States & Territories

The table below summarizes Medicare procedure pricing and provider availability across 56 U.S. states and territories. Click any state to drill into the per-state breakdown — including the most expensive and least expensive procedures, the CMS-certified hospitals reporting from that state, and the count of individual Medicare providers who submitted Part B Fee-for-Service claims during the most recent published service year.

State-level differences in Medicare reimbursement reflect a combination of structural and discretionary factors. The structural drivers are Medicare's locality adjustments: the work Geographic Practice Cost Index (GPCI), which captures regional physician labor costs; the practice-expense GPCI, which captures office overhead, rent, and clinical staff wages; and the malpractice GPCI, which captures professional liability premium variation. A procedure performed in San Francisco, California is paid more than the identical procedure performed in rural Mississippi not because the work is different, but because each input — labor, rent, and insurance — is more expensive in San Francisco's locality.

The discretionary drivers are clinical: the procedure mix billed in each state. States with a high concentration of teaching hospitals and tertiary referral centers tend to bill more complex procedures with higher relative-value units (RVUs), pulling the state average upward. States with predominantly community-hospital and primary-care infrastructure tend to bill more office-based evaluation, simple imaging, and routine diagnostic codes, pulling the average downward. Neither pattern indicates better or worse care — they reflect different healthcare-delivery models adapted to local population density, age structure, insurance mix, and the underlying epidemiology of the state.

Provider counts shown in the third column represent unique National Provider Identifier (NPI) records that submitted at least one qualifying Medicare Part B claim during the published service year. This count excludes Medicare Advantage encounter data, inpatient hospital claims (reported separately under MS-DRG groupings), and claims paid under capitation arrangements. It also applies the CMS privacy floor that suppresses any provider-code combination with fewer than 11 services to distinct beneficiaries per year, which can slightly reduce the count of qualifying providers in low-population states or for rare specialty practices. For verification, the underlying file is published at the official CMS Medicare Provider Charge Data portal.

Hospital counts (second column) reflect CMS-certified institutions reporting at the state level — primarily acute-care hospitals, critical access hospitals, and specialty hospitals enrolled in Medicare. The count does not include freestanding ambulatory surgical centers (reported separately), independent diagnostic testing facilities, or rural health clinics, all of which bill Medicare under different provider-enrollment categories. For a single state, the per-hospital page shows the specific facility's name, address, overall CMS quality rating where reported, and the procedure-level breakdown of billed and allowed amounts for procedures performed at that institution.

Average Medicare payment (fifth column) is computed as the mean of state-specific average allowed amounts across all CPT and HCPCS codes billed at least at the suppressed-threshold volume in that state. It is unweighted by service volume — high-volume codes (e.g., 99213 office visits) carry no more arithmetic weight than rare specialty codes when computing the state-level average, because the underlying provider-level claim counts are aggregated upward. For volume-weighted state averages on specific procedures, drill into the per-procedure-by-state pages, which surface the underlying state-level service counts and total payments. For comparing two states on a specific procedure side by side, use the compare endpoint accessible from each procedure detail page.

Territories — Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands — operate under distinct Medicare administration arrangements compared to the fifty states and the District of Columbia. Puerto Rico's Medicare Part B program participates in the Physician Fee Schedule under separate locality factors that historically have produced lower allowed amounts than mainland averages, reflecting lower input costs and a different practice-expense base. The other Pacific and Caribbean territories see proportionally smaller Medicare populations and consequently smaller datasets, which can produce more volatile year-to-year averages when small denominators amplify the effect of any single high-cost procedure or single high-volume provider opening or closing.

For Medicare beneficiaries planning care across state lines, the data shown here primarily benchmarks reimbursement-rate differences rather than out-of-pocket cost differences. Part B coinsurance is generally twenty percent of the Medicare allowed amount after the annual deductible, so a state with a higher allowed-amount average will produce higher dollar-amount coinsurance for an equivalent procedure category. Medicare Supplement plans typically cover this coinsurance regardless of state, eliminating the geographic out-of-pocket spread for enrollees with comprehensive supplemental coverage. Medicare Advantage enrollees face their plan's own cost-sharing structure, which is set by the contracting MA insurer and generally tracks plan network and contract terms more closely than it tracks underlying Medicare allowed amounts. Cross-state care decisions accordingly depend more on plan-specific benefit design than on the state averages summarized here.

For commercial-insurance comparisons, the state-level Medicare averages serve as the most common benchmark for negotiating in-network commercial rates. Provider-insurer contracts often reference Medicare allowed amounts as a multiplier — formulas such as "one hundred fifty percent of Medicare" or "two hundred percent of Medicare" appear regularly in both physician and hospital agreements. States with higher Medicare averages thus translate, through the contractual multiplier, into higher commercial rates that insurers then recover through premiums, deductibles, and coinsurance assessed on plan members. Uninsured and self-pay patients face the largest exposure because their applicable rate is generally the hospital chargemaster billed amount, which can be several multiples of the Medicare allowed amount — the spread quantified in the Highest Hospital Markup ranking accessible from the rankings hub. Requesting a Good Faith Estimate under the No Surprises Act remains the most reliable way to obtain an enforceable price commitment in advance of scheduled care.