Shopping Around Matters: Where Texans Get Their Care Can Mean Very Different Prices

By: TAHP | Wednesday, April 29, 2026

Part of TAHP's Affordability Series: What's Driving Up the Cost of Coverage

What's new: Most Texans never think about where they get their care. They show up where they are told, get the service they need, and open the bill later. Meanwhile, the same care can cost wildly different amounts from one hospital to the next, and far less at a nearby doctor's office or imaging center. That one decision, often made without the patient, is quietly one of the biggest reasons health care in Texas keeps getting more expensive.

Why it matters: The biggest untapped opportunity to bring those health care costs down is not a new drug or a new technology. It's giving patients the tools and incentives to be smart shoppers. It is helping Texans get the same care they need at a more affordable price. Shifting routine care to the right place could save the U.S. health system $471 billion over the next decade and lower premiums and out-of-pocket costs for every Texan.

Same care, very different prices:

• An X-ray at a Houston hospital imaging lab can run nearly $1,000. A Houston mom scheduling an X-ray for her son was told her out-of-pocket cost was $962. She called her insurer, found a non-hospital imaging lab in network, and paid $102. Same X-ray, $860 difference.
• Average Prices at three Houston hospitals across 11 of the same routine procedures varied dramatically, with the rates at the highest priced hospital up to three times more than their competitors.
• A full year of outpatient chemotherapy averages around $17,493 when delivered in a hospital-based setting. The same treatment in an office-based setting averages closer to $6,775.
• A routine colonoscopy costs roughly $541 more when it happens at a hospital instead of an ambulatory surgery center. Same procedure, but dramatically different prices.
• In North Texas, removing a gallbladder can cost less than $5,000 at one hospital or more than $35,000 at another, according to a D Magazine analysis of Texas hospital pricing data. Even within the same hospital system, a hip or knee replacement at one hospital can cost $20,000 less than another hospital in the same system.
• In Dallas, an MRI can cost as little as $613 or as much as $6,304 depending on the provider. A knee replacement can range from $23,445 to $47,389. Same procedure, same city, same insurance - the price you pay depends almost entirely on where you walk in.

Why the same care costs so much more: It is not because the care is better. In too many cases, providers can charge more simply because patients cannot see prices and have no incentive to shop around. As a result, the same blood draw, the same scan, and the same follow-up visit can carry very different prices. The problem is that when patients end up in the most expensive setting, the bill can double for identical care.

What Texas families could save: Helping Texans access the same care at a more affordable price could lower what Texas employers and families pay in premiums by more than 5%. For a Texas family, that is roughly $1,350 back in their pocket every year.

What's changing: Some providers are starting to offer real upfront prices. Some insurers are building plans that reward Texans for choosing the lower-cost, same-quality setting, including coverage models that cover shoppable services at a set price. But more can be done.

Helping Texans pay less for the same care:

1. Require guaranteed upfront pricing: Patients can't make informed decisions without knowing the actual cost of care. Texas should require all providers to deliver a guaranteed upfront price estimate that won't change in the final bill.
2. Prohibit hiding cash prices: State and federal law require providers to post cash prices, yet many still refuse to share or accept the cash price when a patient is insured. Texas should guarantee every patient can see and pay the cash price when it is the better deal.
3. Reward patients for shopping smart: Eliminate Texas mandates that block health plans from rewarding Texans for choosing the most affordable care.
4. Allow innovative coverage designs: Give insurers flexibility to offer cash-pay options, tiered networks, and other designs that reward patients for seeking the right care at the right price.
5. Allow innovative, affordable networks: Current Texas mandates force employers into expensive, oversized networks, driving up premiums. Texas should allow for more flexible network designs that give families and businesses the freedom to choose plans that promote competition and deliver lower prices.
6. Increase Competition: Ban anti-competitive health care contract terms, stop inappropriate facility fees, and require complete price and billing location (NPI) transparency.

The bottom line: Where Texans get their care matters. It is one of the biggest reasons health care costs keep rising, and the single biggest opportunity to bring them back down.

Keep up with TAHP's affordability series:

• April 14: Addressing affordability starts with hospital prices.
• April 7th: Health care fraud is wasting billions.
• April 2nd: The No Surprises Act is protecting patients, but private equity is creating a new affordability crisis.
• March 30th: Hospitals are using AI to charge more.
• Series Opener: Why is health insurance getting more expensive?