Medicare Rate Lookup: What Medicare Pays for Every Procedure

Medicare publishes what it pays doctors and hospitals for every medical procedure in the US. While your insurance likely pays different rates, Medicare rates serve as a useful benchmark — if your bill is 3-5× what Medicare pays, it may be worth questioning.

The map below shows how Medicare costs vary across the country. Search for a specific procedure to see its rates, or explore the default view showing which states are more and less expensive overall.

Look Up Medicare Rates

Enter a procedure name (like "colonoscopy" or "MRI") or a CPT code from your bill. Add your ZIP code to see rates specific to your area. Click any procedure to see how rates vary across the country.

How to Use This Data

Medicare rates are not what you should expect to pay — commercial insurance rates are typically 1.5-3× higher, and hospital chargemaster prices can be 5-10× higher. But Medicare rates provide a floor that helps you understand whether a charge is in the normal range or significantly inflated.

Facility vs. Office Rates

Medicare pays two different rates for the same procedure depending on where it's performed:

• Facility rate — what Medicare pays when the procedure is done at a hospital or ambulatory surgery center (ASC). This is typically lower because the facility bills separately for overhead costs.
• Office rate — what Medicare pays when the procedure is done in a physician's office. This is often higher because it includes the physician's overhead.

Why Rates Vary by Location

Medicare adjusts its rates based on local cost of living using Geographic Practice Cost Indices (GPCIs). Areas with higher costs of living — like Manhattan, San Francisco, and Honolulu — have higher Medicare rates than rural areas. The map above shows this variation for any procedure you search.

Where This Data Comes From

This tool combines two public CMS datasets:

• Medicare Physician Fee Schedule — from the CMS Physician Fee Schedule. Rates are calculated using Relative Value Units (RVUs), Geographic Practice Cost Indices (GPCIs), and the CY 2026 conversion factor ($32.35). Updated quarterly (Q1 2026 release).
• Medicare Provider Utilization & Payment Data — from the CMS Provider Utilization dataset. This provides procedure volume (how many times each procedure is performed nationally), average submitted charges (what providers actually bill), and full procedure descriptions. Based on 100% of Medicare fee-for-service claims (CY 2023).

Together, these datasets let you see not just what Medicare pays, but what providers actually charge and how common each procedure is — giving you the full picture when evaluating a medical bill.