<p>Five patients are at Advocate Lutheran General Hospital in Park Ridge for a diagnostic echocardiogram.</p><p>For the same noninvasive test of the heart, the five patients could each get different prices — as little as $973 or as much as $1,721, depending on their insurance provider and plan.</p><p>If a patient is uninsured, they’d get a "discounted cash price” of $1,155 — hundreds of dollars less than those with certain insurance plans, according to the hospital’s publicly posted data.</p><p>The wildly varying prices for the same procedure are emblematic of a medical pricing system that some say is far too complicated and the result of secret negotiations between hospitals and insurance companies that occur before patients even walk in the door.</p><p>To try to shed light on this system, the Chicago Sun-Times and the University of Chicago’s Mansueto Institute for Urban Innovation gathered 2025 pricing data on thousands of medical procedures, which hospitals publish to comply with a federal transparency law.</p><p>Their analysis found large differences in prices for procedures throughout the Chicago area, whether comparing across hospitals or between different insurance plans at one hospital.</p><p>The price differences were repeated again and again in the data — from colonoscopies and hemodialysis to x-rays and ultrasounds — revealing a billing system that is opaque, inconsistent and difficult for most consumers to understand.</p><p>“You have a bunch of insurers; you have a bunch of hospitals. They don’t all reach the same pricing deal,” economist and University of Chicago professor Joshua Gottlieb says. Gottlieb is also co-director of UChicago’s Becker-Friedman Institute’s Health Economics Initiative and consulted with the Mansueto data team.</p><p>“Although the hospitals and the insurers have negotiated this, now it’s the consumer who sees that price and says, ‘Where did this come from?’” he says.</p><p>The differences can be stress-inducing for consumers who encounter a higher-than-expected price.</p><p>Emily Kostecka, 29, has had several MRIs over the years, related to her epilepsy diagnosis, and says her portion of the bill is usually a few hundred dollars.</p><p>So the Logan Square resident was floored last year when Northwestern Memorial Hospital’s billing department called to alert her that an upcoming outpatient MRI appointment would cost about $6,000 after her insurance handled the claim.</p><p>“I was kind of freaking out,” says Kostecka, who has a high-deductible insurance plan with Blue Cross Blue Shield.</p><p>She briefly considered taking out a loan to pay for the test but decided to shop around.