Frequently Asked Questions

The average Medicare-allowed amount for a knee replacement (CPT 27447) is $1,374. However, this is the physician/surgeon fee — total facility costs including the hospital stay, implant, anesthesia, and physical therapy can push the real cost much higher. Prices vary significantly by state and provider. See full knee replacement pricing →

Medicare allows an average of $233.31 for a colonoscopy with biopsy (CPT 45380), but hospitals charge an average of $1,709 — a markup of over 41x. Your out-of-pocket cost depends on your insurance, whether the facility is in-network, and whether the procedure is diagnostic or preventive. See full colonoscopy pricing →

MRI costs vary by type. A brain MRI with contrast (CPT 70553) averages $160.39 Medicare-allowed, while one without contrast (CPT 70551) averages $97.35. Hospital charges are typically 100-240x the Medicare-allowed amount. Prices also vary dramatically by location — the same MRI can cost 3-5x more at one facility compared to another in the same city. Compare MRI prices →

Hospitals set their own "chargemaster" prices with no regulatory cap. These list prices bear little relationship to actual costs. A simple blood draw has a markup of 2x over what Medicare actually pays. A comprehensive blood panel is marked up 6x. These inflated prices are used as a starting point for negotiations with insurers, but uninsured patients can be billed the full amount. The lack of price transparency has historically allowed these markups to grow unchecked.

The "markup" is the ratio between what a hospital charges (their list price) and what Medicare actually allows as reasonable payment. For example, if a hospital charges $40 million in aggregate for blood draws but Medicare allows just $19.18 per draw, that's a 2x markup. Most procedures have markups between 2x and 500x, but some reach into the millions. Our data covers markups for all 4,430 procedures. See the most overpriced procedures →

Use our Price Lookup Tool to search any procedure by name or CPT code. You'll see the national average, state-by-state breakdowns, and the gap between hospital charges and Medicare-allowed amounts. You can also compare costs across states or browse all procedures. For the most accurate estimate, call your provider's billing department and ask for the CPT code-specific price with your insurance.

In 2021, the Centers for Medicare & Medicaid Services (CMS) began requiring hospitals to publish their prices online in machine-readable formats. This "Hospital Price Transparency" rule means every hospital must disclose negotiated rates for at least 300 shoppable services. ClearPrices takes this a step further by aggregating Medicare claims data for 4,430 procedures across all 50 states, making it easy to compare what hospitals charge vs. what they actually get paid.

There's a massive gap. Hospitals set their own list prices (charges), but Medicare pays a fraction based on fee schedules. For a colonoscopy, hospitals charge an average of $1,709 but Medicare allows just $233.31 — a 41x difference. For a blood draw, the markup exceeds 2x. Medicare's allowed amounts are based on resource costs, while hospital charges are largely arbitrary. Private insurance typically negotiates rates somewhere between Medicare and list price.

Healthcare prices vary by state due to cost of living differences, local competition (or lack thereof), state regulations, and regional Medicare adjustments. Urban areas with multiple hospitals tend to have more competitive pricing, while rural areas with limited options often see higher costs. States like California and New York tend to have higher charges, while Southern and Midwestern states are often lower. Compare your state →

Yes. Our data comes directly from the CMS Medicare Provider Utilization and Payment Data (2023), the most comprehensive public dataset of healthcare pricing in the United States. It covers 1.26 million providers, 4,430 procedures, and over 1 billion services. We process the raw government data and present it in an accessible format. While this reflects Medicare fee-for-service claims (not private insurance), it's the gold standard for understanding healthcare pricing patterns.