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With Obamacare still a hot topic in Washington, we tend to think of our healthcare system as national and costs being somewhat standardized. In fact, where you live can have huge impact on what you pay for medical procedures like ultrasounds and knee replacements, according to a study issued this week by the Health Care Cost Institute.

Even worse, it can be hard to figure out why prices vary, and there's no telling which provider is likeliest to charge more (or less). "There doesn't seem to be a systematic pattern with respect to what's high and what's low," David Newman, HCCI's executive director, recently told NPR.

The study examined prices for 242 medical services, focused on high- and low-cost states. Among the cheapest places to get medical care were Florida, Texas, and New York, while Alaska, North Dakota and Wisconsin were among the most expensive.

Most striking, however, was the wide range of prices that turned up within states.

For instance, a knee replacement in Sacramento, Calif., could cost you more than $57,500, nearly double the $30,300 price tag in Riverside, outside of Los Angeles. The difference in cost for same procedure was more than $17,000 depending on whether you had it done in Palm Bay, Fla., or Miami, and more than $16,000 in Dallas versus Lubbock, Texas.

While the healthcare system is notoriously difficult to navigate there are some steps you can take to rein in costs. Many insurers and employers now offer Web tools that allow you price services at nearby providers, factoring in your deductible and co-insurance.

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Considering that more Americans have high-deductible plans nowadays, forcing them to pay more out of pocket before insurance kicks in--and probably covers only a portion of the remainder, it's more essential than ever to shop around before agreeing to pricey procedures. Looking beyond specialists recommended by your primary care doctor can also help.