What 136 Texas hospital price files reveal about medical costs
Since 2021, every hospital in the United States has been required to publish its prices. Five years later, that data tells a consistent story: the cost of the same procedure can vary by a factor of five, ten, or more between hospitals only a few miles apart. We analyzed pricing files from 136 hospitals across Texas and found patterns worth understanding if you are comparing costs for a planned, non-emergency procedure.
Brain MRI cash price across 33 Houston-area hospitals
HCPCS 70551. The highest price in this data is about 140x the lowest.
Source: CMS transparency files, as published by each hospital. Cash prices are the hospitals' published self-pay rates for patients without insurance, and are not what most patients actually pay. A higher published cash price does not indicate lower quality of care. Your out-of-pocket cost depends on your insurance coverage, deductible, and other factors. Confirm any figure directly with the hospital before making a decision.
The rule behind the data
Under the CMS Hospital Price Transparency Rule (45 CFR § 180), every US hospital must publish a machine-readable file listing its standard charges, cash prices, and payer-specific negotiated rates. The rule took effect on January 1, 2021. Enforcement has tightened since. As of April 1, 2026, CMS has raised penalties to as much as $5,500 per day for large hospitals that fail to comply.
The files are public. They sit on hospital websites and anyone can download them. What makes the data useful is that every hospital is now publishing the same categories of information in broadly the same format, which allows meaningful comparisons for the first time.
Five things the Texas data shows
1. Same procedure, very different prices
The chart above shows brain MRI cash prices across 33 Houston-area hospitals. The highest published price is about 140x the lowest for the same procedure (HCPCS 70551). Published price is not an indicator of clinical quality or patient outcomes. The variation reflects how each hospital sets its own list prices. See all Houston MRI prices.
2. Cash prices often beat insured rates
For many common procedures, the cash price a hospital publishes for uninsured patients is lower than the negotiated rate paid by some insurance plans. Whether an insured patient can actually access the cash price is a separate question. Some hospitals allow it, but many will not because their contracts with insurers require claims to be billed through the plan. If you are considering paying cash despite having coverage, ask the hospital's billing department about their policy and check with your insurer, because paying outside of insurance can also affect how your deductible and out-of-pocket maximum accrue.
3. Negotiated rates vary by insurer
Two patients in the same hospital room can be charged very different amounts for the exact same procedure, based only on which insurance card they carry. Rates paid by different insurers for the same colonoscopy at the same hospital are frequently hundreds or thousands of dollars apart.
4. Rural hospitals often cost less, but not always
Large urban systems in Houston and Dallas tend to have higher list prices than smaller hospitals in places like Tyler or Texarkana, with exceptions. In some cases, rural hospitals publish higher prices than their city counterparts, particularly in areas with fewer providers.
5. File quality still varies
Some hospitals publish clean, complete files. Others publish files with missing fields or formatting errors that make them hard to process. The CMS rule requires hospitals to update their files at least annually, and we found Texas hospitals whose files had not been updated for extended periods.
Why the variation exists
Hospital list prices, also called gross charges, have never been based on the actual cost of delivering care. They are set by each hospital and have historically acted as a starting point for negotiation with insurers. The price one insurer agrees to pay depends on its bargaining power, the hospital's position in the local market, and the structure of the contract.
Cash prices are a newer concept. Under the transparency rule, hospitals must publish what they will charge a patient who pays without using insurance. These rates are often closer to what the hospital actually expects to collect, which is why they tend to be lower than list prices and sometimes lower than insured rates.
What patients can do
Call the hospital's billing department before scheduling a non-emergency procedure. Ask for the negotiated rate under your specific insurance plan, and ask whether a cash price is available to you (this is usually offered to uninsured patients but is not always extended to people with coverage). Compare those figures to what other hospitals in your area charge. The price transparency files are supposed to make this easier, and they do, but most patients still do not know the information exists.
Published prices are gross charges or negotiated rates. Your actual out-of-pocket cost depends on your deductible, coinsurance, and other factors specific to your plan. Confirm any figure directly with the hospital or your insurer before making a decision.
We aggregate and display pricing data from 136 Texas hospitals across nine metros, sourced directly from the hospitals' CMS transparency files and checked weekly for updates. Start with procedures, hospitals, or insurance rates to compare what different hospitals charge.