Typical markup
4.1x over Medicare
volume-weighted across all services
CMS 2023 data 9,297 procedures Free · public domain
What does your procedure really cost?
See what Medicare actually pays versus what providers bill, for 9,297 procedures, in plain English.
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. Source: CMS Medicare, 2023.
9,297
Procedures
5,426
Hospitals
3.4B
Annual Services
56
States & Territories
The short answer
Medicare pays a fraction of what providers bill: across 9,297 procedures, the typical service is billed about 4.1x the Medicare rate. Look up any procedure to see what Medicare pays, what providers charge, and how it varies by state.
- Procedures
- 9,297
- Typical markup
- 4.1x
- Hospitals
- 5,426
- States & territories
- 56
Source: CMS Medicare Physician & Other Practitioners, 2023. Markup = submitted charge ÷ Medicare payment (volume-weighted).
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
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
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
Most Common Procedures
Top 10 by total Medicare services performed in 2023.
| Code | Procedure | Medicare Pays | Billed |
|---|---|---|---|
| K1034 | Provision Of Covid-19 Test, Nonprescription... | $11.62 | $16.21 |
| 99214 | Established Patient Office Or Other Outpatient Visit, 30-39... | $82.80 | $262.19 |
| A0425 | Ground Mileage, Per Statute Mile | $7.35 | $24.62 |
| Q9967 | Low Osmolar Contrast Material, 300-399 Mg/ml Iodine... | $0.11 | $1.66 |
| J0717 | Injection, Certolizumab Pegol, 1 Mg (code May Be Used For... | $3.89 | $14.59 |
| 99213 | Established Patient Office Or Other Outpatient Visit, 20-29... | $58.67 | $179.13 |
| 97110 | Therapy Procedure Using Exercise To Develop Strength,... | $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 |
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...
Low
$129.32
→
High
$9,894.92
Removal Of Plaque And Insertion Of Stents In...
Low
$392.36
→
High
$10,138.75
Removal Of Plaque And Insertion Of Stents In...
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?
All data comes from the CMS Medicare Physician & Other Practitioners dataset for 2023. This includes actual payment amounts, submitted charges, and utilization data for every procedure performed by Medicare providers.
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.
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.
Research153 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.
ResearchCalifornia 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.
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
- 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.
- 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.
- 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?
All data comes from the CMS Medicare Physician & Other Practitioners dataset for 2023. This includes actual payment amounts, submitted charges, and utilization data for every procedure performed by Medicare providers.
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.