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By Jordan Rau / Kaiser Health News
October 7, 2015

Thinking about getting a mammogram in the Dallas-Fort Worth area? You might check carefully because the cost can vary from $50 to as much as $1,045.

How about an initial routine gynecological exam? Around Phoenix, those prices can range from $72 to $388.

According to an analysis released Wednesday, it can pay to shop around for women’s health care, with mammograms and other routine services often costing far more in one office than in another. Researchers at Castlight Health, a company that helps businesses analyze health care prices, looked at 179 metropolitan areas and found that mammogram prices varied four-fold or more in Atlanta, Houston, Los Angeles, Miami, Philadelphia and Seattle, among others.

“The variation was shocking,” said Jonathan Rende, chief of research and development for Castlight, which is based in San Francisco and collects billing records from employers that show the prices insurers and patients pay. “It speaks to how broken the health care system is.”

The Castlight study is one of the first to look at price variation in women’s health services, and it did not explain what may be causing the disparities or publish the names of providers. However, other studies have identified a host of influences. Private insurers sometimes strike markedly different deals with hospitals, labs and doctors in negotiations that are driven by market power as much as the actual cost of care.

It’s leaving health care consumers in the dark. They are in weak positions to shop around as most medical professionals and insurers do not publish actual prices or make it easy to get quotes. Patients frequently defer to their doctors’ recommendations for where to get a test, and those physicians rarely consider price.

Rende said prices of women’s health services were particularly important: “We’ve seen over the years that women are bigger consumers of health care than men in general and we wanted to drill into some of the more common services and see how those varied.”

Not every type of procedure Castlight examined had gigantic variations. The widest price difference for a follow-up visit with an obstetrician and gynecologist was in Phoenix, where the cheapest visit cost $57 and the most expensive one cost $137.

But Castlight found price differences in tests for the human papillomavirus (HPV)—which is linked to the risk of cervical cancer–of 10 times or more in the majority of the major metropolitan regions it examined. An HPV test in the Philadelphia-Atlantic City area ranged from $32 to $626, a 19-fold variation.

Castlight also found prices varied significantly between some regions, beyond what could be attributed to cost of living differences. The average price for a mammogram ranged from $485 in Sacramento, Calif., to $159 in Cincinnati. The average HPV test in Indianapolis was $165, five times the $32 price in Charlotte, N.C.

Price of a Mammogram

The price of a mammogram for privately insured patients can vary substantially within a region. Castlight Health analyzed data provided by employers to identify the least expensive, most expensive and average price for a mammogram in 179 metropolitan areas. This chart also shows the degree of variation between the cheapest and priciest mammogram in each region. That difference is expressed as a fold change, so that the difference between $200 and $600 would be a three-fold change, because $600 is three times as much as $200.

Metropolitan Area Average Price ($) Minimum Price ($) Maximum Price ($) Variation (Fold Change)
Janesville-Beloit WI 507 507 507 1
Eau Claire WI 486 486 486 1
Sacramento-Yolo CA 485 179 556 3.1
Huntington-Ashland WV-KY-OH 484 227 579 2.6
Pensacola FL 474 337 509 1.5
Jackson MS 446 446 446 1
Indianapolis IN 431 238 604 2.5
San Francisco-Oakland-San Jose CA 425 129 860 6.7
Greenville-Spartanburg-Anderson SC 421 421 421 1
Norfolk-Virginia Beach-Newport News VA-NC 417 260 581 2.2
Albany-Schenectady-Troy NY 415 293 635 2.2
Boston-Worcester-Lawrence MA-NH-ME-CT 409 226 838 3.7
Rocky Mount NC 406 406 406 1
Cheyenne WY 404 404 404 1
Great Falls MT 404 404 404 1
Salinas CA 398 398 398 1
Washington-Baltimore DC-MD-VA-WV 390 150 663 4.4
Harrisburg-Lebanon-Carlisle PA 382 365 399 1.1
South Bend IN 378 378 378 1
Lubbock TX 377 377 377 1
Scranton–Wilkes-Barre–Hazleton PA 377 261 404 1.5
Huntsville AL 374 374 374 1
Fort Pierce-Port St. Lucie FL 373 373 373 1
Utica-Rome NY 372 365 434 1.20
New York-Northern New Jersey-Long Island 371 130 1.90 14.60
Jackson MI 368 368 368 1
Portland ME 366 366 366 1
Yuma AZ 363 363 363 1
Jamestown NY 362 310 414 1.3
Madison WI 362 362 362 1
Bangor ME 360 360 360 1
Providence-Fall River-Warwick RI-MA 360 306 391 1.3
Elkhart-Goshen IN 359 359 359 1
Minneapolis-St. Paul MN-WI 358 182 512 2.80
Fort Collins-Loveland CO 354 321 380 1.20
Chico-Paradise CA 353 353 353 1
Florence SC 350 240 461 1.90
Kokomo IN 338 338 338 1
Richmond-Petersburg VA 335 292 388 1.3
Dover DE 333 333 333 1
Bellingham WA 331 331 331 1
Killeen-Temple TX 331 142 469 3.30
Beaumont-Port Arthur TX 324 312 328 1.1
Salt Lake City-Ogden UT 324 322 327 1
Johnson City-Kingsport-Bristol TN-VA MS 318 318 318 1
Green Bay WI 317 317 317 1
Duluth-Superior MN-WI 315 315 315 1
Kalamazoo-Battle Creek MI 315 263 367 1.40
Champaign-Urbana IL 313 313 313 1
Syracuse NY 309 309 309 1
Austin-San Marcos TX 308 142 422 3
Fort Walton Beach FL 308 298 321 1.1
Lafayette IN 307 307 307 1
Miami-Fort Lauderdale FL 307 96 510 5.30
Milwaukee-Racine WI 307 146 367 2.5
Odessa-Midland TX 306 275 327 1.20
Davenport-Moline-Rock Island IA-IL 304 304 304 1
Boise City ID 302 281 302 1.1
Lafayette LA 299 235 315 1.3
Lawrence KS 299 299 299 1
Charlottesville VA 294 267 322 1.20
Denver-Boulder-Greeley CO 294 165 492 3
Fayetteville NC 293 293 293 1
Buffalo-Niagara Falls NY 292 292 292 1
Myrtle Beach SC 292 210 374 1.8
Lynchburg VA 287 191 364 1.90
Houston-Galveston-Brazoria TX 283 101 472 4.7
Iowa City IA 282 282 282 1
Lincoln NE 276 276 276 1
Allentown-Bethlehem-Easton PA 274 274 274 1
Spokane WA 272 179 331 1.90
Fort Wayne IN 270 261 288 1.1
San Antonio TX 269 137 286 2.1
Hattiesburg MS 268 268 268 1
Medford-Ashland OR 267 179 354 2
Jackson TN 266 266 266 1
Sherman-Denison TX 265 252 291 1.20
York PA 265 188 304 1.6
Seattle-Tacoma-Bremerton WA 264 119 572 4.80
Wilmington NC 261 256 264 1
Corpus Christi TX 259 259 259 1
Kansas City MO-KS 259 115 393 3.40
Fort Myers-Cape Coral FL 256 243 268 1.1
Oklahoma City OK 255 150 400 2.7
Rockford IL 255 210 309 1.5
Columbia SC 251 224 252 1.1
Springfield MA 251 172 361 2.1
Corvallis OR 250 179 285 1.6
Augusta-Aiken GA-SC 249 174 316 1.8
Portland-Salem OR-WA 247 125 461 3.7
Roanoke VA 246 191 273 1.40
Waterloo-Cedar Falls IA 246 246 246 1
Victoria TX 244 244 244 1
El Paso TX 242 165 311 1.90
Atlanta GA 241 89 488 5.5
Chicago-Gary-Kenosha IL-IN-WI 238 83 370 4.5
Phoenix-Mesa AZ 238 140 428 3.1
Cleveland-Akron OH 237 88 363 4.10
Los Angeles-Riverside-Orange County CA 237 86 954 11.20
Bryan-College Station TX 236 105 399 3.80
Las Vegas NV-AZ 236 179 539 3
San Angelo TX 236 183 288 1.6
Shreveport-Bossier City LA 236 236 236 1
Canton-Massillon OH 232 155 253 1.6
Hartford CT 232 72 272 3.80
San Diego CA 232 74 299 4
San Luis Obispo-Atascadero-Paso Robles CA 232 232 232 1
Merced CA 227 220 251 1.1
New Orleans LA 227 136 265 2
West Palm Beach-Boca Raton FL 226 69 520 7.5
Benton Harbor MI 224 224 224 1
Detroit-Ann Arbor-Flint MI 220 66 343 5.2
Richland-Kennewick-Pasco WA 219 206 233 1.1
Jacksonville FL 218 103 321 3.1
Chattanooga TN-GA 215 213 219 1
McAllen-Edinburg-Mission TX 214 214 214 1
Dallas-Fort Worth TX 211 50 1.05 20.90
Tyler TX 211 211 211 1
Columbus GA-AL 209 209 209 1
Columbus OH 209 143 312 2.2
Little Rock-North Little Rock AR 209 208 212 1
Fort Smith AR-OK 208 208 208 1
Knoxville TN 208 191 222 1.20
Rochester NY 208 134 348 2.6
Sumter SC 207 207 207 1
Stockton-Lodi CA 206 110 327 3
Biloxi-Gulfport-Pascagoula MS 205 122 225 1.8
Colorado Springs CO 205 177 260 1.5
Fayetteville-Springdale-Rogers AR 205 205 205 1
Lake Charles LA 205 205 205 1
Greensboro–Winston-Salem–High Point NC 204 184 225 1.20
Birmingham AL 202 151 257 1.70
Youngstown-Warren OH 201 156 327 2.1
Melbourne-Titusville-Palm Bay FL 200 135 279 2.1
Tucson AZ 200 175 232 1.3
Erie PA 197 197 197 1
Nashville TN 196 67 230 3.40
Lewiston-Auburn ME 195 156 235 1.5
Williamsport PA 194 194 194 1
Athens GA 192 192 192 1
Lima OH 192 192 192 1
Orlando FL 191 84 334 4
Philadelphia-Wilmington-Atlantic City PA-NJ-DE-MD 191 106 758 7.2
Charlotte-Gastonia-Rock Hill NC-SC 189 158 220 1.40
Pittsburgh PA 186 130 265 2
Tuscaloosa AL 186 186 186 1
Macon GA 185 184 185 1
Eugene-Springfield OR 184 179 304 1.70
Montgomery AL 183 116 205 1.8
Grand Rapids-Muskegon-Holland MI 178 178 178 1
Savannah GA 178 178 178 1
Yakima WA 178 177 179 1
Fresno CA 177 161 187 1.20
Hickory-Morganton-Lenoir NC 177 177 177 1
St. Louis MO-IL 175 118 286 2.40
Springfield MO 174 174 174 1
Mobile AL 173 158 205 1.3
Daytona Beach FL 170 170 170 1
Visalia-Tulare-Porterville CA 169 77 307 4
Tampa-St. Petersburg-Clearwater FL 162 53 291 5.4
Cincinnati-Hamilton OH-KY-IN 159 123 291 2.40
Dayton-Springfield OH 159 97 214 2.2
Punta Gorda FL 152 152 152 1
Charleston-North Charleston SC 148 148 148 1
Sarasota-Bradenton FL 147 43 307 7.10
Waco TX 147 142 192 1.40
Columbia MO 144 144 144 1
Bakersfield CA 143 128 188 1.5
Omaha NE-IA 143 123 204 1.70
Toledo OH 139 132 145 1.1
Raleigh-Durham-Chapel Hill NC 135 101 239 2.40
Memphis TN-AR-MS 134 114 212 1.90
Sharon PA 130 130 130 1
Tulsa OK 120 65 167 2.6
Baton Rouge LA 105 105 105 1
Lakeland-Winter Haven FL 102 72 132 1.8
Modesto CA 101 101 101 1
Tallahassee FL 94 94 94 1
Jonesboro AR 91 91 91 1

Source: Castlight Health

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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