Methodology
This page explains how MedCostCompare turns public Medicare provider-service records into local procedure price comparisons.
This page explains how MedCostCompare turns public Medicare provider-service records into local procedure price comparisons.
Data source
Price information comes from the 2025 CMS Medicare Physician & Other Practitioners - by Provider and Service report, published by the Centers for Medicare & Medicaid Services.
The source is organized by National Provider Identifier, HCPCS code, place of service, service volume, submitted charges, Medicare-approved amounts, and Medicare payment amounts.
Data year
The current site build uses the report's calendar year 2023 provider-service records. Calendar year 2023 is the service year represented by the current procedure price calculations.
Procedure grouping
Each public procedure page starts with a manually confirmed procedure concept, such as colonoscopy or cataract surgery. A concept may contain one or more subtypes when closely related services should be shown separately.
Procedure pages are built only from codes that have been explicitly included in the local project database. Related codes stay grouped until manual review decides that they should be split into separate subtypes.
CPT and HCPCS
MedCostCompare uses the HCPCS code field in the CMS provider-service report. Many procedures on the site are identified by CPT codes that appear in the CMS data as HCPCS codes.
Included codes must match the user-facing procedure. Codes are not added to a published procedure page only because they share a keyword or sound related; they must be part of a confirmed procedure definition.
Inclusion rules
Pages include clinician records only. Facility entities are excluded from ranked provider comparisons. The system groups records by place of service first and uses the dominant qualifying care setting for comparison.
A local comparison must have enough provider and service volume to publish. Current thresholds require at least 10 included providers, at least 500 included services in the metro area, and at least 30 services for each listed provider.
Pages that do not produce at least one valid local comparison section are suppressed from publish output. This prevents limited or misleading local rows from appearing as consumer-facing price rankings.
Typical prices
The price shown for a provider is based on the CMS average Medicare-approved amount for the included code or codes, weighted by that provider's service volume when multiple rows are combined.
The typical cost shown for a procedure subtype is the median of included provider prices in that metro area and care setting. When a page shows a typical range, it uses the middle spread of included provider prices, usually the 25th to 75th percentile.
Outliers
MedCostCompare reduces noisy comparisons by requiring minimum provider volume, minimum metro service volume, clinician-only rankings, confirmed code sets, and publish thresholds. Provider price summaries use medians and percentile ranges rather than simple averages, which reduces the influence of extreme values.
The site does not manually edit individual provider prices. If a procedure-metro combination produces implausible or unstable local results, it should be suppressed until the procedure logic or setting logic is reviewed.
Refresh cadence
CMS updates this public data annually. MedCostCompare expects to refresh procedure calculations after new CMS provider-service data is available and after the procedure definitions and publish thresholds are reviewed.
Caveats
Medicare-approved amounts are not the same as private insurance allowed amounts, billed charges, cash-pay prices, or a patient's final out-of-pocket cost. Your actual cost can depend on insurance plan rules, deductible status, coinsurance, provider network status, facility fees, anesthesia, imaging, pathology, complications, and other services billed around the procedure.
Use MedCostCompare as a directional public-data comparison. Before scheduling care, confirm expected costs with your insurer, the clinician, and any facility involved in the procedure.