OBJECTIVE. The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system--one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next. CONCLUSION. The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements. 10.2214/AJR.05.0495