The 2026 Same-City Price Spread Report: One Colonoscopy Code, $470 to $22,949 in Metro Detroit

Hospitals now publish their cash prices. Federal price transparency rules have required it since 2021. We read those files so you do not have to.

FairVisitHealth maintains a database of prices that hospitals themselves disclosed in machine-readable transparency files. For this report we took a snapshot on August 23, 2026, kept only rows we could trace to a named hospital-published file, and asked one question: for the same procedure code, how far apart are cash prices at hospitals in the same metro area?

The answer: far apart. Not by percentages. By multiples.

The headline numbers

• Metro Detroit, diagnostic colonoscopy (CPT 45378), 34 facility records. Disclosed cash prices run from $469.76 (McLaren Macomb, Mount Clemens) to $22,949.44 (Detroit Receiving Hospital). That is a 48.9x spread. The midpoint facility lists $5,529.
• Henderson, Nevada, same code. St. Rose Dominican, Rose de Lima campus discloses $332.71. Henderson Hospital discloses $17,488.00. Two hospitals in one suburb, 52.6x apart.
• Miami-Fort Lauderdale, routine metabolic blood panel (CPT 80053). Douglas Gardens Hospital lists $10.56 cash. Hialeah Hospital lists $2,442.71. Same blood test code, 231x apart. For reference, the low end is close to what Medicare pays for this test under its lab fee schedule.
• Metro Detroit, upper GI endoscopy (CPT 43239). McLaren Macomb discloses $2,304. Detroit Receiving discloses $22,720.34. Both figures come from the same community-collected file set, 9.9x apart.

A patient cannot see any of this from a waiting room. The prices sit in files most people never open.

Colonoscopy: the spread by metro

Diagnostic colonoscopy, CPT 45378. For each metro we computed the median disclosed cash price per facility record, then took the lowest, midpoint, and highest facility. Cells require at least 5 facility records.

Metro	Facility records	Lowest	Median	Highest	Spread
Miami-Fort Lauderdale, FL	10	$213	$7,216	$39,982	187.5x
Phoenix, AZ	5	$152	$7,952	$13,712	90.2x
Las Vegas, NV	9	$333	$9,841	$17,488	52.6x
Detroit, MI	34	$470	$5,529	$22,949	48.9x
Dallas-Fort Worth, TX	10	$60	$1,508	$2,514	41.9x
Orlando, FL	9	$335	$1,004	$1,004	3.0x
Boston, MA	10	$3,151	$3,359	$3,359	1.1x
Charlotte, NC	5	$942	$942	$942	1.0x

Two patterns stand out. First, the spread itself: in five of eight metros the highest disclosed cash price is at least 40 times the lowest. Second, the uniform metros. Charlotte facility records all list $942 and Boston clusters at $3,151 to $3,359. Those markets are dominated by single hospital systems that publish one chargemaster across their facilities. Consolidation shows up directly in the price files.

Across all 440 facility records nationally, the median disclosed cash price for this code is $1,941. The 10th percentile is $534 and the 90th percentile is $7,462. See our city pages for colonoscopy prices in Miami and colonoscopy prices in Houston.

A routine blood panel: $11 to $2,443

The metabolic blood panel (CPT 80053, often ordered at an annual physical) shows the widest relative spread in the dataset.

Metro	Facility records	Lowest	Median	Highest	Spread
Miami-Fort Lauderdale, FL	5	$11	$650	$2,443	231.3x
Detroit, MI	17	$48	$88	$535	11.2x
Dallas-Fort Worth, TX	7	$187	$679	$1,583	8.4x
SF Bay Area, CA	5	$141	$158	$852	6.1x

In Detroit, McLaren Macomb lists the panel at $48.00 while Sinai-Grace Hospital lists $535.33. Both numbers come from the same community-collected file set. Nationally, across 258 facility records, the median disclosed cash price is $111, with a 10th percentile of $28 and a 90th percentile of $556. Basics on shopping this test: blood work costs.

Upper GI endoscopy and childbirth

Upper GI endoscopy (CPT 43239):

Metro	Facility records	Lowest	Median	Highest	Spread
Miami-Fort Lauderdale, FL	6	$241	$6,844	$49,875	207.3x
Detroit, MI	26	$139	$6,310	$22,720	163.7x
Houston, TX	7	$288	$288	$794	2.8x
Dallas-Fort Worth, TX	5	$414	$414	$1,117	2.7x

The single highest disclosed cash price in this report is Delray Medical Center in Palm Beach County at $49,874.84 for CPT 43239. The national median across 290 facility records is $1,250.

Vaginal delivery with routine prenatal and postpartum care (CPT 59400, professional global fee) shows narrower but still real spreads: Orlando runs $2,296 to $6,887 (3.0x across 8 records), Houston $1,331 to $2,150 (1.6x across 7), and Charlotte lists $3,407 across all 5 records. National median across 113 records: $4,704.

Why this happens

Cash prices are set by each hospital, not by a market. Chargemaster prices grew for decades as opening bids for insurer negotiations, and the cash price is often derived from them by a discount formula. Two hospitals with different formulas and different starting points land an order of magnitude apart, and neither faces pressure to converge because almost nobody comparison-shops from the files.

The uniform metros show the other force. Where one system owns most beds, one spreadsheet prices the whole market.

What you can do with this: ask for the cash price before you book, by CPT code, and get it in writing. If a bill has already arrived, the same files give you a negotiating position. Our bill fighting tools walk through that process.

Methodology

Source. FairVisitHealth production price database, snapshot taken August 23, 2026. The database aggregates hospital-published price transparency disclosures: files FairVisitHealth parsed directly from hospital machine-readable files and chargemasters (collected January to April 2026), plus the DoltHub hospital-price-transparency community dataset of hospital-published files (collected by that project primarily in 2021 and 2022; imported March 2026), plus a small set of rows parsed from named hospital chargemaster URLs.

Field. The disclosed discounted cash price (self-pay price) attached to each CPT code, as published by the hospital.

Inclusion filters, applied in full-table queries, not samples. (1) Only rows traceable to a named hospital-published source file. This excluded 1,115 seed rows from a demo fixture and 676,251 rows with no source-file attribution whose cash price varied by insurer within a single hospital and code, which is a signature of derived estimates rather than disclosures. (2) Cash price at least $10 and under $500,000, matching the outlier bounds our public benchmark layer already uses. (3) One facility located in Pahrump, NV was excluded from the Las Vegas metro and one facility in Rutherford County, NC from the Charlotte metro; both sit outside those metros. After filtering, 1,744 price rows covered the four reported procedures.

Aggregation. We computed a median price per facility record for each code, deduplicating facility name variants (legal suffixes and entity prefixes stripped). Metro membership uses 3-digit ZIP prefixes chosen to approximate each census metro area; the full prefix list ships with the dataset. A metro-procedure cell is reported only with 5 or more facility records. Spread is the highest facility median divided by the lowest.

Reproducibility. Every statistic in this report traces to a recorded SQL query and result. Journalists and researchers can request the query appendix and the underlying row extracts at [email protected].

Limitations

Read these before quoting the report. Disclosure files carry publication dates from 2021 through 2026, so an individual price may have changed; the spread pattern, not any single price, is the finding. A CPT-level hospital price is usually the facility fee alone and can exclude physician, anesthesia, and pathology fees. A handful of very low disclosed prices, such as $60 for a colonoscopy at a Dallas specialty hospital or $10.56 for a blood panel, likely reflect a component fee or a lab-only price; we publish them as disclosed and flag them here rather than silently editing them. One hospital campus can appear in files under several legal names, so facility record counts are after name normalization and are not exact campus counts. ZIP-prefix metro boundaries approximate, but do not exactly match, census metro definitions. Finally, a disclosed cash price is not a guarantee of the final amount charged; always confirm the price in writing before care.