What Medicare Actually Pays: 100 CPT Codes

Every medical bill has CPT codes on it. For each code below, you can see what Medicare pays versus what providers typically charge. The gap between these two numbers is where most billing problems hide.

Updated May 2026Source: CMS 2026 Physician Fee Schedule & CLFS

Why This Matters for Your Bill

Medicare = Fair Price Benchmark

Medicare rates are set by CMS based on the actual resources each service requires. They are the closest thing to an objective price in U.S. healthcare.

Typical Insurance Pays 1.5x to 2.5x

Commercial insurers negotiate rates that are typically 150% to 250% of Medicare. If you are paying more than 2.5x Medicare, you may be overpaying.

Uninsured? Aim for 1.5x Medicare

Most providers will accept 120% to 200% of Medicare for cash-pay patients. Use the Medicare rate on each page below as your starting point.

Labs only

Showing 100 of 100 codes

Office Visits (Established Patient)

The most commonly billed codes in all of medicine. 99214 alone accounts for 24.6 million Medicare beneficiaries per year.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
99211	Off/op est may x req phy/qhp	$24.38	$58.87	2.4x
99212	Office o/p est sf 10 min	$59.45	$113.04	1.9x
99213	Office Visit, Established Patient, Low Complexity (20-29 min)	$95.19	$179.97	1.9x
99214	Office o/p est moderate 30 min	$135.61	$263.55	1.9x
99215	Office Visit, Established Patient, High Complexity (40-54 min)	$192.39	$381.33	2.0x

Office Visits (New Patient)

New patient visits pay 30% to 50% more than established patient visits for the same complexity level.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
99202	Office o/p new sf 15 min	$75.15	$167.44	2.2x
99203	Office o/p new low 30 min	$117.57	$256.96	2.2x
99204	Office Visit, New Patient, Moderate Complexity (45-59 min)	$177.36	$395.78	2.2x
99205	Office Visit, New Patient, High Complexity (60-74 min)	$236.81	$534.53	2.3x

Emergency Department Visits

ER physician fees are modest. The real cost is the facility fee, which is billed separately and can add $500 to $3,000+.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
99283	Emergency Department Visit (Level 3, Low Complexity)	$69.47	$2,160.03	31.1x
99284	Emergency Department Visit (Level 4, Moderate Complexity)	$118.24	$1,762.83	14.9x
99285	Emergency Department Visit (Level 5, High Complexity)	$171.35	$2,208.99	12.9x

Blood Panels

Panels bundle multiple tests at one price. If you see both a panel and an individual component test on your bill, the component is likely an unbundling error.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
80048	Basic metabolic pnl total ca	CLFS rate	$46.84	N/A
80053	Comprehensive Metabolic Panel (CMP)	CLFS rate	$59.85	5.8x
80061	Lipid Panel (Cholesterol and Triglycerides)	CLFS rate	$91.15	7.0x
80076	Hepatic function panel	CLFS rate	$42.58	N/A

Common Blood Tests

These five tests cover diabetes (A1c), thyroid (TSH), general health (CBC), vitamin D, and prostate screening (PSA).

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
83036	Hemoglobin A1c Test	CLFS rate	$56.42	5.9x
84443	TSH (Thyroid Stimulating Hormone) Blood Test	CLFS rate	$92.50	5.6x
85025	Complete Blood Count (CBC)	CLFS rate	$36.17	4.8x
82306	Vitamin d 25 hydroxy	CLFS rate	$177.41	N/A
84153	PSA (Prostate Specific Antigen) Test	CLFS rate	$99.45	5.5x

Thyroid and Hormone Tests

Thyroid panels often include multiple codes. A full thyroid workup (TSH + Free T4 + Free T3) can cost $25 at a direct-pay lab or $300+ through a hospital.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
84436	Assay of total thyroxine	CLFS rate	$42.21	N/A
84439	Assay of free thyroxine	CLFS rate	$83.35	N/A
84481	Free assay (ft-3)	CLFS rate	$142.24	N/A
84403	Assay of total testosterone	CLFS rate	$140.62	N/A
83970	Assay of parathormone	CLFS rate	$179.00	N/A

Iron and Nutrition Tests

Iron studies (ferritin, serum iron, TIBC) and vitamin levels (B12, folate) are commonly ordered together.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
82728	Assay of ferritin	CLFS rate	$76.78	N/A
83540	Assay of iron	CLFS rate	$32.40	N/A
83550	Iron binding test	CLFS rate	$44.16	N/A
82607	Vitamin b-12	CLFS rate	$85.76	N/A
82746	Assay of folic acid serum	CLFS rate	$82.85	N/A

Kidney and Urine Tests

Urine albumin and creatinine are key diabetes screening tests. Urine culture (87086) is the standard for UTI diagnosis.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
82043	Ur albumin quantitative	CLFS rate	$55.24	N/A
82570	Assay of urine creatinine	CLFS rate	$43.21	N/A
84156	Assay of protein urine	CLFS rate	$33.53	N/A
84550	Assay of blood/uric acid	CLFS rate	$29.56	N/A
87086	Urine culture/colony count	CLFS rate	$49.83	N/A
87186	Sc std microdil/agar dil	CLFS rate	$53.73	N/A

Inflammation and Autoimmune Tests

CRP and ESR are general inflammation markers. ANA (86038) is the first-line test for autoimmune conditions like lupus.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
86140	C-reactive protein	CLFS rate	$53.40	N/A
85652	Rbc sed rate automated	CLFS rate	$28.33	N/A
86038	Antinuclear antibodies	CLFS rate	$78.70	N/A
82550	Assay of ck (cpk)	CLFS rate	$36.44	N/A

Liver and Metabolic Tests

Magnesium and BNP (natriuretic peptide for heart failure) are often added to standard panels.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
83735	Assay of magnesium	CLFS rate	$37.73	N/A
83880	Assay of natriuretic peptide	CLFS rate	$166.07	N/A

Drug Testing

Drug testing is one of the most over-billed areas in healthcare. A single urine drug screen should cost $50 to $100, not the $500+ some labs charge.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
80307	Drug test prsmv chem anlyzr	CLFS rate	$217.78	N/A

Rapid Diagnostic Tests

Point-of-care rapid tests like flu swabs are simple and cheap, but can carry high facility markups when done in an ER or hospital outpatient setting.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
87804	Influenza assay w/optic	CLFS rate	$42.93	N/A

X-Rays

X-rays are among the cheapest imaging studies. The Medicare rate is $33 to $50 for most views, but hospital outpatient departments often charge $100 to $200+.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
71046	Chest X-Ray, 2 Views	$33.07	$86.59	2.6x
72100	X-ray exam l-s spine 2/3 vws	$40.42	$115.91	2.9x
73030	X-ray exam of shoulder	$35.74	$104.94	2.9x
73502	X-ray exam hip uni 2-3 views	$48.77	$122.41	2.5x
73562	X-ray exam of knee 3	$42.42	$118.43	2.8x
73564	X-ray exam knee 4 or more	$49.43	$143.82	2.9x
73630	X-ray exam of foot	$34.07	$92.24	2.7x

CT Scans

CT scans done at a freestanding imaging center can cost 50% to 70% less than the same scan at a hospital outpatient department.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
70450	CT Scan Head Without Contrast	$106.55	$544.89	5.1x
71250	Ct thorax dx c-	$132.60	$657.30	5.0x
74177	CT Abdomen and Pelvis With Contrast	$300.27	$1,049.94	3.5x

MRI Scans

MRIs have some of the largest price gaps in healthcare. A lumbar spine MRI can cost $300 at a cash-pay center or $3,000+ at a hospital.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
70553	MRI Brain With and Without Contrast	$316.97	$1,911.21	6.0x
72148	Mri lumbar spine w/o dye	$191.72	$1,226.47	6.4x

Mammography and Breast Imaging

Screening mammograms (77067) are covered at $0 by most insurance under ACA preventive care rules. 3D tomosynthesis (77063) is an add-on.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
77063	Breast tomosynthesis bi	$51.10	$155.45	3.0x
77067	Screening Mammography	$126.26	$324.40	2.6x

Bone Density

DEXA scans for osteoporosis screening. Medicare pays $39, but hospital charges average $219 (5.5x markup).

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
77080	DEXA Bone Density Scan	$39.41	$218.61	5.5x

Heart Tests

An EKG (93000) costs $15 from Medicare but averages $68 billed. Echocardiograms and stress tests have 3x to 4x markups.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
93000	EKG (Electrocardiogram), 12-Lead	$15.36	$67.91	4.4x
93010	Electrocardiogram report	$8.35	$35.04	4.2x
93015	Cv stress test supvj i&r	$73.48	$289.52	3.9x
93306	Echocardiogram with Doppler (Heart Ultrasound)	$196.73	$683.82	3.5x
93880	Extracranial bilat study	$189.05	$519.47	2.7x
78452	Ht muscle image spect mult	$427.87	$1,203.08	2.8x

Eye Exams and Diagnostics

Ophthalmology uses separate E/M codes (920xx) from general medicine. OCT scans and fundus photos are common add-ons.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
92004	Compre oph exam new pt 1/>	$149.64	$247.06	1.7x
92012	Intrm oph exam est patient	$90.52	$162.44	1.8x
92014	Compre oph exam est pt 1/>	$127.26	$219.94	1.7x
92083	Extended visual field xm	$63.80	$147.34	2.3x
92133	Cptrzd oph dx img pst sgm on	$30.73	$103.07	3.4x
92134	Cptrz oph dx img pst sgm rta	$32.73	$122.17	3.7x
92136	Ophthalmic biometry	$48.10	$155.31	3.2x
92250	Fundus photography w/i&r	$37.07	$118.16	3.2x

Hearing Tests

A comprehensive hearing test (92557) includes pure tone air, bone, and speech audiometry. Tympanometry (92567) tests middle ear function.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
92557	Comprehensive hearing test	$35.74	$119.97	3.4x
92567	Tympanometry	$16.03	$50.54	3.2x

Physical Therapy

PT codes are billed per 15-minute unit. A typical session includes 3 to 4 units across different codes. Hospital-based PT costs 2x to 4x more than private practice.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
97110	Therapeutic Exercise (Physical Therapy, 15 min)	$29.06	$67.22	2.3x
97112	Neuromuscular reeducation	$32.73	$70.12	2.1x
97140	Manual therapy 1/> regions	$27.72	$65.47	2.4x
97161	Pt eval low complex 20 min	$97.86	$184.67	1.9x
97162	Pt eval mod complex 30 min	$97.86	$179.29	1.8x
97530	Therapeutic activities	$35.07	$72.28	2.1x

Chiropractic

Chiropractic manipulation of 3 to 4 spinal regions. One of the lower-markup services, with charges averaging just 1.6x Medicare.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
98941	Chiropract manj 3-4 regions	$38.41	$59.73	1.6x

Injections

Joint injections (20610) and eye injections (67028) include the procedure only. The drug itself (like cortisone or anti-VEGF) is billed separately and often costs much more than the injection.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
20610	Joint Injection or Aspiration (Large Joint)	$68.81	$273.46	4.0x
67028	Injection eye drug	$114.23	$562.06	4.9x
96372	Ther/proph/diag inj sc/im	$15.36	$54.50	3.5x

Skin Procedures

Skin biopsies, lesion destruction, and nail debridement. Mohs surgery (17311) is the most expensive at $667 Medicare rate.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
11056	Parng/cutg b9 hyprkr les 2-4	$81.16	$128.00	1.6x
11102	Tangntl bx skin single les	$95.53	$222.64	2.3x
11103	Tangntl bx skin ea sep/addl	$48.77	$114.96	2.4x
11720	Debride nail 1-5	$32.73	$58.37	1.8x
11721	Debride nail 6 or more	$45.09	$82.92	1.8x
17000	Destruction of Precancerous Skin Lesion	$66.47	$151.51	2.3x
17110	Destruction b9 les up to 14	$111.22	$236.99	2.1x
17311	Mohs 1 stage h/n/hf/g	$667.02	$1,491.02	2.2x

Pathology

Tissue examination fees from biopsies and surgeries. Pathology bills often arrive separately from the surgeon and facility bills.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
88305	Tissue exam by pathologist	$70.14	$182.47	2.6x
88342	Imhchem/imcytchm 1st antb	$110.22	$210.64	1.9x

Bladder and Urology

Ultrasound bladder volume measurement. A $13 Medicare procedure that averages $69 billed (5.5x markup).

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
51798	Us urine capacity measure	$12.69	$69.42	5.5x

Ear Procedures

Ear wax removal. A simple procedure that should cost $30 to $50, but can reach $200+ in a hospital outpatient setting.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
69210	Remove impacted ear wax uni	$47.76	$134.92	2.8x

Care Management

Chronic care management (99490) and advance care planning (99497) are phone/coordination services. Check that you actually received and consented to these services before paying.

CPT Code	Procedure	Medicare Pays	Avg. Charge	Markup
99490	Chrnc care mgmt staff 1st 20	$66.13	$106.88	1.6x
99497	Advncd care plan 30 min	$86.84	$159.77	1.8x

How to Use This Data With Your Bill

1
Request an itemized bill.
Every provider must give you one by law. It lists each CPT code, the quantity, and the charge.
2
Look up each CPT code on this page.
Compare what you were charged to the Medicare rate and national average. Charges above 3x Medicare are a red flag.
3
Check for common billing errors.
Click into any CPT code page for specific billing issues to watch for, including unbundling, upcoding, and duplicate charges.
4
Negotiate or dispute.
Call the billing department with your research. Quote the Medicare rate, ask about cash-pay discounts, and request financial assistance if eligible.

Frequently Asked Questions

What is a CPT code?

CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires. Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is far less than their chargemaster price.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three components: Work RVU (physician time and skill), Practice Expense RVU (overhead), and Malpractice RVU. These are multiplied by geographic factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests use a separate Clinical Laboratory Fee Schedule with flat national rates.

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Important Disclaimer

Medicare rates shown are 2026 national (non-facility) rates from the CMS Physician Fee Schedule and Clinical Laboratory Fee Schedule. Average charges are from 2023 Medicare utilization data (most recent available). Your actual cost depends on location, provider, and insurance. Lab codes show "CLFS rate" because they use a flat national rate rather than the RVU formula. This content is for informational purposes only and does not constitute financial or medical advice.