What the numbers say across 3,331 US hospitals and 535 procedures, straight from the machine-readable files hospitals are required to publish — last refreshed October 2026. These are medians and estimates for comparison; always confirm with the hospital. Journalists & researchers: cite us with a link to this page.
Procedures with the biggest hospital markup over Medicare
How many times the median cash price exceeds what Medicare pays for the same service.
| # | Procedure | Cash (median) | Medicare pays | Markup |
|---|---|---|---|---|
| 1 | Coronary angioplasty / stent (PCI) | $23,324 | $426 | 54.8× |
| 2 | Lower back (lumbar) spinal fusion | $74,742 | $1,511 | 49.5× |
| 3 | Appendix removal (appendectomy) | $22,542 | $592 | 38.1× |
| 4 | Defibrillator (ICD) implant | $29,687 | $798 | 37.2× |
| 5 | Cardiac ablation | $26,566 | $759 | 35.0× |
| 6 | EKG / ECG (tracing only) | $184 | $7 | 26.2× |
| 7 | Blood type test (ABO group) | $74 | $3 | 24.7× |
| 8 | Leg artery angiogram | $3,650 | $149 | 24.4× |
| 9 | Turning a breech baby (version) | $2,276 | $94 | 24.2× |
| 10 | Cervical cerclage | $3,235 | $137 | 23.6× |
| 11 | Vocal cord injection | $4,540 | $211 | 21.5× |
| 12 | Nebulizer breathing treatment | $185 | $9 | 21.3× |
| 13 | Blood type test | $59 | $3 | 19.7× |
| 14 | Electrocardiogram (EKG) | $161 | $8 | 19.2× |
| 15 | Cardiac stress test | $740 | $39 | 18.9× |
Where shopping around saves the most
Procedures with the widest gap between the cheapest and priciest hospitals — comparing pays off most here.
| # | Procedure | Typical low | Typical high | Potential saving |
|---|---|---|---|---|
| 1 | Allergy patch testing | $16 | $546 | 97% |
| 2 | Ankle replacement | $1,084 | $35,304 | 97% |
| 3 | Sinus surgery (endoscopic) | $601 | $16,015 | 96% |
| 4 | Elbow replacement | $1,416 | $34,412 | 96% |
| 5 | Adenoid removal (adenoidectomy) | $461 | $10,953 | 96% |
| 6 | Circumcision | $247 | $5,515 | 96% |
| 7 | Hydrocele repair | $672 | $14,342 | 95% |
| 8 | Allergy testing | $8 | $163 | 95% |
| 9 | Parathyroid removal | $1,244 | $26,286 | 95% |
| 10 | Varicocele repair | $600 | $12,306 | 95% |
| 11 | Bladder tumor removal (TURBT) | $674 | $13,812 | 95% |
| 12 | Tonsillectomy | $653 | $13,273 | 95% |
| 13 | Testicle removal (orchiectomy) | $554 | $11,262 | 95% |
| 14 | Vocal cord injection | $617 | $12,460 | 95% |
| 15 | Prostate removal (prostatectomy) | $2,402 | $47,578 | 95% |
Most & least expensive states
Each state’s overall hospital price level, where 100 = the US average across the procedures hospitals publish.
Most expensive
| # | State | Price level | vs US avg |
|---|---|---|---|
| 1 | Florida | 220 | +120% |
| 2 | Alaska | 218 | +118% |
| 3 | Virginia | 187 | +87% |
| 4 | Utah | 179 | +79% |
| 5 | South Dakota | 174 | +74% |
| 6 | California | 166 | +66% |
| 7 | Delaware | 159 | +59% |
| 8 | Texas | 150 | +50% |
Least expensive
| # | State | Price level | vs US avg |
|---|---|---|---|
| 1 | Puerto Rico | 26 | -74% |
| 2 | Mississippi | 53 | -47% |
| 3 | Maryland | 61 | -39% |
| 4 | Arkansas | 66 | -34% |
| 5 | Rhode Island | 68 | -32% |
| 6 | Alabama | 74 | -26% |
| 7 | Louisiana | 74 | -26% |
| 8 | West Virginia | 83 | -17% |
Most expensive metros
Cities whose hospitals charge the most relative to the US average (100 = US average).
| # | City | Price level | vs US avg |
|---|---|---|---|
| 1 | San Francisco, CA | 293 | +193% |
| 2 | Miami, FL | 293 | +193% |
| 3 | San Antonio, TX | 269 | +169% |
| 4 | Fort Worth, TX | 257 | +157% |
| 5 | Plano, TX | 223 | +123% |
| 6 | Nashville, TN | 218 | +118% |
| 7 | Orange, CA | 217 | +117% |
| 8 | Worcester, MA | 214 | +114% |
| 9 | Philadelphia, PA | 213 | +113% |
| 10 | Long Beach, CA | 210 | +110% |
| 11 | Sacramento, CA | 188 | +88% |
| 12 | Dallas, TX | 178 | +78% |
Method: figures are medians of the cash/self-pay prices hospitals publish in their machine-readable files (45 CFR §180); the Medicare benchmark is the CMS fee schedule for the same service. A state/metro “price level” is the average of each hospital’s price relative to the national average (100 = US average), for hospitals publishing at least 5 procedures. National rankings use procedures published by at least 50 hospitals. Estimates only — confirm with the hospital. See our methodology and data sources.