The Same MRI Costs $466 or $26,411 Depending on Where You Go
Issue 005 • Week of April 20, 2026 • Rate variance across Texas on five high-volume shoppable procedures
Across 519 verified-publishing Texas hospitals (of which 93–130 publish each specific CPT), the price for a brain MRI (CPT 70553) spans from a $467 median to a $26,411 maximum — a 57× spread within a single state. Knee replacement goes from a $12,000 median to $226,778 maximum. Colonoscopy: $915 → $26,196. Vaginal delivery: $2,635 → $73,872. Cardiac catheterization: $3,447 → $76,245. These are not different procedures. Same CPT, same standard of care, same state. The prices are what different payer-hospital combinations negotiated.
The numbers
Data is pulled directly from 6.2 billion negotiated-rate rows captured from Texas hospital MRFs through April 20, 2026. Rates below $0.13 (sentinel / chargemaster-default values) and above $500,000 (data-entry outliers) are excluded. Each procedure shown below is aggregated across every Texas hospital that publishes it.
| CPT | Procedure | TX hospitals | Rate rows | Median | P25 | P75 | Max | Median→Max
spread |
|---|
| 27130 | Total Hip Replacement | 109 | 89,630 | $11,954 | $3,428 | $19,991 | $216,640 | 18× |
| 27447 | Total Knee Replacement | 109 | 90,835 | $12,000 | $3,348 | $20,251 | $226,778 | 19× |
| 43239 | Upper GI Endoscopy w/ biopsy | 129 | 138,004 | $941 | $460 | $1,756 | $29,023 | 31× |
| 45378 | Colonoscopy (diagnostic) | 130 | 138,354 | $915 | $464 | $1,800 | $26,196 | 29× |
| 59400 | Vaginal Delivery | 93 | 25,833 | $2,635 | $2,226 | $4,913 | $73,872 | 28× |
| 59510 | Routine C-Section | 95 | 25,777 | $2,838 | $2,263 | $5,600 | $81,904 | 29× |
| 70553 | Brain MRI w/wo contrast | 122 | 166,942 | $467 | $348 | $1,147 | $26,411 | 57× |
| 93458 | Cardiac Catheterization | 106 | 102,696 | $3,447 | $1,325 | $9,492 | $76,245 | 22× |
What these numbers actually mean
Brain MRI: the shoppability champion
A brain MRI is a commodity procedure. Every hospital performs it the same way, uses the same imaging equipment, and produces the same clinical output. Yet its negotiated rate spans 57× across Texas ($467 median, $26,411 max). This isn't case-mix adjustment. It's negotiation leverage: a major payer's high-volume book of business negotiates at $348–$467, while a low-volume out-of-network payer or a thin-contract specialty hospital lands at $20–$26k.
Knee replacement: the six-figure outlier story
Total knee replacement has a $12k median and $20k P75. That's the normal range. But at the 95th+ percentile we see $226,778. That rate likely exists in a specialty or wholesale-package contract (physician services + implant + facility bundled) in a small specialty hospital. For a self-insured employer or out-of-network shopper, this is the difference between a routine procedure and a six-figure claim.
Colonoscopy: the GI shoppability story
$915 median vs $26,196 max — a 29× spread on a routine screening procedure. This is the classic "US healthcare pricing failure" anecdote made concrete: the same colonoscopy can cost $500 at one TX facility and $26,000 at another. Consumer-directed shopping, HSA-accompanying policies, and site-of-service optimization all live here.
Vaginal delivery: the maternity pricing story
93 hospitals, $2,635 median, $73,872 max. 28× spread. Even at the P75 ($4,913) to Max, there's a 15× gap. Maternity benefits are consumer-visible — expectant parents shop hospitals. The pricing signal they see from MRFs is this: pick a median-priced hospital and save ~$70k vs the extreme. That's mortgage-down-payment money for 9-month-out planning.
Cardiac catheterization: the elective-cardiology story
$3,447 median to $76,245 max. 22× spread across 106 TX hospitals. Cardiac cath is the gateway procedure for most cardiac interventions — the price signal here shapes downstream elective-cardiology spend. Payers doing network-design cycles on cardiac care have $70k/case variance to account for.
Why this matters — by role
For health plan contracting teams.
Your TX provider network is trading against these rates right now. If your in-network rate for Brain MRI is in the $467-$1,147 band (median to P75), you're well-positioned. If you're above $1,147 on a volume-heavy CPT, you're overpaying by a material margin. We can provide per-facility, per-CPT rate benchmarking against the full TX distribution.
For self-insured employer benefits teams.
Your employees' out-of-pocket cost depends on which TX facility they go to for a shoppable procedure. For brain MRI, site-of-service can change their cost by 57×. Most plan-design teams have not seen actual rate distributions this granular because the data wasn't accessible. We deliver procedure-by-procedure rate distributions for the specific facilities in your network.
For consumer healthcare navigation / transparency tools.
The best case for a consumer-facing "shop for your procedure" product is now supportable with hard data. Knee replacement, colonoscopy, brain MRI, C-section, cardiac cath — all have 19-57× spreads within Texas alone. We can license the per-facility price data feed to power consumer apps.
For healthcare journalism and policy advocacy.
"The same brain MRI costs $467 or $26,411 depending on which Texas hospital" is a publishable data story with rigorous SHA-256-verified backing. The chart that shows the IQR and the outlier tail is a visualization that will go on the front page. We can produce the figure set with full methodology appendix.
The data caveats
- Rates below $0.13 and above $500,000 are excluded as likely sentinel / outlier errors. Real negotiated rates don't go below a dime; a $10M entry is a data-entry mistake.
- The same CPT code can be billed with different modifiers (-26 professional component, -TC technical component, etc.). These distributions are mixed, which explains part of the spread.
- "Median" here is dollar-level median across all payer-hospital combinations, not volume-weighted. A high-volume payer with a $500 rate and a rare payer with a $5,000 rate both contribute one row.
- Parser garbage (see Brief #004) affects <3.5% of payer attribution but not the procedure-level rate values themselves.
What we offer
Single-Procedure Rate Benchmark — $8,500: For a named CPT (or code group) and a named TX metro or geography, deliver the full rate distribution, top payer-hospital pairs, and outlier analysis. Board-ready PDF + raw data CSV. 1-week turnaround.
Network Negotiation Prep Pack — $25,000: For a named health plan + a named hospital system, deliver the 30 most-expensive procedures the system charges your plan vs. peer payer rates at the same system. Drives next-cycle rate renegotiation prep. 2-week turnaround.
Consumer Shoppability Feed — $60,000/yr: Monthly refreshed per-facility per-CPT median/P75/max rate feed for a consumer-navigation product. Covers all 519 verified-publishing TX hospitals and the active FL (239) and NY (98) publishers, expanding as newly-seeded states (CA/IL/GA/PA/AZ/OH/NC/MI/NJ/VA) come online.
Reply to discuss an engagement or subscribe to next week's brief.
Next issue
Week of May 11: Coming soon — when a rate changes. Our SHA-256 change-detection layer will surface the first detected rate-change event across Texas hospitals since March 19, 2026 (if one fires this week). That single event is the single highest-value data point we produce.