CMS 2023 claims RAND 2024 estimates 9,297 procedures

What does your procedure really cost?

See what Medicare actually pays versus what providers bill, for 9,297 procedures, in plain English.

About this data → Methodology

Compare actual Medicare payments for 9,297 procedures across 5,426 hospitals and 56 states and territories, with RAND-derived commercial and cash-price estimates. Populations: CMS Medicare Part B claims (2023); RAND 2024 commercial-to-Medicare ratios; CMS Hospital Compare ratings (separate schedule).

According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.

9,297
Procedures
5,426
Hospitals
3.4B
Annual Services
56
States & Territories

The short answer

According to CMS 2023 Part B claims, K1034 is #1 of 9,297 by national service volume (153.5 million services) at markup rank 4302 of 4,435 (1.4x) ≠ 95938 #1 markup at 76.4x (volume #1193).

153.5 million
K1034 services (#1 volume)
76.4x
95938 billed / Medicare (#1 markup)
9,297
Procedure codes in this extract

Source: CMS Medicare Physician & Other Practitioners, 2023. Volume rank is national service count; markup rank is billed charge ÷ Medicare payment among codes with payment above $10 and more than 1,000 services.

How much above Medicare do providers bill?

Across 9,297 procedures, the typical service is billed about 4.1x what Medicare actually pays (volume-weighted). Here is the average markup for the highest-volume procedure categories.

Average markup by procedure category

Drugs (Administered)4.2 xMedicine5.6 xOffice Visit4 xTemporary Codes3.4 xMedical Supplies3.3 xDME (Temporary)3.3 x
Average markup by procedure category-Submitted charge ÷ Medicare payment, averaged across each category's procedures (drug-administration codes excluded)

Typical markup

4.1x over Medicare

volume-weighted across all services

Procedures tracked

9,297 HCPCS codes

Highest-markup category

5.6x Medicine

States & territories

56 covered

Medicare service volume by state

Total annual Medicare Part B services across 56 states and territories

Darker states bill more total Medicare services. Source: CMS, 2023.
AK
ME
VT
NH
WA
ID
MT
ND
MN
IL
WI
MI
NY
MA
OR
UT
WY
SD
IA
IN
OH
PA
NJ
CT
RI
CA
NV
CO
NE
MO
KY
WV
VA
MD
DE
AZ
NM
KS
AR
TN
NC
SC
DC
OK
LA
MS
AL
GA
HI
TX
FL
Scale: 86–72.8M 72.8M–145.6M 145.6M–218.4M 218.4M–291.2M 291.2M–364.0M
View all 56 states as a list
  1. California: 364.0M
  2. Florida: 347.6M
  3. Texas: 273.9M
  4. New York: 192.5M
  5. Illinois: 178.4M
  6. Pennsylvania: 146.1M
  7. New Jersey: 137.0M
  8. North Carolina: 104.7M
  9. Arizona: 89.7M
  10. Virginia: 89.0M
  11. Maryland: 88.8M
  12. Georgia: 85.6M
  13. Ohio: 84.3M
  14. Tennessee: 83.0M
  15. Michigan: 65.1M
  16. Massachusetts: 64.5M
  17. South Carolina: 60.8M
  18. Alabama: 59.2M
  19. Indiana: 53.1M
  20. Missouri: 50.4M
  21. Washington: 50.2M
  22. Colorado: 47.2M
  23. Minnesota: 42.3M
  24. Oklahoma: 37.9M
  25. Kansas: 37.3M
  26. Arkansas: 36.9M
  27. Louisiana: 36.6M
  28. Wisconsin: 33.2M
  29. Nevada: 33.0M
  30. Kentucky: 32.6M
  31. Mississippi: 31.3M
  32. Iowa: 28.1M
  33. Oregon: 26.8M
  34. Connecticut: 25.0M
  35. Nebraska: 24.8M
  36. Utah: 17.9M
  37. Idaho: 14.0M
  38. Delaware: 13.5M
  39. New Mexico: 13.3M
  40. West Virginia: 9.9M
  41. New Hampshire: 9.1M
  42. Maine: 8.0M
  43. South Dakota: 7.2M
  44. Rhode Island: 7.0M
  45. Montana: 6.7M
  46. Hawaii: 6.3M
  47. North Dakota: 6.3M
  48. Alaska: 6.3M
  49. District of Columbia: 5.3M
  50. Wyoming: 4.9M
  51. Vermont: 3.0M
  52. PR: 2.8M
  53. GU: 615K
  54. VI: 346K
  55. MP: 16K
  56. AS: 86

Which categories cost the most, overall?

Drugs (Administered) combines high service volume (1.3B services) with a 4.2x markup -- the category where the total billed-vs-Medicare gap is largest in dollar terms, not just in ratio.

Drugs (Administered) combines high service volume (1.3B services) with a 4.2x markup -- the category where the total billed-vs-Medicare gap is largest in dollar terms, not just in ratio. 2×2 strategic matrix plotting 18 entities by Annual services (volume) (X) and Avg markup (x Medicare) (Y), with a crosshair dividing the plot into four quadrants. Biggest total impactSteep, but rareHigh volume, fair pricingLower impact 0500,000,0001,000,000,0001,500,000,000 3x4x5x6x7x8x Annual services (volume) Avg markup (x Medicare) Procedure categories by service volume and markup Drugs (Administered) - 1319128787, 4.2xMedicine - 281357795, 5.6xOffice Visit - 218937626, 4xTemporary Codes - 204184478, 3.4xMedical Supplies - 182019719, 3.3xDME (Temporary) - 153467596, 3.3xBlood Test - 131547152, 6.4xHospital Visit - 86791797, 4.1xLaboratory - 86408771, 6.1xEmergency - 65556952, 4.4xSkin/Integumentary Surgery - 59400452, 5.7xX-Ray - 51602009, 5.4xPathology Services - 47514185, 4.1xCardiovascular Surgery - 44756783, 7xTemporary Procedures - 41159859, 4xCardiac Testing - 33089596, 7.2xUrinalysis - 29326020, 5.4xCT Scan - 28479612, 6.9x
Drugs (Administered) combines high service volume (1.3B services) with a 4.2x markup -- the category where the total billed-vs-Medicare gap is largest in dollar terms, not just in ratio.

Volume vs. markup by procedure category: Drugs (Administered), 1.3B annual services, 4.2x markup. Medicine, 281.4M annual services, 5.6x markup. Office Visit, 218.9M annual services, 4.0x markup. Temporary Codes, 204.2M annual services, 3.4x markup. Medical Supplies, 182.0M annual services, 3.3x markup. DME (Temporary), 153.5M annual services, 3.3x markup. Blood Test, 131.5M annual services, 6.4x markup. Hospital Visit, 86.8M annual services, 4.1x markup. Laboratory, 86.4M annual services, 6.1x markup. Emergency, 65.6M annual services, 4.4x markup. Skin/Integumentary Surgery, 59.4M annual services, 5.7x markup. X-Ray, 51.6M annual services, 5.4x markup. Pathology Services, 47.5M annual services, 4.1x markup. Cardiovascular Surgery, 44.8M annual services, 7.0x markup. Temporary Procedures, 41.2M annual services, 4.0x markup. Cardiac Testing, 33.1M annual services, 7.2x markup. Urinalysis, 29.3M annual services, 5.4x markup. CT Scan, 28.5M annual services, 6.9x markup.

Most Common Procedures

Top 10 by total Medicare services performed in 2023.

Code Procedure Medicare Pays Billed
K1034 Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count $11.62 $16.21
99214 Established Patient Office Or Other Outpatient Visit, 30-39 Minutes $82.80 $262.19
A0425 Ground Mileage, Per Statute Mile $7.35 $24.62
Q9967 Low Osmolar Contrast Material, 300-399 Mg/ml Iodine Concentration, Per Ml $0.11 $1.66
J0717 Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Administered Under The Direct Supervision Of A Physician, Not For Use When Drug Is Self Administered) $3.89 $14.59
99213 Established Patient Office Or Other Outpatient Visit, 20-29 Minutes $58.67 $179.13
97110 Therapy Procedure Using Exercise To Develop Strength, Endurance, Range Of Motion, And Flexibility, Each 15 Minutes $18.05 $67.23
J1439 Injection, Ferric Carboxymaltose, 1 Mg $0.87 $3.55
J1071 Injection, Testosterone Cypionate, 1 Mg $0.02 $0.41
J0897 Injection, Denosumab, 1 Mg $18.17 $46.49
View all 9,297 procedures →

Browse by Category

73 procedure categories covering all of medicine.

Musculoskeletal Surgery
1,411 procedures
Avg: $488.66
Digestive Surgery
765 procedures
Avg: $474.46
Cardiovascular Surgery
568 procedures
Avg: $631.70
Medicine
533 procedures
Avg: $100.02
Drugs (Administered)
530 procedures
Avg: $154.37
Laboratory
502 procedures
Avg: $50.42
Nervous System Surgery
441 procedures
Avg: $692.31
Skin/Integumentary Surgery
395 procedures
Avg: $284.00
Genetic/Molecular Test
298 procedures
Avg: $795.12
Respiratory Surgery
290 procedures
Avg: $516.60
Urinary Surgery
281 procedures
Avg: $451.93
Eye Surgery
266 procedures
Avg: $473.02

Same Procedure, Different Price

The biggest price spreads between what Medicare pays in different states.

Not Otherwise Classified, Antineoplastic Drugs
Low
$0.39
→
High
$25,170.15
Radioelements For Brachytherapy, Any Type, Each
Low
$29.31
→
High
$14,464.25
Insertion Of Spinal Neurostimulator Generator Or Receiver
Low
$129.32
→
High
$9,894.92
Removal Of Plaque And Insertion Of Stents In Arteries Of Leg
Low
$392.36
→
High
$10,138.75
Removal Of Plaque And Insertion Of Stents In Artery Of Leg, Initial Vessel
Low
$517.18
→
High
$9,844.64

Browse by State

Procedure costs by state and territory.

AL
Alabama
AK
Alaska
AS
American Samoa
AZ
Arizona
AR
Arkansas
CA
California
CO
Colorado
CT
Connecticut
DE
Delaware
DC
District of Columbia
FL
Florida
GA
Georgia
GU
Guam
HI
Hawaii
ID
Idaho
IL
Illinois
IN
Indiana
IA
Iowa
KS
Kansas
KY
Kentucky
LA
Louisiana
ME
Maine
MD
Maryland
MA
Massachusetts
MI
Michigan
MN
Minnesota
MS
Mississippi
MO
Missouri
MT
Montana
NE
Nebraska
NV
Nevada
NH
New Hampshire
NJ
New Jersey
NM
New Mexico
NY
New York
NC
North Carolina
ND
North Dakota
MP
Northern Mariana Islands
OH
Ohio
OK
Oklahoma
OR
Oregon
PA
Pennsylvania
PR
Puerto Rico
RI
Rhode Island
SC
South Carolina
SD
South Dakota
TN
Tennessee
TX
Texas
VI
U.S. Virgin Islands
UT
Utah
VT
Vermont
VA
Virginia
WA
Washington
WV
West Virginia
WI
Wisconsin
WY
Wyoming

Frequently Asked Questions

What is PlainProcedure?

PlainProcedure makes healthcare costs transparent by showing what Medicare actually pays vs. what providers charge for 9,297 medical procedures. We help you understand price variation across states and providers.

Where does this data come from?

Three populations, not one dump: (1) Medicare payment, billed charge, and utilization figures from the CMS Medicare Physician & Other Practitioners dataset for calendar year 2023; (2) commercial and cash-price estimates that apply RAND Hospital Price Transparency Study (4th Edition, 2024) commercial-to-Medicare ratios to that Medicare baseline; (3) hospital quality ratings from CMS Hospital Compare on a separate rolling extract. Do not treat RAND estimates or Hospital Compare ratings as 2023 Medicare claims.

What is the difference between Medicare payment and billed charge?

The Medicare payment is what the government actually pays for a procedure. The billed charge (submitted charge) is what the provider bills. The difference, or markup, shows how much above the Medicare rate a provider charges. Patients without insurance may be billed closer to the submitted charge.

Is this free to use?

Yes. All data and tools are completely free to use. CMS data is public domain.

Healthcare Cost Guides

In-depth resources to help you understand medical costs and billing.

Understanding Medicare Costs

How Medicare sets rates and what billed charges really mean.

Most Expensive Procedures

The costliest medical procedures ranked by Medicare payments.

Hospital Markup Explained

Why hospitals charge 3-10x what Medicare pays.

View all guides →

Research

Original analysis from our editorial process, every statistic derived from our own database. See all research.

Research

How Far Above Medicare Hospitals Bill: The US Markup Distribution

Weighted by how often each procedure is performed, US providers bill roughly 4.1x the Medicare rate. The simple per-code average is higher because a small tail of near-zero-payment drug and vaccine codes produces extreme ratios, which we exclude from typical-markup figures.

 Research

153 Million Services: COVID Tests Top US Medicare Procedure Volume

CMS Medicare data shows COVID-19 testing (153M services) Established Patient 30-39 minute visits (100M) and Ground Mileage (99M) leading US procedure volumes, with the top-10 codes collectively delivering more than 1 billion annual Medicare services.

 Research

California 364 Million Medicare Services: Top 10 US States by Procedure Volume

CMS Medicare state rollups show California (364M services) Florida (348M) and Texas (274M) leading US states by Medicare physician-service volume, with the top-3 states collectively delivering 985M services and an average $303-$347 Medicare payment per service.

Using this data

Medicare's rate is the baseline -- your own procedure, provider, and state decide what you actually pay.

  • Medicine bills an average of 5.6x the Medicare rate here -- look up any of the 9,297 procedures to see where yours falls. Browse procedures
  • Markup and price vary sharply by state -- see which states bill the most above Medicare. State markup rankings
  • Estimate your own out-of-pocket cost for a specific procedure and state. Cost estimator

Figures are CMS 2023 Medicare Part B averages; markup ratios apply RAND Hospital Price Transparency Study estimates to that baseline. Benchmarks, not a quote for any specific bill.

About this data

How PlainProcedure works, and why you can trust these numbers

What this site is

PlainProcedure makes healthcare costs transparent by showing what Medicare actually pays versus what providers charge for over 9,000 medical procedures. Every figure comes from the CMS Medicare Physician & Other Practitioners dataset, aggregated Medicare Part B fee-for-service claims, not estimates or survey data.

Editorial process

  1. Source. Pull the CMS Medicare Physician & Other Practitioners dataset (2023), which aggregates Medicare Part B claims across CPT/HCPCS procedure codes and providers, plus CMS Hospital Compare for quality ratings.
  2. Verify. Datasets are downloaded from data.cms.gov, validated for file integrity, and loaded into a structured database with no adjustment to the underlying payment or charge figures.
  3. Publish. Compile per-procedure and per-provider pages showing Medicare payment versus billed charge, linking back to CMS so readers can verify any figure themselves.

Editorial independence & corrections

PlainProcedure is not affiliated with CMS, Medicare, or any government agency, and does not accept payment, sponsorship, or promoted placement from providers, hospitals, manufacturers, or any healthcare entity. Found an error? Email hello@plainprocedure.com. See our methodology for full source attribution.

Frequently asked

What is PlainProcedure?

PlainProcedure makes healthcare costs transparent by showing what Medicare actually pays vs. what providers charge for 9,297 medical procedures. We help you understand price variation across states and providers.

Where does this data come from?

Three populations, not one dump: (1) Medicare payment, billed charge, and utilization figures from the CMS Medicare Physician & Other Practitioners dataset for calendar year 2023; (2) commercial and cash-price estimates that apply RAND Hospital Price Transparency Study (4th Edition, 2024) commercial-to-Medicare ratios to that Medicare baseline; (3) hospital quality ratings from CMS Hospital Compare on a separate rolling extract. Do not treat RAND estimates or Hospital Compare ratings as 2023 Medicare claims.

What is the difference between Medicare payment and billed charge?

The Medicare payment is what the government actually pays for a procedure. The billed charge (submitted charge) is what the provider bills. The difference, or markup, shows how much above the Medicare rate a provider charges. Patients without insurance may be billed closer to the submitted charge.

Is this free to use?

Yes. All data and tools are completely free to use. CMS data is public domain.

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error. Data current as of March 2026.

Download the jurisdiction extract used on this site: cms-procedure-cost-by-state.csv (state/territory Medicare payment, billed charge, services, and provider counts). Full national reference on statistics.