $911 billion over 10 years will push hospitals to jack up prices across private insurance plans. “The costs have to be recouped somewhere,” she said.
Some consumer-focused websites are trying to help people navigate comparisons. PatientRightsAdvocate.org offers an online price comparison tool, and ClearHealthCosts.com has undertaken its own deep dives into healthcare pricing in several metro areas.
Consumer advocates say that for planned diagnostic tests, patients can shop around using hospitals’ online price tools while understanding they are only estimates. They also suggest reviewing hospital quality metrics at hospitalsafetygrade.org.
The UChicago researchers found numerous examples where discounted cash prices are lower than prices under private insurance plans. A cash price for a minimally invasive balloon angioplasty at Endeavor Health’s Northwest Community Hospital is $7. 962. while median prices under insurance plans are $18. 423 for Blue Cross Blue Shield; $21. 155 for Humana; $22. 014 with Cigna; $25. 917 with United Healthcare; and $29. 742 with Aetna.
Some consumer groups advise obtaining the CPT codes before planned procedures or tests. then asking hospitals for their discounted cash price to compare against the price a patient’s insurance plan would set. They also suggest that if a person with a high-deductible plan finds the cash price lower. they can ask the hospital to not run the transaction through their insurance.
But Patients Rights Advocate warns that paying cash won’t apply to a person’s annual insurance deductible, which could reduce or erase savings over time.
Kostecka, who found that cheaper MRI option in her own search, said she was glad she shopped around. In a perfect world, she said, prices would be more uniform. “Just having it be more transparent, easier to find out the difference — that would be helpful, too.”
Not everyone contacted for comment agreed to the same level of detail. A Northwestern Medicine spokesman declined to comment but provided the hospital’s online price estimator. Advocate Health did not respond to requests for comment.
Endeavor Health declined an interview request. but in a statement it said: “We recognize that healthcare affordability is a significant concern for many in our community and navigating billing for services can be challenging. Endeavor Health is focused on providing high-quality care while ensuring patients are aware of the resources available to them. including financial assistance programs and various payment options. We encourage patients with questions about their bills to contact our billing department for assistance.”.
The federal transparency rule was built around a simple promise: publish prices so consumers can make choices. The new data shows a system in which the same procedure can carry radically different numbers, posted in forms most people can’t readily compare.
For patients like Kostecka, that gap doesn’t stay theoretical. It turns into phone calls, last-minute planning, and the uneasy feeling that even as healthcare bills are supposed to be clearer on paper, the real cost is often something patients have to discover for themselves.
hospital price transparency CPT codes health insurance high-deductible plans No Surprises Act No Surprises Act Advanced Explanation of Benefits Chicago area healthcare costs patient billing CMS hospital compliance