Imaging pricing study shows highest-cost U.S. states

What creates pricing discrepancies in radiology imaging services across the U.S.? Analysts are taking the first step at understanding by using price transparency requirements to identify the highest-cost and lowest-cost states.

Three radiology Current Procedural Terminology (CPT) codes cost considerably more for people in Alabama, New Mexico, California, and Nevada compared with Rhode Island, Arkansas, New Hampshire, and Oklahoma, according to Torrin Jacobsen of the Lake Erie College of Osteopathic Medicine in Florida, and colleagues from Emory University School of Medicine in Georgia and Radiology of Indiana.

Many in the U.S. are paying "cash prices" for imaging services because they are not insured, they have high-deductible health plans, or they have chosen a cash-pay option, the group noted.

"Research on price transparency is still new," Jacobsen told AuntMinnie in an email. "Due to the complexity, the data is not perfect, and therefore some states may have stronger or weaker data comparatively, just based on what may have been published for any given state’s facilities. With these reasons in mind, we wanted to start very simply and understand the trends of a reliable data point that may impact a significant % of the populace, being cash cost."

In a 2025 year-ending report, Jacobsen and colleagues analyzed charge-master data of diagnostic imaging CPT codes. The researchers considered publicly available data, median household income by state, hospital cost reports, and state-level price trends in relation to the following CPT codes for diagnostic imaging services:

• 70553: Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences. Researchers found Pennsylvania to be least affordable overall (highest Z-score, 2.813).
• 72193: Computed tomography, pelvis; with contrast material(s). Nevada was least affordable (highest Z-score, 3.501).
• 76700: Ultrasound, abdominal, real time with image documentation; complete. Alabama was least affordable overall (highest Z-score, 2.544).

The report published December 31 in Clinical Imaging presents a wide range of data -- from the U.S. Centers for Medicare and Medicaid Services (CMS) summed total costs per state, to a "Z-score" for the three CPT codes as a metric of uniform affordability by state, and the ratio of for-profit to nonprofit hospital beds by state (per 2022 data). 

States with higher affordability had higher discounts on gross charges (50% to 57%) and states with less affordability had lower discounts off gross charges (less than 30%), according to the findings. The costliest states were also among the states with the highest ratio of for-profit hospital beds to nonprofit beds per 1,000 people, according to the report.

The group used a limited research dataset from Turquoise Health as of October 10, 2024, to analyze hospital facilities' discount cash prices. They did not investigate insurance reimbursements.

"The underlying 'Why?' of healthcare prices, in respect to the two-party payer-provider model, remains a true ‘what caused what?’ conundrum," Jacobsen and colleagues wrote.

Find all data for the three codes and the complete paper here.