A Fort Myers, Fla., man got two different bills for separate but similar CT scans of his abdomen; however, one cost $268, while the other cost $8,897, according to an NPR report.
The difference between the scans is where Benjamin Hynden received them: The cheaper one took place at Summerlin Imaging Center in Fort Myers, while the more expensive one was done in an emergency department at Gulf Coast Medical Center near the same city. Gulf Coast Medical Center is a part of Lee Health, also based in Fort Myers.
Mr. Hynden's physician referred him to Summerlin for the first CT scan, which was inconclusive, after Mr. Hynden came in with abdomen pain and discomfort. The second scan happened three months later, when Mr. Hynden's pain persisted and a nurse practitioner — his physician was unavailable — told him to go to the hospital due to possible appendicitis. There, a triage nurse determined it probably wasn't appendicitis, but recommended another CT scan.
Gulf Coast Medical Center's $8,897 CT price was nearly 33 times that of the outpatient imaging center's. When NPR asked Lee Health why Gulf Coast Medical Center charged so much more for the same test, the system declined an interview.
Mary Briggs, a Lee Health spokesperson, told NPR in an emailed statement, "Generally that it is not unusual for the cost of providing a CT scan in an emergency department to be higher than in an imaging center. Emergency department charges reflect the high cost of maintaining the staffing, medical expertise, equipment, and infrastructure, on a 24/7-basis, necessary for any possible healthcare need — from a minor injury to a gunshot wound or heart attack to a mass casualty event."
The second image came back inconclusive again. After Mr. Hynden's insurer, Cigna, negotiated its in-network discount with Lee Health, Mr. Hynden ended up with a $3,394.49 bill.
Rick Davis, a co-owner of Summerlin Imaging Center, told NPR his small, independent practice doesn't have as much bargaining power as larger health systems in Florida. This leaves insurers with more say in how much Summerlin can charge for a scan. An office manager at Summerlin also told NPR the most it bills for a CT scan is $1,200, but usually the negotiated rate is less than $300.
Gerard Anderson, PhD, a health policy and management professor at Baltimore-based Johns Hopkins University, told the publication the higher price could result from Lee Health's large pricing power in Fort Myers.
"Anybody who's in Fort Myers is going to want to get care at these hospitals. So by having a dominant position, they have great bargaining power," Dr. Anderson said. "So they can raise their rates, and they still do OK."
Mr. Hynden's two CT scans didn't reveal what was causing the pain. Several weeks after the second test, he went to an urgent care center run by Lee Health. There, an ultrasound test that cost him about $175 revealed he had benign cysts.