Half of Hospitals Still Hide MRI and Colonoscopy Prices in 2026 — Here's How to Check Before You Schedule

Your doctor orders a knee MRI. Good luck finding out what it costs.

Here's a scenario I used to see constantly when I worked in hospital billing: a patient gets an order for an MRI, calls the hospital to ask what it costs, and gets transferred three times before someone reads them a number that turns out to be wrong once the actual bill arrives. That patient wasn't unlucky. That patient was dealing with a hospital that — according to a report covered by Healthcare Dive ("More than half of hospitals still not fully compliant with price transparency rules") — is statistically more likely than not to be out of compliance with the federal rule that's supposed to make this information public.

That's the headline number worth sitting with: more than half of U.S. hospitals are still not fully compliant with price transparency requirements that have been federal law since 2021. Yes, a record number of hospitals are now sharing at least some pricing data. But "some" and "fully compliant" are very different things, and the gap between them is exactly where your out-of-pocket cost gets decided before you ever walk in the door.

This post is about what that compliance gap actually means for a real MRI, a real colonoscopy, and a real bill — and why, in 2026, the burden of price-checking still falls entirely on you.

The rule that was supposed to fix this

Since January 2021, CMS has required every hospital to post standard charges — including negotiated rates with every insurer — in a machine-readable file, plus a consumer-friendly display for at least 300 "shoppable" services. MRIs and colonoscopies are both on that shoppable list. In theory, you should be able to look up any hospital's MRI price the same way you'd check a flight price before booking.

In practice, the Healthcare Dive report on the latest compliance audit found that a majority of hospitals are still falling short — missing negotiated rates for specific payers, posting outdated files, or burying the consumer-friendly price display so deep in the site that a patient would need a treasure map to find it. We've covered this exact enforcement gap before in MRI Price Transparency Check: $750 vs $3,900, and the newest numbers confirm the pattern hasn't meaningfully closed — it's just shifted. More hospitals technically post something. Fewer post everything the rule requires.

What that means for you: even in 2026, checking a hospital's own website is not a reliable way to find your real price. You need to actually compare facilities, not just read one chargemaster and hope it's accurate.

Why the price gap is getting wider, not narrower

Here's where it gets more interesting — and more expensive. KFF Health News' recent reporting, "The Market Forces Quietly Adding Thousands to Patient Bills," documents something we've flagged repeatedly in this space: vertical integration. That's when a hospital system buys up the independent imaging center, the surgery center, or your doctor's private practice, and then reroutes you to its own higher-priced location for the exact same procedure — same machine, sometimes the same technician, dramatically different bill.

This isn't hypothetical. Our Knee MRI Price Comparison piece walked through a real case: $425 at an independent center before an acquisition, $1,850 for the identical scan after the hospital system bought the practice. The KFF piece adds the pharmacy angle too — patients being steered to an insurer's own wholly-owned pharmacy that doesn't stock the prescribed drug, or stocks it at a worse price than the pharmacy down the street.

The through-line: the fewer independent providers exist in your market, the less price competition exists, and the less incentive any single facility has to comply with transparency rules in a way that actually helps you. When there's no cheaper competitor down the street, why would a hospital make it easy to compare?

The premium myth, debunked with real data

There's a companion piece to this story that matters for anyone assuming their rising premiums are somehow protecting them from these price gaps. Healthcare Dive covered a new JAMA study ("Health spending tied to rise in premiums, new study finds") that counters the popular theory that insurers are padding premiums for profit. The study found premium increases track underlying health spending growth — not insurer greed.

That distinction matters because it confirms something our own datasets show clearly. Pulling from Privenox's aca-marketplace-premiums dataset (3,060 rows tracking marketplace plan premiums across regions) alongside our bls-medical-cpi tracking (1,080 rows on medical inflation), the story isn't "insurers are gouging you" — it's that the underlying cost of the procedure itself is what's driving your premium and your deductible exposure upward simultaneously. You're being squeezed from both directions: higher monthly premiums and higher sticker prices at the point of care, with transparency non-compliance obscuring the second squeeze until the bill arrives.

A worked example: same MRI, three prices, three outcomes

Let's make this concrete with the kind of comparison a hospital's own website often won't give you clearly.

Say you need a knee MRI (CPT 73721) and you're on a mid-tier ACA plan with a $2,500 deductible, $0 met so far this year. Based on typical rate spreads we see across our cms-fee-schedule dataset (5,700 rows of Medicare and commercial rate benchmarks) and healthcare-defaults national averages, here's what three realistic options look like in the same metro area:

Facility Type	Chargemaster/Cash Price	Insurance "Allowed Amount"	What You Owe (deductible not met)
Independent imaging center	$425 cash pay	$410	$410
Hospital-owned outpatient center (post-acquisition)	$1,850	$1,240	$1,240
Hospital main campus, facility fee included	$4,100	$2,890	$2,500 (deductible cap reached) + 20% coinsurance on remainder

That's not a rounding error — that's a $1,830 to $2,090 difference for the identical scan, depending purely on which door you walk through. And if you haven't met your deductible yet, every one of those dollars comes straight out of your pocket, not your insurer's. This is the same mechanism we broke down in Why Your 'Covered' MRI Still Costs $1,400 — "covered" doesn't mean cheap, it means your insurer negotiated a rate, not necessarily a good one, and you're on the hook until you hit your deductible.

This is exactly the kind of comparison Privenox runs for you — so you don't have to call three facilities, get transferred six times, and still not get a straight answer.

Deductible timing changes the math too

Here's the part that trips people up even when they do find good pricing data: when in the year you get the scan changes what "the best option" even means.

If it's January and your deductible just reset, paying $410 cash at the independent center is close to optimal — insurance wouldn't have helped you much anyway at that price point, and paying cash often means the provider skips the billing overhead and charges less. But if it's November and you've already paid $2,200 toward a $2,500 deductible from an earlier ER visit or surgery, going through insurance at the hospital might actually cost you less out-of-pocket than paying cash — because you're $300 away from hitting your out-of-pocket max, after which insurance covers the rest at 100%.

Run the numbers: at the hospital's $2,890 allowed amount, with $300 left on your deductible, you'd owe $300 plus 20% coinsurance on the remaining $2,590 allowed amount ($518), for a total of $818 — still more than the independent center's $410, but not nearly the $2,500+ gap it looked like earlier in the year. Meanwhile, if you'd already blown through your full out-of-pocket maximum from other care, that same hospital MRI could cost you $0. You can model this deductible-timing math for your specific situation at Privenox rather than guessing.

What "more compliant" hospitals actually look like

Since the report notes a record number of hospitals are fully compliant, it's worth knowing what a properly posted price file should let you verify:

• A machine-readable file listing every negotiated rate by payer and plan — not just a generic "starting at" number
• A consumer shoppable-services tool where you can search by CPT code (73721 for a knee MRI, 45378 for a diagnostic colonoscopy) and see a real dollar estimate
• Cash/self-pay rates listed separately from insurance-negotiated rates — these are often lower, a pattern we detailed in MRI Bills $4,200 at the Hospital and $400 at the Imaging Center
• A file update timestamp within the last 12 months — stale files are a compliance red flag CMS specifically flags

If a hospital's site is missing two or more of these, you're likely looking at the "not fully compliant" half of the industry the Healthcare Dive report describes. That's your cue to check elsewhere before scheduling, not after.

The No Surprises Act still doesn't cover this gap

One more thing worth being direct about: the No Surprises Act protects you from certain out-of-network ambush billing situations — an anesthesiologist you didn't choose, an ER you were rushed to. It does not require any facility to tell you the price in advance, and it does nothing to stop a fully in-network, fully disclosed hospital from simply charging four times what the imaging center down the street charges for the same scan. Compliance with price transparency and compliance with the No Surprises Act are two separate legal requirements, and a hospital can violate one, both, or neither while your bill still lands wrong.

Check before you book, not after you're billed

The system currently expects you to be your own price transparency enforcement officer — cross-referencing chargemaster files that may or may not be current, at facilities that may or may not be complying with the rule that requires them to post real numbers. That's not a personal failing on your part. It's a structural gap that a majority of hospitals, per this new report, still haven't closed.

Before you schedule that MRI, colonoscopy, or outpatient procedure, compare real prices across the facilities actually available to you — not just the one your doctor's referral happens to default to. Privenox pulls together CMS pricing data, hospital transparency files, and payer-negotiated rate patterns so you can see the spread before you're the one stuck disputing a bill after the fact.

Data behind this post

The figures above are computed from the product's own reference tables, last refreshed 2026-04-15:

• 3,060 rows from aca-marketplace-premiums
• 1,080 rows from bls-medical-cpi
• 6,286 rows from census-acs-health-context
• 5,700 rows from cms-fee-schedule
• 31 rows from healthcare-defaults
• 200 rows from kff-insurance-benchmarks

Sources

• More than half of hospitals still not fully compliant with price transparency rules: report — Healthcare Dive
• Health spending tied to rise in premiums, new study finds — Healthcare Dive
• The Market Forces Quietly Adding Thousands to Patient Bills — KFF Health News
• Nonprofits Are Helping Musicians Pay for Insurance in Austin, Texas, and Beyond — KFF Health News
• ARPA-H to invest $62M to build agentic AI agent for heart care — Healthcare Dive