New report shows wild price variation at NYC hospitals

C-Sections vary from $7k to $64k depending on the hospital and insurer

The New York City Department of Health and Mental Hygiene recently released their Healthcare Accountability Annual Report 2026 (pdf), with data on price variation among hospitals in the city.

The report found that insurer-negotiated prices varied widely depending on the hospital and payer. At the low end, average prices for inpatient procedures at NYC Health + Hospitals, the city’s public system, were 76% of Medicare rates. At the high end, NewYork-Presbyterian averaged 336% of Medicare.

Some services had extreme pricing differences. At St. Barnabas Hospital in the Bronx, the c-section price negotiated with insurer Emblem was only $7,332. The same service at NewYork-Presbyterian hospital for patients with Healthfirst insurance was $63,753. 

Widespread price variation was found across the city, from emergency room visits to colonoscopies.

Table 1: Example variation between services

Transparency is supposed to be a tool for standardizing prices and lowering healthcare costs, but this report suggests that isn’t happening. It also indicates that prices are the main driver of rising costs, not utilization.

Despite this trend, the average person may not be experiencing the effects of higher prices, at least not in their premiums. While premiums rose across every market examined, the report shows that private-sector employee contributions actually decreased in 2024. The authors write, “This may allow for consumers to feel their healthcare is more affordable or at least, not increasing, while the cost of care paid by employers continues to increase.”

This pattern of extreme price variation among New York City hospitals reflects a national trend. A recent report from Patient Rights Advocate found that prices for appendectomies at Indiana hospitals varied by 27x and prices for cervical spinal fusion at Kansas hospitals varied by 177x. Research on cardiac and psychiatric care pricing across different states and insurers have also found significant price variation. 

Why are prices so high?

Why do some hospitals charge so much more than others? Generally, it’s because they can. Analyses of commercial prices find that greater market share is associated with higher prices; having more market power gives hospitals leverage to negotiate with insurance companies, because insurers can’t exclude them from their network. While higher prices have been associated with better quality of care in areas with high competition, in areas without competition there was no such association.

Some hospitals have said they need to charge high prices because government reimbursement is low, forcing them to compensate by charging higher prices to private insurers. But many of the hospitals serving the highest share of Medicaid patients are not the ones with the highest prices. According to the report, NYC Health + Hospitals serves some of the city’s largest shares of Medicaid and uninsured patients yet has the lowest average negotiated inpatient rates among the major systems. In contrast, NewYork-Presbyterian system has the highest inpatient prices, yet most of their hospitals serve disproportionately few Medicaid and uninsured patients. 

The report refers to this pattern as a “hidden subsidy” that academic medical centers receive by not having to care for as many publicly insured or uninsured patients due to the existence of the public hospitals.

Across the country, rising prices and a widening gap between wealthy and struggling hospitals are likely to intensify. Transparency rules and incremental fixes haven’t worked, and reforms big enough to make a difference require the biggest players to have a willingness to compromise that so far seems to be absent.