If you’ve ever shopped for a big-screen TV, chances are you visited several stores, online retailers or both. While exact numbers for TV shoppers are hard to find, Google’s Copilot AI reports that in general, 73 percent of us shop multiple sellers for such items.

For hospital costs, though, not so much.

A Gallup survey conducted in 2023-24 found 73 percent of us were not even aware that we could request estimates for common hospital procedures. As for those over age 65, a cohort most likely to need hospital care, the number was a mere 11 percent, both figures provided by theincidentaleconomist.com.

Hospital costs, the largest component in health care costs, are expected to increase even faster through 2033, according to a March report from KFF, an independent health-policy research group.

Since 2021, the federal Center for Medicare and Medicaid Services has required hospitals to publish costs for 300 common procedures. The goal: To lower health care costs, $5.3 trillion in 2024, by fostering competition.

A 2023 report in the Journal of Hospital Management and Health Policy, though, found that a mere 33 percent of hospitals were in compliance with price transparency regulations. And, in 2024, the Inspector General of the federal Department of Health and Services discovered that only 63 of 100 hospitals surveyed followed its rules.

As a result, effective April 1 this year, CMMS imposed penalties and, to ensure accuracy, even required a sign-off by a top hospital executive.

Patients now more readily can search hospital sites using terms such as “cost/price estimate.” They then can refine a search using a keywords such as colonoscopy.

Here it becomes tricky, though.

In some cases, the pricing tool may offer an out-of-pocket price without insurance. In other instances, shoppers can enter their insurance subscriber and group numbers for a customized report.

Not all procedures are easy to locate. Keywords often fail, menus are incomplete, and specific procedures may be discoverable only by an obscure CPT code used by hospitals for billing. A hospital or physician scheduling a specific patient’s procedure often may select from a range of codes with similar descriptions.

The 2021 legislation was intended to foster competition. Analysts though, have cautioned that nearly half of metropolitan markets now have only one or two hospital systems, skewing pricing.

This concentration applies to the Lehigh Valley with its two dominant hospital systems:

St. Luke’s University Health Network (SLUHN) in Bethlehem, now claims 16 campuses and 350-plus outpatient sites across Pennsylvania and New Jersey.

Lehigh Valley Hospital Network, in July 2024, announced completion of a merger with Philadelphia-based Jefferson Health. The combination cites more than 700 “sites of care” with 32 hospitals.

Is there a measurable difference in quoted costs, using price-estimate tools at each hospital system?

Take one procedure offered by both: Positron Emission Tomography (PET scans) used in most cases (90 percent) to diagnose cancer, but also to detect Alzheimer’s and cardiac issues.

For PET scans, CT billing codes range from 78811 to 78818, depending on the areas of the body scanned. A common code is 78815, used below.

Medicare, on its website medicare.gov, provides dollar-based averages for subscribers. The estimated cost for CT 78815 is $313, listed as covering facility and doctor fees. A warning is included though that additional costs may apply.

Patient costs estimated under the Affordable Care Act for the scan above vary at two area hospitals: $512.36 (20 percent-copay) at Hospital A, compared to $2,070 out-of-pocket at Hospital B. The latter, Hospital B, does not specify insurance coverage, if any, or co-pay. Both estimates warn that the actual bill might not list some charges.

How accurate are the estimates? As an example, Hospital B billed a patient with Medicare $1,747.09, below its estimate, even as it charged Medicare $101,509 overall.

Much of that second charge, $78,876, was for a radioactive agent used to detect tumors, not listed specifically in its estimate. Hospital A listed a different agent at no charge.

These estimates do not specifically address medical costs for that 7.9 percent of patients without health insurance. Or the one-quarter of working-age Americans considered underinsured, despite having employer-sponsored plans. So would the uninsured at Hospital B be expected to pay not $2,070, but $101,509?