Medical Procedure Rankings

Medicare procedure pricing varies substantially across the United States. The same CPT or HCPCS code reimburses providers differently depending on the state, the local Geographic Practice Cost Index (GPCI), the participating institution, and the procedural setting (inpatient, outpatient, ambulatory surgical center, or office). The rankings below summarize state-level differences in average Medicare payment, hospital count, provider count, procedure variety, and the hospital markup ratio — the multiple by which submitted charges exceed Medicare allowed amounts.

The Most Expensive States and Least Expensive States rankings reflect the unweighted average Medicare payment across all procedure codes billed in each state during the most recent CMS Medicare Provider Utilization and Payment Data release. States with concentrations of teaching hospitals, specialty referral centers, and higher wage indices tend to occupy the top of the expensive rankings; rural and lower-cost-of-living states cluster at the bottom. These differences are largely structural — Medicare adjusts payments through formula-driven locality factors — but they materially affect what beneficiaries face for coinsurance and what commercial insurers benchmark against when negotiating contracts.

The Highest Hospital Markup ranking measures the gap between what hospitals bill (submitted charges) and what Medicare actually pays (allowed amounts). A higher markup ratio does not necessarily mean a hospital overcharges paying patients — Medicare, Medicaid, and commercial insurers rarely pay the submitted charge — but it does signal exposure for uninsured patients and out-of-network claims. Federal Hospital Price Transparency rules now require hospitals to publish negotiated rates and cash prices, but submitted charges remain the most consistent cross-state benchmark.

The Most Hospitals, Most Healthcare Providers, and Most Procedures Available rankings reflect supply-side capacity: how many institutions and clinicians submit Medicare claims, and how broad the procedural mix is in each state. Larger states with denser populations naturally have more of all three, but per-capita differences reveal underlying access patterns. Higher provider density correlates with shorter wait times for routine care, more specialty coverage, and broader procedure availability for Medicare beneficiaries.

All rankings draw from the CMS Medicare Provider Utilization and Payment Data release, which aggregates Part B Fee-for-Service claims submitted by physicians, non-physician practitioners, and other suppliers. The dataset covers the calendar year published by CMS and excludes Medicare Advantage encounter data, inpatient hospital claims (reported separately under MS-DRG groupings), and claims paid under capitation. Rankings are recomputed when CMS publishes a new release — typically annually with a two-year lag (e.g., 2023 service-year data published 2025). For verification, see the official CMS Medicare Provider Charge Data portal.

A note on interpretation: state-level averages mask within-state variation. A single state can include both high-cost metropolitan teaching centers and low-cost rural community hospitals. To compare specific institutions or procedures, drill into the per-state pages, the per-category breakdowns, or the per-procedure detail pages — each surfaces underlying provider-level claims data with the same CMS sourcing. For the rural-urban gap inside a single state, the per-procedure state breakdowns are usually more informative than the cross-state ranking alone. None of the figures shown should be interpreted as the price a specific patient will pay; they are reference benchmarks for context.

For Medicare beneficiaries, the most direct application of these rankings is in understanding why your share of cost may differ from a peer's in another state. Medicare Part B coinsurance is generally 20% of the allowed amount after the annual deductible, so states with higher allowed amounts produce higher coinsurance dollars for the same procedure category — even though the proportion is identical. Medicare Supplement (Medigap) plans typically cover this coinsurance, but Medicare Advantage plans set their own cost-sharing structures, which often vary by plan and network rather than tracking allowed-amount differences directly. The state rankings shown here capture the underlying Fee-for-Service Part B benchmark; they are not a direct estimate of what an MA enrollee will pay.

For commercially insured patients, state-level Medicare averages serve as a floor for negotiating in-network rates. Most commercial insurance contracts reference Medicare allowed amounts when negotiating physician-fee schedules — common formulas include "150% of Medicare," "200% of Medicare," or all-payer benchmark databases derived from Medicare baselines. Higher Medicare averages in a state therefore translate, with a multiplier, into higher commercial reimbursement, which insurers recover from beneficiaries through premiums, deductibles, and coinsurance. Self-pay and uninsured patients face the highest exposure because their applicable rate is often the chargemaster billed amount, which can be several multiples above the Medicare allowed amount — the markup ratio quantified in the Highest Hospital Markup ranking.