Every figure on this page is a Medicare physician payment from CMS 2023 data, covering 128 procedures across 72.5 million patients per year. Commercial insurance typically pays 2 to 4 times the Medicare amount for the same procedure, so a $52 Medicare mammogram often runs $150 to $400 on a private plan before your deductible kicks in. Use Medicare as the floor, not the ceiling.
Most-Searched Procedures
Highest annual Medicare patient volume. Click any procedure for state-level pricing and providers.
These are the 10 most-searched procedures, ranked by Medicare patient volume in 2023. Each row shows what Medicare pays a physician per episode, not the retail price or what your commercial insurer reimburses.
Imaging
Mammography
Medicare pays
$52
12.7M patients/yr
Imaging
CT Scan Abdomen & Pelvis
Medicare pays
$91
6.0M patients/yr
Imaging
CT Scan Chest
Medicare pays
$56
5.3M patients/yr
Imaging
CT Scan Head / Brain
Medicare pays
$36
4.7M patients/yr
GI
Colonoscopy
Medicare pays
$187
3.1M patients/yr
Imaging
DEXA Bone Density Scan
Medicare pays
$22
2.7M patients/yr
Eye
Cataract Surgery
Medicare pays
$334
2.6M patients/yr
Imaging
MRI Spine
Medicare pays
$85
2.3M patients/yr
Imaging
MRI Brain
Medicare pays
$96
2.0M patients/yr
GI
Upper Endoscopy
Medicare pays
$110
2.0M patients/yr
Mammography costs Medicare $52 per screening, but commercial insurance commonly pays $150 to $400 for the same study. The Medicare-vs-commercial section below works through the math for the procedures patients ask about most.
Browse by Category
15 clinical categories across 128 procedures.
128 procedures across 15 clinical categories. Each tile shows the typical Medicare payment and the most-common procedure in that category.
30
procedures
Imaging
30 procedures averaging $71 on Medicare, led by Mammography at $52 across 12.6 million patients per year.
Medicare avg: $71
50.8M Medicare patients/yr
13
procedures
Heart
13 procedures averaging $381 on Medicare, with Heart Rhythm Monitors (Holter, Zio Patch, Event Monitor) drawing the highest volume.
Medicare avg: $381
2.4M Medicare patients/yr
13
procedures
Vascular
13 procedures averaging $557 on Medicare, with Peripheral Arterial Doppler Ultrasound (Leg / Arm) the most-used.
Medicare avg: $557
1.5M Medicare patients/yr
9
procedures
Urology
9 procedures averaging $293 on Medicare, anchored by Prostate Biopsy.
Medicare avg: $293
490K Medicare patients/yr
8
procedures
GI
8 procedures averaging $165 on Medicare, with Colonoscopy serving 3.1 million patients per year.
Medicare avg: $165
5.3M Medicare patients/yr
7
procedures
Hand
7 procedures averaging $395 on Medicare, led by Carpal Tunnel Release Surgery.
Medicare avg: $395
304K Medicare patients/yr
7
procedures
Eye
7 procedures averaging $352 on Medicare, with Cataract Surgery covering 2.6 million patients per year.
Medicare avg: $352
3.1M Medicare patients/yr
6
procedures
Spine
6 procedures averaging $335 on Medicare, with Epidural Steroid Injections the highest-volume.
Medicare avg: $335
2.6M Medicare patients/yr
5
procedures
ENT
5 procedures averaging $551 on Medicare, led by Nasal Polyp & Growth Removal.
Medicare avg: $551
95K Medicare patients/yr
3
procedures
Other
3 procedures averaging $208 on Medicare, with Lymph Node Biopsy the most-common.
Medicare avg: $208
74K Medicare patients/yr
3
procedures
Kidney
3 procedures averaging $272 on Medicare, anchored by monthly Dialysis physician fees.
Medicare avg: $272
609K Medicare patients/yr
3
procedures
Womens Health
3 procedures averaging $610 on Medicare, led by Laparoscopic Hysterectomy.
Medicare avg: $610
31K Medicare patients/yr
3
procedures
Cancer
3 procedures averaging $170 on Medicare, with External Beam Radiation Therapy (IMRT, 3D Conformal) the highest-volume.
Medicare avg: $170
1.6M Medicare patients/yr
3
procedures
Breast
3 procedures averaging $327 on Medicare, led by image-guided Breast Biopsy.
Medicare avg: $327
165K Medicare patients/yr
15
procedures
Other Specialty
15 lower-volume procedures spanning Skin, Foot, Hip, Knee, Lung, Shoulder, Mental Health, and Endocrine categories.
3.4M Medicare patients/yr
Where Your Setting Choice Matters Most
Medicare pays different rates depending on whether a procedure is done in-office or in a hospital facility.
The same procedure can cost two or three times more depending on where it's performed. A spinal cord stimulator implant costs Medicare $1,092 in an office or ambulatory surgery center, versus $3,874 in a hospital outpatient department: a $2,781 difference for identical work. Ambulatory surgery centers run leaner, with lower facility fees, simpler staffing, and no inpatient overhead, and Medicare reimburses them accordingly.
Before any scheduled procedure, ask which setting will be billed and whether an in-network ambulatory surgery center is an option. Those structural savings flow through to your coinsurance and your annual out-of-pocket spend.
Where Your State Matters Most
Same procedure, different Medicare payments across states. Click either state for its full health report.
Medicare doesn't pay the same rate everywhere. Leg artery angioplasty pays physicians $1,709 on Medicare in Washington DC and $6,550 on Medicare in New Jersey, a $4,841 swing on the same code. Medicare's Geographic Practice Cost Index (GPCI) adjusts physician payments by region using local wage data, malpractice premiums, and practice overhead, which is why the gap can stretch into the thousands.
Commercial insurance variance is typically wider than Medicare's, because negotiated rates depend on metro market dynamics and hospital-system bargaining power. Treat your state's Medicare rate as a defensible floor; your local commercial rate may sit well above it.
Medicare vs. Commercial: The Real Math
Medicare figures are a floor, not a retail price. Commercial insurance and cash pay run 3x to 7x higher on most procedures.
Medicare pays roughly 40 to 60 percent of what commercial insurers pay for the same procedure. Each provider keeps a separate fee schedule for Medicare, Medicaid, and every commercial plan they're contracted with, so the same CPT code carries multiple prices at the same address. The Medicare figures on this site are the lowest credible benchmark; commercial rates almost always sit higher.
Mammography (Screening)
Colonoscopy (Physician Fee)
Cataract Surgery (Physician Fee)
What that multiplier means in practice depends on your plan. Most 2025 commercial plans carry a deductible between $2,000 and $8,000 plus 20 to 30 percent coinsurance after the deductible. On a plan with a $3,000 deductible, you'll likely pay the full commercial rate out-of-pocket for a screening mammogram until you reach that threshold, even though Medicare patients pay nothing for the same scan. Total billed amounts including facility fees and anesthesia run higher than the physician fees shown above.
What you actually pay
The 2025 ACA out-of-pocket maximum is $9,200 for an individual plan and $18,400 for a family plan. Once you hit that ceiling, in-network covered care is fully paid for the rest of the plan year, which is why a single high-cost procedure can be the event that resets your math.
Surprise Bills: What Goes Wrong and How to Avoid It
Even an in-network facility can generate out-of-network bills. The four most common sources.
An in-network facility can still produce out-of-network bills when separately-contracted clinicians are involved in your care. The federal No Surprises Act (2022) closed the gap for emergency care and certain ancillary services at in-network hospitals, but scheduled procedures still carry blind spots, especially when anesthesia, pathology, or implants are billed on separate contracts.
Anesthesiologist
CommonAnesthesia services are almost always billed by a separate practice group, even at hospitals where every other clinician is in-network. The hospital contracts with one anesthesia group, the anesthesia group contracts with insurers separately, and there's no requirement that those networks line up. Commercial anesthesia bills often run $1,500 to $4,000 for a routine outpatient surgery. Ask the surgeon's office for the name of the anesthesia group and request written confirmation of network status before the date of service.
Pathologist or Radiologist
CommonWhen tissue is removed during surgery or imaging is read after a scan, a pathologist or radiologist interprets the result and bills separately from the facility and the procedural physician. Their professional fees commonly run $100 to $600 on commercial plans and may not appear until weeks after the procedure. Hospital-based pathology and radiology groups frequently sit outside major commercial networks. Request the names of the contracted pathology and radiology groups in advance and verify each one with your insurer.
Implants and Devices
SometimesHardware like spinal cord stimulators, defibrillators, joint replacements, and stents is often billed as a separate line item, sometimes by the device manufacturer's billing arm rather than the hospital. Commercial implant charges can run $5,000 to $40,000 depending on the device, and pass-through pricing rules vary by payer. Ask the surgical scheduler for the specific device manufacturer, model, and billing entity, then call your insurer to confirm the device is covered under your plan benefits.
Ambulance and Transfers
SometimesGround ambulances are largely excluded from the No Surprises Act, so a transfer between facilities or a non-emergency transport can produce a bill from a private ambulance company that doesn't contract with your insurer. Commercial ambulance bills frequently run $500 to $2,500 per leg and arrive months after the procedure. If a transfer is being arranged, ask whether the receiving facility's preferred ambulance provider is in your network and request the company name in writing.
How to protect yourself
Patients without insurance are entitled to a Good Faith Estimate under the No Surprises Act (2022), and providers must furnish it on request. If you carry insurance, request written network confirmation for every clinician involved before the date of service and keep printed copies. If your final bill exceeds the Good Faith Estimate by $400 or more, the federal Patient-Provider Dispute Resolution process is available at no cost.
What Drives Procedure Costs
The structural reasons two hospitals charge different amounts for the same operation.
Medicare prices procedures using the Resource-Based Relative Value Scale. Every CPT or HCPCS code carries three Relative Value Unit (RVU) components: physician work (time, skill, intensity), practice expense (staff, supplies, equipment), and malpractice. Medicare multiplies the total RVUs by an annual conversion factor to get the base payment. That's why a 15-minute office visit and a 4-hour spine fusion sit at opposite ends of the fee schedule even though both are billed to the same payer.
RVU Base
The base Medicare payment for any procedure is total RVUs multiplied by the annual conversion factor, currently around $32.35 per RVU. A standard mammogram (CPT 77067) carries roughly 1.6 total RVUs, which is why Medicare pays about $52 for it. A leg artery angioplasty carries roughly 140 RVUs, which is why Medicare pays $4,572.
Geographic Practice Cost Index
Medicare adjusts each RVU component by a Geographic Practice Cost Index (GPCI) tied to the local wage, rent, and malpractice market. That's why leg artery angioplasty pays $1,709 on Medicare in DC and $6,550 on Medicare in New Jersey for the same code. High-cost metros like New York, San Francisco, and Boston consistently push procedure prices above the national average.
Facility Type
Medicare assigns separate payment rates depending on whether a procedure happens in a physician office, an ambulatory surgery center, or a hospital outpatient department. Hospital settings carry higher facility fees to cover overhead. Spinal cord stimulator pays Medicare $1,092 in an office and $3,874 in a hospital outpatient department, a structural difference that propagates through commercial contracts as well.
Complexity and Modifiers
Bilateral procedures, multi-stage surgeries, and add-on codes all carry payment adjustments. A bilateral cataract surgery doesn't pay double; Medicare reduces the second eye to 50 percent of the primary code. Modifier 22 (increased complexity) can add 20 to 30 percent when documented. These adjustments stack on top of the base RVU calculation.
Devices and Implants
Hardware is almost always paid as a separate line. Medicare's pass-through payment rules cover certain new technologies for up to three years; outside that window, devices roll into the facility payment but are still tracked separately. A spinal cord stimulator generator alone carries thousands of dollars in implant cost beyond the physician fee, which is why total billed charges far exceed the Medicare physician payment shown on this site.
Time and Staffing
Practice expense RVUs reflect typical clinical staff time, supplies, and equipment for each code. Procedures requiring conscious sedation, scrub techs, or specialty equipment carry higher practice expense than office-based work. This is also why teaching hospitals, with their resident overhead, often command higher commercial reimbursement even when Medicare pays the same.
A single procedure's final Medicare payment is total RVUs multiplied by Medicare's national conversion factor, multiplied again by the local GPCI, plus any complexity or bilateral modifier. Commercial contracts begin from that number and apply their own multiplier, often 1.5 to 4 times the Medicare rate. Implants, anesthesia, and pathology add separate line items that don't appear in Medicare physician data.
Frequently Asked Questions
About this data, how it was built, and what to expect at the register.
How much do US medical procedures cost on average?
Across the 128 procedures tracked here, Medicare physician payments range from $21 for a knee X-ray to $4,572 for a leg artery angioplasty. The bulk of common diagnostic imaging sits between $35 and $100 on Medicare, while major implant and vascular work clusters between $1,000 and $4,500. Commercial insurance typically pays 2 to 4 times the Medicare rate for the same procedure.
Why is Medicare data useful for procedure cost research?
Medicare publishes its actual paid amounts by procedure code, by state, and by setting, which makes it the only national, transparent benchmark for what physicians get paid. Hospitals and commercial insurers don't release their negotiated rates in a comparable form. Treat Medicare as the floor: your commercial price will almost always be higher, but the Medicare figure tells you what an unsubsidized market rate looks like.
Are procedure costs always higher with commercial insurance?
Almost always, yes. Commercial insurers typically pay 1.5 to 4 times the Medicare rate, depending on the procedure, the market, and the hospital system's leverage. A colonoscopy that pays $187 on Medicare commonly runs $500 to $1,200 in physician fees on commercial plans, with total billed amounts much higher once facility fees and anesthesia are added. The exception is the small number of self-funded employer plans that contract on Medicare-pegged rates.
Which procedures have the biggest state-to-state price variation?
On Medicare, leg artery angioplasty swings from $1,709 in DC to $6,550 in New Jersey, a 283 percent spread. Embolization, vertebroplasty, and implantable loop recorders show similar or wider gaps. Geographic Practice Cost Index adjustments and local utilization patterns drive the range. Commercial variance tends to be larger still, because negotiated rates also depend on hospital-system market power.
Does choosing an ambulatory surgery center always save money?
Usually, when ASC is an appropriate setting. Spinal cord stimulator implants cost Medicare $1,092 in an office or ASC versus $3,874 in a hospital outpatient department. Cataract surgery shows a similar pattern: $168 on Medicare in office settings versus $518 in hospitals. Those savings flow through to your coinsurance, but only some procedures are clinically appropriate for ASC, so confirm with your surgeon.
What is a Good Faith Estimate?
Under the federal No Surprises Act (2022), uninsured and self-pay patients are entitled to a Good Faith Estimate of expected charges before any scheduled procedure. The estimate must include the primary item or service plus expected ancillary services. If your final bill exceeds the estimate by $400 or more, you can challenge it through the federal Patient-Provider Dispute Resolution process at no cost.
How do I avoid surprise bills for a scheduled procedure?
Ask the scheduler for the names of every billing entity involved: surgeon, anesthesia group, pathology group, radiology group, and any implant manufacturer. Verify each one with your insurer in writing. Confirm the facility is in-network and ask whether the procedure can be performed at an in-network ambulatory surgery center. Keep printed copies of every confirmation before the date of service.
When is a procedure cheaper in an office setting?
Office settings are reliably cheaper than hospital outpatient departments for procedures Medicare prices with a separate office rate. The four largest gaps in our data are spinal cord stimulator (72 percent cheaper in office on Medicare), glaucoma surgery (69 percent), cataract surgery (68 percent), and corneal transplant (5 percent). For minor surgeries, injections, and many endoscopies, office and ASC settings save the patient real money.
Where This Data Comes From
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