Cost-Comparison Map Published

By Christine Kern, contributing writer

Castlight Health uncovers wide gaps in healthcare pricing nationwide.

A patient insured through an employer in Dallas might pay as little as $15 or as much as $343 for a cholesterol test, and a patient in Philadelphia could pay anywhere between $264 and $3,271 for a head CT scan, according to a new cost-comparison map from Castlight Health.

Using historical prices and analytics, Castlight has determined what many in the largest slice of the U.S. insured population – i.e., the 150M Americans who receive health insurance through their employer – are likely to pay for in-network services. The analysis focuses on four common outpatient services: a lipid panel, a CT scan (of head/brain), an MRI (of lower back), and an adult preventive primary care visit. The results show just how much price varies for the same services, both within cities and across them.

The company, which sells price transparency products and services to large employers, compared prices of the above services in more than 62 metropolitan areas of the U.S. and found tremendous variation in what patients pay, even when they are insured by their job.

Consumers often assume that by choosing an in-network plan, they are getting a better price or value, said Dr. Jennifer Schneider, president of strategic analytics for Castlight, who notes that 48 percent of Americans are covered by employer-sponsored insurance. The new findings highlight that more transparency on costs is needed to prevent employees, especially those in high-deductible plans, from feeling sticker shock.

When looking at cost within cities, the price range for the same service can be staggering. The most expensive MRI in New York City comes in at a whopping $4,527. And while expensive MRIs may not be news, this is: the same MRI is available to New Yorkers for $416. The study offers many more examples of wide pricing for the same service.

 “There's no way today for someone to know what things will cost if they simply follow the rules and go in-network,” Schneider said. “It's like letting someone shop on your credit card without any sort of limit.”

Castlight gathered medical claims data from self-insured employers, as well as rate sheets from providers, to create the city-by city tool showing prices for four common procedures: a cholesterol test, head CT scan, an MRI of the lower back, and a visit to a primary-care doctor. Among the most notable variations revealed was the 23-fold gap between the lowest and highest prices paid to providers in Dallas for a cholesterol test, and the 12-fold difference between the lowest and highest costs for CT scans in Philadelphia. In New York City, the lowest price for an MRI of the lower back was $416, while the highest (11 times higher) was $4,527. In Charlotte, N.C., a patient might pay as little as $60 or up to $241 to visit a primary-care physician.

“Healthcare is a line item that just keeps increasing,” noted Schneider, who says employers need to negotiate better to help drive down the costs.”

“Understanding healthcare costs is a first step in enabling employers to fix what is broken in enterprise healthcare,” Schneider said.