Healthcare Costs by State: Why the Same Surgery Can Cost Twice as Much (and a Fraction of That Abroad)

Published: September 10, 2026

By Lyka Antonio – CureValue Customer Success Manager

Key Takeaways

Hospitals charge private insurance patients 2.4x the government's baseline rate on average, but that ranges from 1.7x in Arkansas to 3.5x in Florida for the exact same procedures.
If you have insurance, you're still paying these markups. They show up in your deductible, your coinsurance, and your premium, not just in a cash-pay bill.
The price gap isn't about quality. RAND found it tracks how many competing hospitals are left in an area, not care ratings or how many government-insured patients a hospital treats.
A verified hospital abroad often costs a quarter of the U.S. price, surgeon included, with savings of 50 to 80% typical across common procedures.
Every provider on CureValue is checked for accreditation, so you can compare local and international pricing before you talk to anyone.

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I spent last week looking at hospital price data from RAND, the research group that has been tracking what private insurers pay hospitals since 2017. I wanted to know something simple. If you need surgery in America, how much does the state you live in change the bill?

The answer is a lot more than I expected, and the reason isn't what hospitals usually say it is.

How hospital prices are calculated

RAND takes real claims from employer health plans and reprices each one using the government's own payment formula for the same procedure at the same hospital. That formula already adjusts for local wages and how sick the patient was. So it works as a baseline. If a hospital lands at 2x, it charged private patients double what the baseline says that procedure should cost in that town.

Nationally, hospitals charge private patients about 2.4x the baseline. That average hides a huge spread.

Private-plan hospital prices as a multiple of the baseline rate, by state

Based on 2020 data, Arkansas hospitals charged about 1.7x and Florida hospitals charged about 3.1x. In RAND's newest data (2022), Florida moved to the top of the country at 3.5x. Same procedures, same baseline, nearly double the markup.

Insurance doesn't protect you from state price differences

It's easy to read this as a problem for people paying cash. It isn't. If you're on an employer plan, you pay these prices in three places.

Your deductible and coinsurance

Most employer plans have a deductible around $1,900 for an individual and close to $4,000 for a family, then 20% coinsurance until you hit the out-of-pocket max. Take a knee replacement where the hospital collects roughly $23,500 in Arkansas and $43,700 in Florida. Your 20% share is about $4,700 in one state and $8,700 in the other. Same insurance card, same surgery, double the check.

Your premium

The average employer family premium is now about $27,000 a year, and the employee's share is about $6,850 out of paychecks. Insurers set premiums off what hospitals charge. Higher markups in a state mean higher premiums in that state.

Your paycheck

About two thirds of covered workers are on self-funded plans, which means the insurer processes the claim but your employer pays it. Money spent on a $43,700 knee is money that didn't go into raises. Economists have been measuring this for decades. Hospital price growth shows up as flat wages.

What these price gaps cost you in dollars

Percentages are abstract, so I translated two common procedures into what the hospital roughly collects. Two things to know about these figures. The US numbers are the hospital's portion only, so the surgeon and anesthesia are billed on top. And they apply the state markups to this year's baseline rate, so treat them as illustrations, not quotes.

Knee or hip replacement

The baseline hospital payment for a standard joint replacement is about $14,000 this year.

Where	What you pay
Arkansas	about $23,500, hospital only
US average	about $33,900, hospital only
Florida	about $43,700, hospital only
Top hospital abroad	about $9,000, surgery, airfare, and stay included

Gastric sleeve

The baseline hospital payment for bariatric surgery without complications is about $11,000.

Where	What you pay
Arkansas	about $18,500, hospital only
US average	about $26,600, hospital only
Florida	about $34,300, hospital only
Top hospital abroad	about $6,000, surgery, airfare, and stay included

The abroad figures cover the surgeon, the hospital stay, the flight, and usually a few nights of recovery lodging. The US figures don't cover any of that beyond the hospital.

Why Florida's healthcare costs nearly double Arkansas

The obvious guess is that Florida hospitals are better, or that they're covering losses from patients who can't pay. RAND checked both.

Price had no clear relationship to quality ratings. Hospitals with more government-insured patients didn't charge private patients more. The one thing that reliably predicted a high price was how many competing hospitals were left in the area. When a hospital system buys its last competitor, prices go up, and nothing about the care changes.

That's worth sitting with whether you're on a high-deductible plan or paying cash. The price you're quoted isn't a measure of what you're getting. It's a measure of how much choice you had.

Is care abroad actually safe?

It's the first question anyone asks, and it deserves a straight answer, not reassurance for its own sake. Accreditation is what to check. Look for hospitals certified by Joint Commission International or an equivalent national accreditation body, the same standard many U.S. hospitals hold themselves to. Ask how many times the surgeon has performed your specific procedure, not just how long they've been practicing. Confirm what happens if you need follow-up care once you're home, in writing, before you book anything.

CureValue makes it clear which providers clear this bar, and every listing shows the accreditation right on the page, so you're not taking anyone's word for it.

What other procedures cost in the U.S. vs. abroad

Here's the same comparison for the procedures people most often travel for. US figures are typical cash or negotiated prices. Abroad figures are typical all-in packages at accredited hospitals.

Procedure	Typical US price	Typical abroad	Common destinations
Dental implant (single)	$4,500	$1,500	Mexico, Costa Rica, Turkey
Hair transplant	$10,000	$2,500	Turkey
IVF (one cycle)	$15,000	$5,500	Czech Republic, Spain, Mexico
Hip replacement	$40,000	$12,000	Thailand, India
Gastric bypass	$25,000	$6,000	Mexico
Cataract surgery (per eye)	$4,000	$1,800	India, Mexico
LASIK (both eyes)	$2,500	$1,200	Turkey, Mexico
Heart bypass	$123,000	$7,900 to $12,500	India
Rhinoplasty	$8,000	$3,000	Colombia, Turkey, South Korea

Savings on the order of 50 to 80% are normal. That's before you factor in the flight, which for Mexico is often cheaper than a rideshare across a major US city.

What to do with this information

If you have a planned procedure coming, three things are worth knowing:

The quoted price is a negotiating position. Hospitals set it based on leverage, not cost, which means it moves.
Your plan's network almost certainly includes hospitals on both ends of that chart. On a $40,000 procedure, picking one over the other can be several thousand dollars of your own money, and your insurer won't point that out.
A top hospital abroad may charge a quarter as much, with the surgeon and the flight included.

That's what we built CureValue to help you find. Every provider on the platform is checked for quality and transparency, and every listing shows the local price next to the US price so you can see the gap before you talk to anyone.

You don't have to leave the country to use this. Even if you never book a flight, knowing that hospitals in one state charge nearly double what hospitals in another do for the same surgery changes how you read your own bill.

Source for state price ratios: RAND Corporation, Hospital Price Transparency Study, Round 4 (2020 inpatient claims) and Round 5.1 (2022). Baseline dollar figures use the federal fiscal year 2026 inpatient payment rates published by CMS and are approximate. Premium and deductible figures are from the KFF 2025 Employer Health Benefits Survey. Abroad prices are typical all-in packages from accredited providers and vary by hospital and case.