Methodology & Data Sources

Three populations (do not collapse)

Pages that show Medicare figures next to commercial estimates and hospital ratings are combining three populations. Treating them as one "2023 CMS dump" is a data-truth defect.

  1. CMS Medicare Part B claims (2023). Payment, billed charge, and utilization aggregates from the CMS Medicare Physician & Other Practitioners dataset (2023), published by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. Covers 9,297 CPT/HCPCS codes billed by 162,808 providers in calendar year 2023.
  2. RAND commercial-to-Medicare ratios (2024 study). Commercial-insurance and cash-price estimates apply ratios from the RAND Hospital Price Transparency Study (4th Edition, 2024) to the 2023 Medicare baseline. These are statistical estimates, not observed commercial claims for 2023.
  3. CMS Hospital Compare (rolling). Hospital quality ratings, ownership, and emergency-service flags come from CMS Hospital General Information on CMS's Hospital Compare schedule, independent of the 2023 claims year.

What We Track

  • 9,297 procedures: Every CPT/HCPCS code billed to Medicare, with national and state-level pricing statistics.
  • 5,426 hospitals: CMS Hospital Compare data including quality ratings, bed counts, and emergency service availability.
  • 162,808 providers: Individual Medicare providers with their procedure volumes and charge/payment data.
  • 198,292 state-level price records: Geographic variation in procedure costs across 56 states and territories.

Processing Pipeline

We download the CMS Medicare Physician and Other Practitioners dataset and process each CPT/HCPCS code to extract national and state-level pricing. For every procedure, we calculate:

  • National average Medicare payment amount (what Medicare actually pays providers)
  • National average submitted charge (what providers bill, their "chargemaster" rate)
  • Markup ratio: submitted charge ÷ Medicare payment
  • State-level variation: average Medicare payment and submitted charge by state

No data is modified, interpolated, or editorialized. Medicare payment amounts reflect the actual average amounts paid by Medicare for each procedure at each provider.

Understanding the Numbers

  • Medicare Payment: What Medicare actually reimburses the provider. This is a standardized rate based on the procedure code and a geographic adjustment factor (GPCI). Private insurers often pay similar but not identical amounts.
  • Submitted Charge: The provider's list price ("chargemaster" rate). This is typically far higher than what any payer actually pays. Uninsured patients may receive bills closer to this amount before any financial assistance is applied.
  • Markup: Submitted charge ÷ Medicare payment. A 4.0x markup means the provider's list price is 4 times what Medicare pays.

Corpus placement (where each entity sits)

Every procedure and rated-hospital detail page states a corpus-relative placement, #N of M, computed from live queries against this portal's CMS extract.

  • Procedures: rank by national_total_services descending among all tracked CPT/HCPCS codes (same basis as /procedures). Within a category, an additional ordinal ranks by national_avg_medicare_payment descending.
  • Hospitals: rank by CMS overall_rating descending among hospitals with a published star rating > 0 (Hospital Compare population).

Ties break on slug ascending so ordinals are stable. The according-to lead on each detail page restates that ordinal before the raw record fields.

Data Collection Method

CMS collects Medicare claims data from all Medicare-certified providers who bill under fee-for-service Part B. Each claim includes the procedure code (CPT/HCPCS), the amount billed by the provider, the amount Medicare paid, the provider's NPI, and the geographic location. CMS aggregates these individual claims into annual summary files that report average charges and payments by provider and procedure code, suppressing any provider-procedure combination with fewer than 11 beneficiaries to protect patient privacy.

Update Schedule

CMS publishes the Medicare Physician and Other Practitioners dataset annually, typically 12–18 months after the reference calendar year. We update our database when each new annual release becomes available. Between updates, the most recent published year's data is displayed. Medicare payment rates are adjusted annually through the Physician Fee Schedule rulemaking process, so year-over-year comparisons reflect both utilization changes and rate adjustments.

Corrections and changelog

If a figure looks wrong, use the data corrections channel (include the page URL and the number). We verify against the CMS source, fix at the ETL/DB when we are wrong, and acknowledge reports within a few business days, full process on the editorial & corrections policy. Material refreshes and corrections are listed on the public data changelog; that log only records changes corroborated by git or portal metadata, never invented backfill.

Limitations

  • Data covers Medicare fee-for-service claims only. Commercial insurance rates are not disclosed publicly.
  • Procedure codes describe services, not outcomes. A surgeon billing the same CPT code as a high-volume procedure center may provide very different service quality.
  • State-level averages mask significant variation within states (urban vs. rural, academic vs. community settings).
  • CMS releases updated data annually; prices change year to year based on Medicare rate adjustments.
  • Provider-procedure combinations with fewer than 11 beneficiaries are suppressed by CMS for privacy, which may exclude some low-volume specialists.
  • Submitted charges (chargemaster rates) are set by each provider and do not reflect what any payer actually reimburses.

Editorial Workflow

The cost and utilization figures are loaded directly from the CMS Medicare Physician & Other Practitioners dataset and CMS Hospital Compare, every number shown on a procedure, state, or rankings page is computed from those official source records, never invented, estimated by hand, or interpolated. The surrounding written material, guide articles, methodology notes, and the framing on each page, is compiled by the PlainProcedure and reviewed before it is published. Commercial and cash-price figures are clearly labelled as estimates derived from the RAND Hospital Price Transparency Study, not as quoted prices. This site is for informational purposes only and does not provide medical advice - always consult a licensed physician for clinical decisions. We do not accept payment for coverage, placement, or rankings; markup and cost figures are computed directly from CMS-published Medicare payment data.

Not Affiliated

PlainProcedure is not affiliated with CMS, Medicare, or any government agency. This site is for informational purposes only and does not provide medical or financial advice.

Revenue diversification readiness

This section records what is already productized for reuse or licensing, how affiliates may appear if activated, and which alternative monetization paths are paperwork-ready. It is a readiness assessment only. Nothing here turns on new revenue without operator sign-off ([operator]).

Downloadable and citable assets today

  • CMS procedure cost by state CSV at /data/cms-procedure-cost-by-state.csv - jurisdiction-level Medicare payment/charge extract that grounds methodology and /statistics. License: CC BY 4.0 for the compiled extract; name PlainProcedure as the compiler and keep CMS as the upstream public source.
  • Dataset JSON-LD + DataDownload on this methodology page declares the same CSV with license and download URL.
  • CiteThis on methodology for one-click attribution of the CMS-backed tables.
  • RSS at /feed.xml for discovery, not a paid product surface.
  • Not productized: no bulk procedure-cost API, no embeddable chart iframe product, no paid data-licensing terms page. [operator] must approve pricing, keys, and partnership terms before any launch.

Attribution ask: when reusing the CSV or citing a table, name PlainProcedure as the compiler and link to the source page or this methodology. Attribution does not imply CMS or Medicare endorsement.

YMYL-safe affiliate placement rules (if activated)

PlainProcedure is a Medicare cost registry (POSTURE-C / health-adjacent YMYL). If the operator ever enables affiliate or referral units beyond existing disclosure prose:

  • Allowed page types (only if activated): general insurance-literacy or billing-workflow comparisons on long-form guides where the reader is already evaluating a non-clinical purchase, never adjacent to procedure cost tables, hospital ratings, or any page that could be read as medical advice or a care recommendation.
  • Forbidden: affiliate links on procedure/hospital/state entity pages, rankings, markup calculators, or any “choose this hospital/procedure” CTA tied to a cost figure.
  • Labeling: every paid link carries a visible affiliate disclosure; no disguised buttons inside data tables.
  • Density: same Module 36 ceilings as display ads; no affiliate block above the first CMS source-attribution line on registry pages.

Status: no affiliate units are live. Activation is [operator]-gated.

Alternative ad-network eligibility (paperwork only)

  • Google AdSense: portal is in GETTING_READY; no manual ad slots are enabled pre-approval. Do not treat resubmit as the next lever while /procedure/* rendered-similarity stays REJECT-RISK (77%, measured 2026-09-03; soft-rotate fence binds through 2026-09-17).
  • Mediavine Journey: requires ~1,000 real sessions per 28-day window. PlainProcedure measured ~387 Umami visitors in the latest 28-day window (progress log 2026-09-04); GA4 is bot-heavy and is not the eligibility numerator. Not eligible today. Re-check when real sessions cross the threshold. [operator] applies to network enrollment.
  • Data licensing / API: CSV + Dataset schema are the passive product surface; any commercial API or white-label embed requires [operator] pricing, terms of use, and legal review before publication.

Frequently Asked Questions

Where does PlainProcedure's cost data come from?

Three populations: (1) Medicare payment/charge/utilization from the CMS Medicare Physician & Other Practitioners dataset (2023) across 9,297 CPT/HCPCS codes and 162,808 providers; (2) commercial and cash-price estimates from RAND 2024 commercial-to-Medicare ratios applied to that 2023 baseline; (3) hospital quality ratings from CMS Hospital Compare on a separate rolling schedule. CMS datasets are public at data.cms.gov; RAND ratios are published research, not observed commercial claims.

How often is the data updated?

CMS releases the Medicare Physician & Other Practitioners dataset annually, typically 12–18 months after the reference year. Hospital Compare quality ratings are updated on a separate CMS schedule. PlainProcedure refreshes its database within weeks of each upstream release. Medicare payment rates change year to year based on the Physician Fee Schedule rulemaking process.

How accurate are the numbers shown?

Medicare payment and submitted charge figures are CMS-reported averages for each procedure, no modification, interpolation, or editorialization. Our markup calculations are simple arithmetic (submitted charge ÷ Medicare payment). Accuracy is bounded by the underlying dataset: CMS suppresses provider-procedure combinations with fewer than 11 beneficiaries for patient privacy, so some low-volume specialists are excluded.

Is this medical advice? Can I use these prices to plan my care?

No, PlainProcedure is for informational and research use only and is not medical advice. Always consult a licensed physician for clinical decisions. The data shown reflects Medicare averages; your actual out-of-pocket cost depends on your insurance, your provider's negotiated rates, your geographic region, and your specific clinical circumstances. Submitted charges (chargemaster rates) rarely reflect what privately insured patients pay. Contact your insurer and your provider's billing office for pricing that applies to your situation.

Download the jurisdiction extract cited on this methodology page: cms-procedure-cost-by-state.csv. National reference on statistics.

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure 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.