Northwestern quoted $6,000 for an MRI. Another Chicago hospital charged $115.
Two documented bills — a Chicago woman's $6,000 MRI quote that became a $115 charge across town, and a New York patient's $4,340 therapy bill cut to $1,300 — show how to find a hospital's published prices, compare them, and challenge a bill, with the questions to ask and a First 3 Moves checklist.
The short version
Two women, two bills, and one fact underneath both: for the same care, an American hospital carries several prices at once, and the number a patient meets first is often the highest.
Emily Kostecka is 29 and lives in Chicago's Logan Square. She has epilepsy and has been getting MRIs for years, so she knows what her share of one usually costs: a few hundred dollars. Her coverage is a high-deductible Blue Cross Blue Shield plan. Last year, before an appointment, the billing department at Northwestern Memorial Hospital called to tell her that the outpatient MRI she was about to have would cost about $6,000 after her insurance handled the claim. 1
Six thousand dollars was more than she could cover in one payment, and she briefly weighed taking out a loan. She looked around instead, moved the scan to Humboldt Park Health, a small safety-net hospital, and paid $115 for the same test. 1
Cynthia Rivera runs a small business in Corning, New York. When her doctor prescribed physical therapy for plantar fasciitis, the administrators affiliated with Guthrie hospital in Corning left the price unstated. Rivera took nine semi-weekly sessions, stopped, and waited; the price arrived weeks later inside a bill for $4,340, of which her share was $2,759, with a related charge pushing her own expense past $3,000. 2
Rivera kept pushing on that bill, and the hospital reduced it to $1,300. 3 The next time care was prescribed, she priced it first. A mammogram that two hospitals quoted at $1,039 and $1,098 cost her $239, and an MRI cost her $395 in cash. Across those two tests, she estimates she saved roughly $2,000. 2
| Emily Kostecka | Cynthia Rivera | |
|---|---|---|
| Who and where | Chicago (Logan Square), 29, epilepsy, on a high-deductible Blue Cross Blue Shield plan 1 | Corning, New York, small-business owner 2 |
| The care | One outpatient MRI, the routine monitoring she has had for years 1 | Nine physical therapy sessions for plantar fasciitis 2 |
| What she was told to expect | About $6,000, her share, quoted by the hospital's billing office before the scan 1 | No price given before or during the sessions 2 |
| What she did | Moved the scan to Humboldt Park Health, a safety-net hospital 1 | Disputed the bill, then shopped her next two tests and paid cash 2 |
| Final amount paid | $115 1 | $1,300 on the therapy bill; $239 for the mammogram; $395 for the MRI 3 |
| Reduction | About 98% off the quote, on the same test 1 | More than half off her share of the therapy bill, plus about $2,000 saved by shopping 2 |
Since January 1, 2021, a federal rule has required every hospital in the country to publish its prices, both as a machine-readable file covering all its items and services and as a consumer-friendly display of the services a patient can shop for in advance. 4 Research shows that most patients still take whatever their doctor orders, at whatever price they are handed. 1 These two stories show what the published prices are worth to someone who checks them before the bill exists.
The quote, and the other price
Kostecka's MRI was routine for her: the epilepsy monitoring she has had done for years. Her insurer and the hospital had negotiated a rate for the scan, and the hospital's billing office told her that her own part of it would run about $6,000.
"I was kind of freaking out," she said. 1
She had the scan done somewhere else. Humboldt Park Health, a small safety-net hospital, quoted her a price she could pay, and her portion of that bill came to $115. The trade was modest logistics: she picked up the disc with her results in Humboldt Park and dropped it off at Northwestern's Streeterville campus for her doctor to read. 1
"Why is this on me to look for a better price for this thing that I need?" she said afterward. 1
A Northwestern Medicine spokesman declined to discuss her case and pointed the reporters to the hospital's online price estimator. Advocate Health, another large Chicago system, did not respond to their questions. 1
Nine sessions, and the price that arrived afterward
Rivera's experience started from the other end. She was diagnosed with plantar fasciitis and prescribed physical therapy, mostly stretching and taping. The hospital administrators she dealt with gave her no price, and she noticed that her sessions were costing her insurer claims she never saw.
Nine semi-weekly sessions in, she stopped. Her reasoning was simple: had she known the price going in, she would have bought private physical therapy at around $100 a session instead. 2
The bill landed weeks later: $4,340 in total charges, of which her insurer covered part, leaving her $2,759. A related bill took her own expense past $3,000. She fought the charge, and the hospital lowered it to $1,300. 3
That fight turned her into a shopper. Before her next two tests, she asked for prices in advance. Cayuga Medical Center quoted $1,039 for her mammogram and Arnot Ogden Medical Center nearby quoted $1,098. Elizabeth Wende Breast Care charged $239 for the same procedure. For the foot MRI her doctor recommended, Open MRI of Elmira quoted $395 in cash, at a time when nearby hospitals were quoting thousands. She had both procedures without filing an insurance claim. 2
Why one scan carries several prices
Hospitals set a sticker price for every test and procedure, then negotiate a different rate with each insurer, and set a further discounted price for people paying out of pocket. The gaps between those numbers explain both stories.
The Chicago area shows the spread in the published data. At Advocate Lutheran General Hospital in Park Ridge, the median price for a diagnostic echocardiogram ran from $973 under UnitedHealthcare to $1,721 under Humana, while the discounted cash price for an uninsured patient was $1,155 — below two of the insured prices. A minimally invasive balloon angioplasty carried a cash price of $7,962 at Endeavor Health's Northwest Community Hospital, against median insurance prices of $18,423 for Blue Cross Blue Shield and $29,742 for Aetna at the same hospital. 1
Prices also move with the building. A hand X-ray under one Blue Cross Blue Shield plan cost $330 at Advocate Christ Medical Center in Oak Lawn, $424 at Advocate Illinois Masonic in Lake View, $521 at Advocate Good Samaritan in Downers Grove, and $647 at Advocate South Suburban in Hazel Crest — four hospitals belonging to one health system. 1
The numbers hit hardest in the plans that ask patients to pay first. High-deductible plans made up about 42% of the private insurance market in 2023, according to a federal survey 1, and patients on them pay much of the bill themselves until the deductible is met. Kostecka is one of them.
Compliance with the price-posting rule is uneven. The Centers for Medicare & Medicaid Services has notified 28 hospitals that they were out of compliance since June 2022, including an $847,740 penalty against Community First Medical Center in Chicago's Portage Park in 2023 and a $51,615 fine against Pinnacle Hospital of Crown Point, Indiana, in February. Enforcement of the rule's 2026 requirements began on April 1, 2026. 14
The published prices are a starting point rather than a final answer. Molly Smith, a policy vice president at the American Hospital Association, told the reporters that most consumers never pay the number in the data, and that what a patient ends up billed depends on the plan, the remaining deductible, and any bundled discount the insurer applies. 1
How to do it yourself
The two cases map onto two moments. If the care can be scheduled, you can price it first. If the bill has already arrived, you can dispute the number.
Before the appointment
- Get the code. Ask the doctor's office for the CPT code — the five-character code that identifies the exact test or procedure. Every price you are quoted is attached to that code, and comparing anything else is guesswork.
- Pull the posted prices. The hospital's own price estimator or posted file is the primary source. 4 PatientRightsAdvocate.org publishes a Hospital Price Files Finder, and ClearHealthCosts collects prices by metro area. 56
- Ask for both numbers in one call. This wording is this article's own, adapted from what both women did:
"I'm scheduling [the test] under code [CPT]. Two questions: what will I owe after my insurance, and what is your discounted cash price for the same code?"
- Compare cash against insurance. Paying cash can be cheaper than running a test through a high-deductible plan, and it comes with a catch worth weighing: a cash payment usually does not count toward your deductible, so the cheaper bill today can leave you paying more later in the year. 1
- Check the quality of the cheaper provider. A lower price means little if the scan is poor. Hospital Safety Grade publishes hospital safety ratings at hospitalsafetygrade.org. 1
- If you are paying without insurance, ask for the written estimate first. A patient who tells a provider in advance that insurance is not being used and then receives a bill at least $400 above the written Good Faith Estimate can file a federal dispute for a $25 administrative fee. Late fees stop and collections pause while the review runs, and the fee comes off your bill if you win. 7
After the bill arrives
- Request the itemized bill. Ask for the line-by-line statement with the billing codes, not the summary. Compare it against your medical records and your insurer's explanation of benefits. 8
- Check for double billing and unfamiliar codes. Duplicate charges are common when more than one provider bills for one visit. Look up each code and confirm it matches the care you received. 8
- Use the posted price as leverage. Rivera's route: find what the same code costs elsewhere in writing, then put the comparison to the billing office. PatientRightsAdvocate.org publishes a step-by-step version of this dispute, from asking for a copy of the signed financial agreement to writing the hospital's chief executive. 5
- Get help if you want it. A state Consumer Assistance Program or a patient advocate can take over the calls, and CMS publishes how to find both. 8 Paid bill-negotiation services also exist, and their published pricing tends to be a share of what they save you rather than a flat fee, so ask how they are paid before signing anything. 9
First 3 moves in the first 72 hours
These three apply to any US medical bill, whatever it is for and whoever sent it.
1. Request the itemized bill
The first bill is usually a summary. The coded, line-by-line statement is where a duplicate charge or a wrong unit count becomes visible, and every later argument rests on it. Ask by mail or secure message, and keep a reference number. 8
2. Hold the first invoice
The first invoice carries the list price, before any review or correction. Call the billing office, confirm the payment deadline, and ask them to note the account as under review while you gather documents.
"I'm reviewing the charges on account [number] and gathering documents. Please confirm the payment deadline and note that the bill is under active review."
3. Check financial assistance eligibility
Search the hospital's name with "financial assistance," or ask the billing department for the policy, the application, the income limits, and the deadline. 10 Section 501(r) of the tax code is what requires a nonprofit hospital to keep a written financial assistance policy and to tell patients about it. 11
Dollar For's handbook publishes the wording it tells patients to use on that call, and this is quoted exactly as the handbook prints it: 12
"Hi. My name is [YOUR NAME] and my date of birth is [YOUR DATE OF BIRTH]. I submitted a financial assistance application on [THE DATE YOU SENT IT IN]. Can you confirm you received my application and share the status?"
The handbook also publishes a hardship appeal letter for a denial, and it tells patients to file it with the most recent tax return, pay stubs, and bank statements attached. 13
What these two cases leave to the fine print
Shopping needs time. Both women's savings came from care they could schedule and compare, and an emergency leaves no room for either. Kostecka's case works because an MRI can be booked elsewhere; a heart attack cannot.
An estimate is an estimate. The other side of the equation is Anne Hug, a professor of radiology in Ohio, whose in-office polyp removal was moved at the last minute into a hospital surgery center by the system that owned the practice, turning a roughly $3,000 estimate into a roughly $6,000 bill. 14 Where a procedure happens can change its price more than any negotiation that follows.
A balance that is correct and that you can afford belongs on a payment plan or a settlement, and it is worth keeping in good standing. Financial assistance, price comparison, and an honest payment arrangement are three different tools for three different situations. Rivera's route cut her therapy bill by more than half; she paid the rest.
This article is educational information. Prices, discounts, insurance rates, and financial assistance policies vary by hospital, plan, and state, so confirm the specifics with the hospital's billing office, your insurer, or your state insurance department before you rely on them.
References
- 1
- 2
- 3New York Patient's Price Transparency Success Story — PatientRightsAdvocate.org
patientrightsadvocate.org
- 4
- 5How to Fight Medical Bill Overcharges — PatientRightsAdvocate.org
patientrightsadvocate.org
- 6ClearHealthCosts
clearhealthcosts.com
- 7Dispute a medical bill — CMS
cms.gov
- 8
- 9MedEx Shield
medexshield.com
- 10
- 11
- 124. Follow Up With The Hospital — Dollar For
dollarfor.org
- 13
- 14The market forces quietly adding thousands to patient bills — ClearHealthCosts
clearhealthcosts.com
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