State of Cash-Pay Hospital Prices in America, 2026

If you have a medical emergency, call 911 or go to the nearest emergency room (ER). Do not wait to compare prices.

What we found

We read the price files of 5,141 hospitals in all 50 states and DC in October 2026. We looked at the cash price, which is what a hospital charges a person who pays the bill themselves, for 24 common services. This report covers hospitals only, not doctors who offer care for a flat monthly fee.

What we measured

Since January 1, 2021, a federal rule has made most hospitals post a public price file with a "discounted cash price". We used fixed written rules to pick one cash price per hospital for each service.

The services are CT scans, which are detailed X-ray pictures, and MRIs, which are scans made with magnets. They also include a chest X-ray, two ultrasounds, a mammogram, seven lab tests, a blood draw, four ER visit levels and an EKG, which is a quick heart test. Every price is the hospital's part of the bill only, because doctors usually bill separately.

A "middle price" is the price in the middle of the list, so half of hospitals charge more and half charge less.

Cash is usually higher than the middle insurance plan rate

Hospitals also post the rates that insurance plans have agreed to pay them. We compared the cash price with these rates in 73,922 cases at 3,478 hospitals. A case means one service at one hospital. For each case, the "middle insurance plan rate" is the middle of all the dollar rates that plans pay that hospital for that service.

The cash price was lower than the middle insurance plan rate in only about 1 case in 4 (25%). It was at least 10% lower in about 1 case in 5 (19%). In a typical case, the cash price was 1.71 times the middle insurance plan rate.

In about 1 case in 4 (25%), cash was higher than even the highest plan rate at that hospital. It was at or below the lowest plan rate in only 4% of cases. Among 3,349 hospitals with at least 10 cases, 1,356 never had a cash price below the middle plan rate.

The answer depends on the kind of plan. Cash was lower than the middle job-based or Marketplace plan rate in about 39% of cases. A Marketplace plan is one you buy on HealthCare.gov or a state website. Cash was lower than the Medicare Advantage rate in about 10% of cases, and lower than the Medicaid plan rate in about 13%. Medicare Advantage plans are private plans for people on Medicare, and Medicaid is public coverage for people with low incomes.

A plan's rate is what the plan and the patient pay together. If you have not met your deductible, which is the amount you pay each year before your plan pays, you often pay the full plan rate yourself.

At 1 hospital in 5, the cash price is the full list price

Every hospital keeps a list price for each service, called the "gross charge". In a typical case, the posted cash price was 62% of that list price, a discount of about 38%. Still, 17% of the cash prices we found were within 2% of the list price.

At 745 hospitals, the cash price was within 2% of the list price on more than half of their services. That is about 1 in 5 of the hospitals that posted a usable cash price. On most services there, the posted cash price gives no discount.

Where paying cash comes closest

These numbers come from the hospitals that posted both a cash price and insurance rates for each service.

Cash did best for ER visits, mammograms and blood draws. The cash price was below the middle insurance plan rate in 34% to 35% of cases for each ER visit level. The share was 36% for a screening mammogram and 38% for a blood draw. For a level 3 ER visit, the middle cash price was $635 and the middle job-based or Marketplace plan rate was $648.

Lab tests other than the blood draw had the biggest gaps, and so did CT scans. At a typical hospital, the cash price for these was about 2 to 3 times that hospital's middle insurance plan rate. For a common blood panel called a CMP, which checks blood sugar, salts, and kidney and liver health, it was about 2.9 times. At hospitals that posted both a cash price and insurance plan rates for a brain MRI, the middle cash price was $1,837 and the middle insurance plan rate was $736.

The same scan can cost 5 times as much across town

We compared the highest and lowest cash price in each city. For a brain MRI without dye, 115 cities had at least 3 hospitals with a usable price. In 46 of them, the highest price was at least 5 times the lowest. In a typical city, it was 4.3 times the lowest.

For a CT scan of the belly and pelvis with dye, the gap was 5 times or more in 47 of 114 cities. For a level 3 ER visit, it was 5 times or more in 39 of 114 cities.

These large cities show the brain MRI gap. We checked each lowest and highest price against the hospital's own current price file.

• In Houston, 13 hospitals had a usable price, from about $232 to about $17,454.
• In Dallas, 14 hospitals had a usable price, from $238 to about $6,583.
• In Manhattan, New York, 7 hospitals had a usable price, from about $286 to about $4,034.
• In Chicago, 19 hospitals had a usable price, from about $303 to $4,097.
• In Kansas City, Missouri, 4 hospitals had a usable price, from $237 to about $10,574.

Prices differ a lot from state to state

We worked out a middle cash price for each state where at least 5 hospitals posted a price. The middle brain MRI cash price was $3,648 in South Dakota, $3,642 in Florida and $896 in Tennessee. Across the country, it was $1,857, and the middle half of hospitals charged $1,121 to $2,878.

Florida also had the highest middle cash price for a CT scan of the head ($3,054) and the CMP blood panel ($424). New Jersey was the lowest state for 16 of our 24 services, including a $331 brain MRI. Those low New Jersey prices may not be open to everyone.

Where state law shapes hospital prices, cash does best

The cash price beat the middle insurance plan rate in 74% of Maryland cases, at 14 hospitals. It did so in 66% of New Jersey cases, at 54 hospitals. Across the country, it was 25%. Delaware was lowest at 1%, and Florida was the lowest large state at 6% of 3,385 cases.

In Maryland, a state agency called the Health Services Cost Review Commission has set hospital rates since July 1, 1974. The commission says that all payers pay the rates it sets. In our data, the typical Maryland cash price was 98% of the middle insurance plan rate.

In New Jersey, a 2008 state law covers uninsured residents whose family income is under 500% of the federal poverty level. A hospital may charge them no more than 115% of what Medicare pays. Medicare is the federal plan for people 65 and older and some people with disabilities. At 34 New Jersey hospitals, posted lab prices are 0.90 to 1.15 times Medicare's lab rates. So New Jersey's low posted cash prices may apply only to residents who qualify, and others may pay more.

Critical access hospitals charge less for the ER and more for MRIs

The federal government calls some small rural hospitals "critical access hospitals". They have no more than 25 inpatient beds and are usually far from other hospitals. We used them to stand in for rural hospitals. They posted a usable cash price a little more often than other general hospitals, at 88% compared with 84%.

Their ER visits cost less in cash. For a level 3 ER visit, the middle cash price was $545, compared with $751 at other general hospitals. Across all four ER levels, they were 23% to 28% lower.

Their MRIs and lab tests cost more. For a brain MRI, the middle was $2,000 compared with $1,751, about 14% higher. Each lab test, including the blood draw, cost 3% to 16% more. Their X-rays, ultrasounds and EKGs cost a little less.

How many hospitals post a usable cash price

Of the 5,141 hospitals we covered, 3,892 posted a usable cash price for at least one of our 24 services. That is about 3 in 4 (76%). Most psychiatric hospitals do not offer these tests, and with them left out, the share was 85%.

Only 2,231 hospitals posted a price for all 24 services. The share that posted ranged from all 12 hospitals in Rhode Island to 5 of 9 in the District of Columbia.

State table

For each state, this table shows how many hospitals posted a usable cash price and two middle cash prices. The last column shows how often cash was below the middle insurance plan rate, for states with at least 5 hospitals that posted both prices. New Jersey's low prices may apply only to residents who qualify under its 2008 law.

How we did it, and what the data cannot tell you

We started from the federal list of hospitals in each state and read their price files between October 11 and October 31, 2026. Federal hospitals, such as VA hospitals, are not counted. One Kansas hospital is left out because a Foundation director works there.

Our rules keep only the hospital's own charge, and our methods page explains every rule. A separate checker wrote its own code and matched all 85,110 prices in our library. Every price figure in this report comes from scripts run on our price library. A second checker recomputed them without seeing our code, and every one matched.

"Usable" means our rules could find a cash price in the file. Some hospital websites did not allow automated downloads, and some files could not be read. This is not a finding that a hospital broke the federal rule. State middles count hospitals that share one identical price file only once. Prices our rules mark as unusual, which are often file errors, are left out of all middles and city gaps.

For the insurance comparison, we used only the dollar rates in the same hospital files. Regular Medicare is left out, because the government sets its rates. Maryland has no CT or MRI prices, because its hospitals post those in units we could not turn into a price per scan. Our data cannot prove that New Jersey's law caused its low prices, but the pattern fits it.

These are posted prices, and your bill can be different. They leave out financial assistance, which can lower a bill a lot. The typical price file was about 6 months old when we read it, and 3% were more than 365 days old. The hospitals that post prices may not be typical of all hospitals.

How to get the data

The prices in this report are free to read and to quote. If you quote them, please credit FindMyDirectDoctor Foundation and link to this page.

Researchers, reporters and other nonprofits can ask for the full data set for noncommercial use. Our methods page explains how to ask for it.

If you work at a hospital and think a price is wrong, please tell us through our contact page. We will check it against the hospital's file and fix it.

Sources

• Hospital cash prices and insurance plan rates: FindMyDirectDoctor Foundation hospital cash price library, rules version 1.10e, hospital price files read October 11 to 31, 2026. Methods: /prices/methods/.
• Hospital Price Transparency rule, 45 CFR part 180, in effect since January 1, 2021: Centers for Medicare & Medicaid Services, https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency (read November 1, 2026).
• New Jersey limit on charges to uninsured residents: P.L.2008, chapter 60, approved August 8, 2008, N.J.S.A. 26:2H-12.52, https://pub.njleg.gov/bills/2008/PL08/60_.PDF (read November 1, 2026).
• Maryland hospital rate setting: Health Services Cost Review Commission, "Maryland's All-Payor Hospital Payment System", https://hscrc.maryland.gov/Documents/pdr/GeneralInformation/MarylandAll-PayorHospitalSystem.pdf (read November 1, 2026).
• Critical access hospitals: Centers for Medicare & Medicaid Services, https://www.cms.gov/medicare/health-safety-standards/certification-compliance/critical-access-hospitals (read November 1, 2026).
• Good Faith Estimate disputes: Centers for Medicare & Medicaid Services, https://www.cms.gov/medical-bill-rights/help/dispute-a-bill (read November 1, 2026).
• Financial assistance policies of nonprofit hospitals, Internal Revenue Code section 501(r)(4): Internal Revenue Service, https://www.irs.gov/charities-non-profits/financial-assistance-policy-and-emergency-medical-care-policy-section-501r4 (read November 1, 2026).