By Andrea D. Murphy
updated 9:39 a.m. PT, Sat., Dec . 19, 2009

The cost of housing also pushed San Francisco, San Jose, Los Angeles and Washington, D.C., to top spots on our list. In all four cities, the average home price during that time was well over $600,000. While further down the list, the average price fell to $226,998 in Austin and $201,020 in Nashville.

However, housing prices are only part of the story.
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To compile this list, we looked at cost of living expenses in six categories: grocery items, housing, utilities, transportation, health care, and miscellaneous goods and services. We used the most recent ACCRA Cost of Living Index, a measure of urban living costs the Council for Community and Economic Research (C2ER) produces each quarter.

C2ER identifies the costs of 57 consumer items and services in different metro areas, from groceries to medical and housing costs to dungarees, for 320 Metropolitan Statistical Areas and Metropolitan Divisions (U.S. Office of Management and Budget-defined areas that the federal government uses to collect statistics). C2ER weights them according to how households typically distribute their spending.

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From that, they calculate an index number that compares the price of this basket of goods and services in different cities. An index number above 100 indicates a higher-than-average cost of living. From the C2ER's Index, we looked at the 40 largest Metropolitan Statistical Areas and Metropolitan Divisions for which they had data, and ranked them by index number to find the costliest cities.

California led with six cities on the list, four that make our top 10. Texas follows closely behind with four cities: in addition to Austin, San Antonio, Houston and Dallas appeared.

While East and West Coast cities grabbed most of the top spots, the rest of the country is well represented. Chicago (No. 14), Las Vegas (No. 18), Phoenix (No. 25) and St. Louis, Mo., (No. 35) all make this year's list.

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Detroit hasn't seen much in the way of good news this year, with the ailing auto industry shedding jobs. The latest numbers from the Department of Labor put the unemployment rate for the Detroit metro at 16.7 percent, compared to 15.1 percent for the state. Still, Motor City grabs a spot on our list in large part because of the high cost of utilities. Residents pay, on average, $243.56 per month for electricity. In contrast, in Atlanta the average bill is $141.64.

Even among the costliest cities, what is surprising is the amount of variation in some categories and lack of it in others. Housing is one with quite a bit of geographic difference in pricing. Health care is another. A visit the doctor costs $130 in Manhattan while in Pittsburgh the same trip will put you back only $69.80. Lipitor, the cholesterol-lowering medication, costs $150.35 in Pittsburgh and only $123.67 in Philadelphia.

Grocery items saw less variation in pricing. Consumers living in New York City will shell out $2.17 for a two-liter bottle of Coca-Cola, but spend just $1.10 in Charlotte, North Carolina. And a box of Kleenex costs between $1.48 and $2.99.

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© 2009 Forbes.com

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