Insights / Price data
Why the Same Scan Costs Four Times More Across Town
We parsed the published price files from thirteen Montana hospitals. The same brain MRI ranges from $840 to $3,860, and insurers pay about $784.
Two Montanans can walk into two hospitals ninety minutes apart, get the same scan on similar machines, and be asked for wildly different amounts. Not ten percent different. Four times different.
We know this because every hospital in the country is now required to publish its prices, and we went and read them.
What we did
Federal price transparency rules require each hospital to post a machine-readable file listing what it charges for every billing code, what it will accept from a self-paying patient, and what it has negotiated with each insurer. CMS also requires a small index file at each hospital's web domain so the pricing file can be found.
We pulled those files directly from thirteen Montana hospitals in August 2026 and parsed nineteen common procedure codes out of them. Nothing below is estimated or modelled. Every figure is the hospital's own published number.
What the same scan costs across Montana
These are list prices for a single billing code at each hospital, lowest and highest of the Montana facilities that published a figure.
| Scan | Lowest published | Highest published | Spread |
|---|---|---|---|
| Chest X-ray, two views | $103 | $351 | 3.4x |
| Screening mammogram | $124 | $798 | 6.4x |
| Lower back MRI | $823 | $3,420 | 4.2x |
| Brain MRI | $840 | $3,860 | 4.6x |
| Head CT without contrast | $443 | $2,106 | 4.8x |
| Abdominal and pelvic CT with contrast | $1,292 | $6,312 | 4.9x |
The pattern holds across every imaging code we checked. The cheapest published price in Montana is usually a small rural or critical access hospital. The highest is usually a larger regional facility.
The number almost nobody sees
Here is the part that matters more than the geography.
Alongside the list price, hospitals must publish what they have actually negotiated with insurers. For a brain MRI, the median negotiated amount across Montana hospitals is about $784. The highest list price for that same scan is $3,860.
So the insurer pays roughly $784. The list price is roughly five times that. And the person most likely to be quoted something near the list price is the one paying out of pocket, because they have nobody negotiating for them.
That gap is the actual story. It is not that one hospital is expensive and another is cheap. It is that the list price is close to fiction, and whether you ever see the real number depends entirely on who is standing behind you.
An honest caveat
These are published rates for a single billing code. A real episode of care usually involves several codes, and a facility fee may apply on top. Some of the largest gaps in the raw data come from hospitals that bundle differently rather than from a genuine price difference, which is why we have stuck to imaging codes above, where the comparison is closest to like for like.
Use these numbers to compare facilities and to know what to ask. Do not treat them as a quote.
What to actually do with this
Ask for the cash price by name. Most hospitals publish a discounted self-pay rate that is well below list. It is often not offered unless you ask for it specifically.
Ask for a good faith estimate. For scheduled care, you have a right to a written estimate before the procedure. Our good faith estimate guide covers how to request one.
Call more than one facility. A ninety minute drive is worth it for a difference of two thousand dollars, and in Montana that drive is often the difference between the regional hospital and the critical access hospital one county over.
Check the itemized bill afterwards. Billing errors are common and the itemized bill guide explains what to look for.
Ask whether an independent imaging centre can do it. Hospital outpatient departments are frequently the most expensive place to get a routine scan.
Where to see the numbers
We publish the full comparison, hospital by hospital, on the Montana hospital price pages. Each one shows what every facility that published a figure asks for that procedure, what insurers actually pay, and where the data came from.
If a scan is coming up and you want help working out where to get it, email us at info@coremedhealth.com. We will tell you what we see in the data even if the answer has nothing to do with a CoreMed membership.
Source: CMS hospital price transparency machine-readable files, published by each hospital and parsed August 2026. Figures are list prices for a single billing code and are not a quote.
