About MedicalCosts.info
Free, transparent medical cost data for patients, researchers, journalists, and developers.
Our Mission
Medical costs in the United States are notoriously opaque. Even after the Hospital Price Transparency Rule took effect, most patients have no practical way to understand what a procedure will cost before receiving care.
MedicalCosts.info aggregates 17 public government data sources to provide free, searchable cost estimates for 21,000+ medical procedures, 10,000+ prescription drugs, and 2,500+ hospital stay categories (DRGs) across all 50 states and DC.
All data is derived from publicly available CMS (Centers for Medicare & Medicaid Services) fee schedules, CDC injury cost studies, and hospital discharge data. We do not collect user data or require registration.
How We Calculate Costs
Medicare Physician Rates (RVU-based)
Medicare pays physicians based on Relative Value Units (RVUs), which measure the resources required for a service. Each procedure has three RVU components:
- Work RVU -- physician time, skill, and intensity
- Practice Expense RVU -- clinical staff, equipment, supplies
- Malpractice RVU -- professional liability insurance
These are multiplied by the CMS Conversion Factor ($33.40 for CY 2026) to produce a dollar payment amount. Geographic adjustments (GPCIs) modify each component by locality.
Commercial Insurance Estimates
Commercial insurance rates typically range from 150% to 250% of Medicare rates, depending on provider negotiating power, market competition, and payer mix. We display estimated commercial ranges using these multipliers. These are estimates only -- actual negotiated rates vary by insurer and provider. Research from the RAND Corporation's Hospital Price Transparency Study and KFF analyses consistently find commercial rates averaging 200% of Medicare.
Hospital & Surgery Center Rates
Hospital outpatient rates come from the CMS Outpatient Prospective Payment System (OPPS), which groups procedures into Ambulatory Payment Classifications (APCs). ASC rates come from the separate ASC Payment System and are generally 30-50% lower than hospital outpatient rates for the same procedure.
Drug Pricing
Drug prices use NADAC (National Average Drug Acquisition Cost) data, which reflects what pharmacies actually pay to acquire drugs. This is more accurate than the commonly cited AWP (Average Wholesale Price), which is often called "Ain't What's Paid" in the industry. We display per-unit NADAC costs as the baseline, with notes on typical retail markups.
Geographic Cost Variation
Medical costs vary significantly by location. CMS divides the country into 109 Medicare payment localities, each with its own Geographic Practice Cost Index (GPCI) that adjusts the work, practice expense, and malpractice components of each procedure's payment. High-cost areas like Manhattan and San Francisco can have rates 30%+ above the national average, while rural areas may be 10-15% below.
Our state-by-state cost pages and cost comparison tool let you explore these geographic differences.
Data Freshness
Our data reflects Calendar Year (CY) 2026 CMS fee schedules and payment rates, published in the CMS Final Rules for CY 2026.
- Physician Fee Schedule: CY 2026 Final Rule (Conversion Factor: $33.40)
- OPPS/ASC rates: CY 2026 Final Rule
- CLFS rates: CY 2026
- DMEPOS rates: CY 2026 Q1
- NADAC drug prices: Latest available survey (updated regularly)
- NY SPARCS data: 2022 discharge year
- CDC/NHTSA cost studies: Latest published (adjusted for inflation where applicable)
Our 17 Data Sources
Every cost estimate on this site is derived from one or more of these public government data sources. We do not use proprietary data or user-submitted prices.
1. CMS Physician Fee Schedule (PFS) CY 2026
The primary source for physician/professional service rates. Contains relative value units (RVUs) and national payment amounts for 7,700+ CPT/HCPCS codes.
2. CMS Clinical Lab Fee Schedule (CLFS) CY 2026
Payment rates for clinical laboratory tests billed under the Clinical Laboratory Improvement Amendments (CLIA).
3. CMS Outpatient Prospective Payment System (OPPS) CY 2026
Hospital outpatient department payment rates organized by Ambulatory Payment Classification (APC) groups.
4. CMS Ambulatory Surgery Center (ASC) Payment System CY 2026
Payment rates for procedures performed in freestanding ambulatory surgery centers, generally lower than hospital outpatient rates.
5. CMS DMEPOS Fee Schedule CY 2026
Payment rates for durable medical equipment, prosthetics, orthotics, and supplies such as wheelchairs, crutches, and braces.
6. CMS Ambulance Fee Schedule CY 2026
Base rates and mileage rates for ground and air ambulance services.
7. CMS Geographic Practice Cost Indices (GPCIs)
Cost-of-practice adjustments for 109 Medicare localities across all 50 states plus DC. Adjusts work, practice expense, and malpractice RVU components by geography.
8. CMS MS-DRG Classification System
Medicare Severity Diagnosis Related Groups used for inpatient hospital payment. Includes relative weights and geometric/arithmetic mean length of stay.
9. CMS Medicare Inpatient Provider & Service Data
Hospital-level data on DRG discharges, average charges, total payments, and Medicare payments across 3,000+ hospitals.
10. NADAC (National Average Drug Acquisition Cost)
The actual acquisition cost pharmacies pay for drugs, surveyed weekly by CMS. More accurate than AWP for estimating real drug costs.
11. NY SPARCS Hospital Discharge Data
New York State hospital inpatient discharge records with total charges AND total costs by DRG and severity level. One of the few public datasets with actual cost data.
12. CDC WISQARS Cost of Injury Data
Centers for Disease Control injury cost estimates including medical costs and work loss costs by injury mechanism, intent, and severity.
13. NHTSA Economic Impact of Motor Vehicle Crashes
National Highway Traffic Safety Administration data on the economic and comprehensive costs of motor vehicle crashes by severity (KABCO scale).
14. NSCISC Spinal Cord Injury Cost Data
National Spinal Cord Injury Statistical Center data on first-year and lifetime costs by injury level and severity (paraplegia, tetraplegia).
15. CDC TBI Cost Studies
Traumatic brain injury cost estimates by severity from CDC surveillance data, including acute care and long-term rehabilitation costs.
16. ABA Burn Cost Data
American Burn Association data on treatment costs by total body surface area (TBSA) burned and burn severity.
17. ICD-10-CM Injury Code Mappings
International Classification of Diseases codes (S00-T88, V00-Y99) used to map injuries to treatment procedures and cost categories.
API & Developer Access
All of our data is accessible through a free REST API and an MCP (Model Context Protocol) server for AI assistants.
REST API
Free JSON API for procedure costs, drug prices, DRG data, and geographic comparisons. No authentication required.
medical-costs-api.david-568.workers.dev MCP Server
Model Context Protocol server for Claude, ChatGPT, and other AI assistants. Look up costs in natural language.
npx @anthropic/mcp install Important Disclaimer
This site is for informational purposes only. Cost estimates displayed on MedicalCosts.info are based on publicly available Medicare reimbursement rates and government data sources. They are not quotes, guarantees, or predictions of what you will actually pay.
Actual medical costs vary significantly based on:
- Your insurance plan and in-network/out-of-network status
- The specific provider or hospital
- The complexity of your individual case
- Geographic location
- Whether additional procedures or services are needed
- Your deductible, coinsurance, and out-of-pocket maximum
This is not medical, financial, or legal advice. Always consult with your healthcare provider and insurance company for cost estimates specific to your situation.
Data Attribution
All data on this site is derived from publicly available U.S. government sources, primarily the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the National Highway Traffic Safety Administration (NHTSA). We comply with all applicable data use agreements and attribution requirements.