Markup

The Most Overpriced Medical Procedures in America

Top 20 procedures by markup ratio — what hospitals charge vs. what Medicare pays.

Hospital billing is one of the most opaque systems in America. When you receive a medical bill, the "charge" — what the hospital lists as the price — often bears little resemblance to what your insurance or Medicare actually pays. We analyzed 4,430 medical procedures using 2023 Medicare data to find the biggest gaps.

The Top 20 Most Marked-Up Procedures

These procedures have the highest ratio of hospital charges to Medicare-allowed amounts, filtered to procedures with at least 10,000 services:

#ProcedureHospital ChargeMedicare AllowedMarkup
1Sarscov2 vac bvl 30mcg/0.3ml$7.23$0.01723x
2Sarscov2 vac bvl 50mcg/0.5ml$10.09$0.03336.3333333333333x
3Placement of skin electrodes and measurement of stimulated sites on arms and legs$3,375$55.8060.48530465949821x
4Measurement of brain wave activity (eeg) outside the brain during surgery$3,186$54.8658.08257382427998x
5Needle measurement of electrical activity in arm, leg, trunk or head muscles, limited study$876.87$20.3043.19556650246305x
6Exam of lung airways using an endoscope$663.76$17.3038.36763005780347x
7Placement of skin electrodes and measurement of central motor stimulation in arms and legs$4,356$124.0835.1084784010316x
8Insertion of probe in esophagus for heart ultrasound$380.43$11.1834.02772808586762x
9Measurement of voltage-gated calcium channel antibody$263.96$11.8022.369491525423726x
10Continuous infusion of anesthetic agent and/or steroid into thigh nerve (femoral nerve) through catheter$1,532$69.5522.029762760603884x
11Continuous infusion of anesthetic agent and/or steroid into arm nerve bundle through catheter$1,581$77.8120.3198817632695x
12Needle measurement of electrical activity in arm or leg muscles, 2 extremities$1,687$83.5720.18942204140242x
13Antibody identification test for white blood cell antibodies$281.44$14.7319.106585200271553x
14Incision of pancreatic outlet using a flexible endoscope$1,449$76.1819.015620897873454x
15Computer-assisted image-guided navigation of lung airways using an endoscope$1,798$95.5418.820494033912496x
16Measurement of substance using immunoassay technique, by radioimmunoassay$315.66$18.0117.52692948362021x
17Electronic assessment of bladder emptying$184.72$10.7017.26355140186916x
18Electrocardiogram (ecg) up to 30 days continuous with symptom monitoring$136.97$7.9417.250629722921914x
19Antithrombin iii antigen (clotting inhibitor) activity$192.86$11.5916.640207075064712x
20Ultrasound of heart with color-depicted blood flow, rate and valve function$99.49$6.0016.581666666666667x

What This Means

Hospital "charges" are essentially list prices that nobody actually pays. Medicare negotiates much lower rates, and private insurers negotiate their own (usually somewhere in between). The uninsured, however, may be billed the full charge — which is why price transparency matters.

The biggest markups tend to be on high-volume, low-cost procedures like blood draws and basic lab tests. The hospital may charge thousands for a service that Medicare values at under $20.