Americans don’t just pay more for prescription drugs compared to Europe. They also face higher prices for medical devices.

A new study released Friday found that prices for heart implants were two to six times higher in the U.S. than in Germany, where the implants were the cheapest, a disparity that helps explain why Americans face higher overall healthcare prices. European countries already pay much lower prices for prescription drugs because government healthcare programs negotiate for lower prices.

The study published in Health Affairs looked at the prices for heart stents and pacemakers throughout several European countries from 2006 to 2014. Researchers looked at data from a large hospital survey to determine the prices.

It found that prices for the devices were higher in France and Italy than in the United Kingdom and Germany.

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Medical devices account for about 6 percent of healthcare spending in the U.S. and 7 percent in European Union countries, according to the researchers.

In the U.S., hospitals paid about $670 for metal stents in 2014, compared to $120 in Germany, according to the study.

The cost for pacemakers was even higher, at $4,200 in the U.S. versus $1,400 in Germany.

Prescription drug pricing has become a major controversy in the U.S. in recent years after massive spikes to even decadesold products. The Trump administration rolled out a blueprint in May to combat high prices and Congress has passed several pieces of legislation to tackle the issue.

But medical device prices have not gotten as much scrutiny. The medical device industry has mainly been focused on getting rid of Obamacare’s medical device tax, which a recent spending deal delayed.