Does the setting change the price?

The same procedure category, priced across different kinds of facility. Each figure is the median markup: what hospitals of that type charge relative to what they told Medicare the service costs them. Lower is cheaper. The last column is how much the setting alone moves it.

Procedure category	Small hospital	Mid-size hospital	Large hospital	Hospital in a health system	Government or public hospital	Spread
Surgery (operating room)	4.3×	6.0×	6.0×	5.6×	4.1×	1.5×
Post-surgery recovery	4.1×	5.0×	4.8×	4.9×	3.8×	1.3×
Childbirth and delivery	2.0×	2.4×	2.9×	2.4×	2.1×	1.5×
Anesthesia	9.9×	12.6×	12.9×	13.4×	8.4×	1.6×
X-ray and diagnostic imaging	4.7×	6.2×	6.7×	6.0×	4.6×	1.4×
CT scan	19.0×	21.8×	24.4×	21.6×	19.9×	1.3×
MRI	11.1×	13.6×	14.0×	13.9×	11.7×	1.3×
Cardiac catheterisation	6.7×	8.5×	9.8×	8.7×	8.1×	1.5×
Lab tests and bloodwork	5.1×	8.3×	9.0×	7.3×	5.1×	1.8×
Respiratory therapy	3.4×	6.0×	6.3×	5.3×	3.9×	1.8×
Physical therapy	2.6×	3.3×	3.4×	3.1×	2.4×	1.4×
Occupational therapy	3.0×	4.1×	4.2×	3.6×	2.6×	1.6×
Speech therapy	2.7×	4.0×	4.0×	3.6×	2.5×	1.6×
EKG and heart monitoring	9.9×	11.6×	12.1×	11.9×	9.1×	1.3×
EEG brain monitoring	4.3×	4.8×	5.8×	5.1×	4.3×	1.4×
Implanted devices	2.8×	3.2×	3.2×	3.2×	2.6×	1.2×
Drugs given at the facility	3.5×	4.8×	4.5×	4.2×	3.5×	1.3×
Dialysis	2.8×	3.1×	3.4×	3.2×	2.5×	1.4×
Outpatient clinic visit	2.3×	2.5×	2.3×	2.5×	1.8×	1.4×
Emergency room visit	5.0×	7.3×	7.0×	7.2×	4.6×	1.6×
Observation stay	1.9×	2.8×	2.8×	2.6×	1.9×	1.4×
Inpatient room and board	1.8×	2.2×	2.3×	2.1×	1.5×	1.5×
Intensive care (ICU)	1.8×	2.4×	2.8×	2.4×	2.0×	1.5×

What this shows. For most categories the small community hospital and the public hospital sit at the cheap end, and the large hospital or health-system member sits at the expensive end. The gap is not small: for laboratory work and emergency visits the setting alone moves the markup by roughly half again. If a procedure can safely be done in more than one setting, that choice is worth real money.

Ambulatory surgery centres are missing from this table, and that matters. Surgery centres do not file Medicare cost reports, so no audited cost-to-charge figure exists for them and we will not invent one. They are listed throughout this directory but deliberately left unrated. The evidence that they are usually the cheaper setting comes from Medicare's own payment rules, which pay a surgery centre less than a hospital outpatient department for the same outpatient procedure. See the roadmap.