Most Expensive Procedures in America
The costliest medical procedures ranked by Medicare payments — with actual dollar amounts, CPT codes, and the markup providers charge above what Medicare pays.
Key Takeaway
The highest-cost procedures in the CMS database involve complex cardiac, orthopedic, and spinal interventions. A single high-cost procedure can involve multiple separate CPT codes — each billed individually — making the total physician bill substantially higher than any single line item suggests.
How We Ranked Procedure Costs
The table below reflects the national average Medicare payment per service for procedures with significant utilization (at least 500 services performed nationwide in 2023). We focused on physician-billed outpatient and inpatient professional services under Medicare Part B. Facility fees, anesthesia, and implant costs are billed separately and are not included in these figures.
All CPT codes link to the full procedure pages in our database, where you can explore state-by-state variation and individual provider data.
Top 10 Most Expensive Procedures by Medicare Payment
| Procedure | CPT | Medicare Pays | Avg Billed | Markup |
|---|---|---|---|---|
| TAVR — Transcatheter Aortic Valve Replacement | 33361 | $24,780 | $168,400 | 6.8x |
| Coronary Artery Bypass Graft (CABG), 4+ vessels | 33536 | $18,920 | $124,300 | 6.6x |
| Spinal Fusion, Anterior Lumbar (ALIF), 3+ levels | 22558 | $9,840 | $78,500 | 8.0x |
| Implantable Cardioverter Defibrillator (ICD) | 33249 | $8,560 | $95,200 | 11.1x |
| Total Hip Replacement (with prosthesis) | 27130 | $1,810 | $18,900 | 10.4x |
| Total Knee Replacement | 27447 | $1,620 | $18,200 | 11.2x |
| Percutaneous Coronary Intervention (PCI), complex | 92941 | $1,430 | $11,800 | 8.3x |
| Esophagectomy (cancer resection) | 43117 | $1,390 | $16,200 | 11.7x |
| Whipple Procedure (pancreaticoduodenectomy) | 48153 | $1,270 | $14,600 | 11.5x |
| Liver Transplant (back-table surgery component) | 47135 | $1,180 | $22,400 | 19.0x |
Source: CMS Medicare Physician & Other Practitioners dataset, 2023 CMS Medicare Physician & Other Practitioners dataset, 2023 Physician fee component only — does not include facility, anesthesia, or implant costs
Compiled by the " research team.
Highest Markup Ratios: Where Billed Charges Are Most Inflated
Markup ratio (billed ÷ Medicare payment) reveals how aggressively providers price certain services above Medicare's valuation. Higher markups do not necessarily mean higher Medicare payments — some relatively modest procedures carry extreme markups.
| Procedure | CPT | Medicare Pays | Avg Billed | Markup |
|---|---|---|---|---|
| Liver Transplant (surgical component) | 47135 | $1,180 | $22,400 | 19.0x |
| Esophagectomy with reconstruction | 43117 | $1,390 | $16,200 | 11.7x |
| Total Knee Replacement | 27447 | $1,620 | $18,200 | 11.2x |
| ICD Implantation | 33249 | $8,560 | $95,200 | 11.1x |
| Colonoscopy with Biopsy | 45380 | $356 | $2,890 | 8.1x |
State-by-State Variation in High-Cost Procedures
Even for the same procedure, Medicare payments can vary by 30–60% depending on where you receive care. This is primarily driven by the Geographic Practice Cost Index (GPCI), which adjusts payments for local cost differences. Procedures in high-cost metro areas (New York, San Francisco, Boston) typically pay 20–40% more than in rural Midwest or Southern states.
Explore cost variation for any procedure across all 56 states and territories by browsing our full procedure list. Each procedure page shows a breakdown of Medicare payments by state.
Why Total Costs Are Often Much Higher
The Medicare Part B physician fees listed above are only one component of total procedure costs. For inpatient surgeries, you should expect additional costs from:
- Facility fees — Hospital or ambulatory surgery center charges, billed under Medicare Part A or DRG codes
- Anesthesia — Billed separately by anesthesiologists using time-based codes
- Implants & devices — Prosthetic joints, cardiac devices, and spinal hardware are often billed as separate line items
- Post-operative care — Rehabilitation, follow-up visits, and medications
- Assistant surgeon — Complex procedures may involve a second surgeon, each billing independently
For a total knee replacement, for example, the physician fee might be $1,620 under Medicare — but the total hospital payment (DRG 470) averages approximately $22,000 for the facility component alone.
How to Use This Data Before Your Procedure
Before undergoing any high-cost procedure, consider these steps:
- Look up your procedure's CPT code on PlainProcedure to understand the Medicare benchmark payment
- Ask your provider what they bill and whether they accept Medicare assignment
- Request an itemized estimate of all expected charges, not just the surgeon's fee
- If uninsured, ask about the hospital's charity care or financial assistance program
- Compare costs at different facilities — significant variation exists even within the same city
Browse all 9,297 procedures or view costs by state to start your research.
Frequently Asked Questions
What is the most expensive medical procedure by Medicare payment?
Among physician-billed services, complex spinal fusion surgeries, heart bypass procedures (CABG), and transcatheter aortic valve replacements (TAVR) consistently rank as the highest Medicare payments — often exceeding $5,000–$25,000 per procedure in physician fees alone, before facility costs.
Does the highest billed charge always mean the highest Medicare payment?
Not necessarily. Providers can bill any amount regardless of what Medicare pays. Some procedures with relatively modest Medicare payments have extremely high submitted charges, inflating the markup ratio. The Medicare payment reflects the procedure's true resource intensity more accurately than the billed charge.
Why do some procedures cost so much more in certain states?
Geographic cost differences stem from several factors: local wages (which affect practice expense RVUs), cost of living, facility density, and state-level regulations. The Geographic Practice Cost Index (GPCI) adjusts Medicare payments by region, which is why the same procedure can pay $1,200 in one state and $1,900 in another.
Are these the most expensive procedures including hospital costs?
No. PlainProcedure data covers physician and outpatient service payments under Medicare Part B. Hospital inpatient costs (Part A) are billed separately using DRG codes and involve much larger facility fees. For procedures requiring hospitalization, the physician fee in our database is only a fraction of the total cost.
Can I negotiate these costs if I don't have insurance?
Yes, and Medicare rates provide an excellent benchmark. Hospitals and providers typically accept negotiated rates at or near Medicare levels for uninsured or self-pay patients who ask. Many hospitals have charity care programs, and several states require hospitals to offer financial assistance to patients below 200–400% of the federal poverty level.
How often do procedure costs change?
The CMS updates the Medicare Physician Fee Schedule annually, typically publishing the final rule in November for the following year. Conversion factors and RVU values change each year based on Congressional budget adjustments. PlainProcedure uses 2023 data, which reflects the most recently published complete annual dataset.
Sources
- CMS Medicare Physician & Other Practitioners by Provider and Service, 2023. Centers for Medicare & Medicaid Services.
- CMS Physician Fee Schedule, 2023 Final Rule. Federal Register, November 2022.
- CMS Medicare DRG payment rates, Inpatient Prospective Payment System (IPPS), FY2023.
- American Hospital Association, Uncompensated Care Data, 2022.
This guide is for informational and educational purposes only. Dollar figures represent national averages from CMS data and may not reflect costs at specific providers or facilities. Always obtain itemized estimates from your provider before any procedure.
Understanding the Data
The information presented throughout this guide is informed by publicly available public records published by federal and state government agencies. Our database aggregates and standardizes these records to make them more accessible and easier to interpret for general audiences. When we reference specific statistics or trends, they are drawn directly from these authoritative sources unless explicitly noted otherwise.
It is important to understand the limitations of any large-scale data dataset. Records may contain errors from the original data collection process, some fields may be incomplete for older entries, and classification systems may have changed over time. Our analysis accounts for these factors by clearly labeling data vintage, flagging records with missing critical fields, and noting when temporal comparisons span methodology changes in the source data.
For readers who want to conduct their own research, we recommend going directly to the source whenever possible. federal and state government agencies provides detailed documentation on collection methodology, sampling frames, and known data quality issues. Our goal is not to replace primary sources but to make them more approachable and to highlight patterns that may not be immediately obvious when browsing raw records.
How We Analyze Data Records
Our analytical approach involves several steps designed to surface meaningful insights from large datasets. First, we clean and standardize the raw data, handling variations in naming conventions, date formats, and categorical labels. Then we compute summary statistics, distributions, and comparative benchmarks across relevant dimensions such as geography, time period, and category type.
Key metrics we examine include statistical records, geographic distributions, temporal trends. These indicators provide a multi-dimensional view of each entity in our database, allowing users to understand not just individual records but how they compare to peers, regional averages, and national benchmarks. We believe this contextual approach is far more valuable than presenting raw numbers in isolation.
