Medicare Q&ASeptember 17, 2026·8 min read·By Jacob Posner, Founder & Editor
Does Medicare Have a Price Lookup Tool for Procedures? (2026)
Short answer: Yes. A free tool compares 2026 outpatient costs by site of care.
Full answer: Yes. Medicare.gov runs a free Procedure Price Lookup tool that lets people with Original Medicare compare the national average 2026 out-of-pocket cost of roughly 3,900 outpatient procedures at a hospital outpatient department versus an ambulatory surgical center. The tool shows the Medicare-approved amount and the average copayment a beneficiary without Medigap would pay, but it does not include anesthesia, physician fees, or your specific hospital's negotiated price. It only applies to Original Medicare, not Medicare Advantage, and it is separate from CMS's Physician Fee Schedule Look-up Tool and the hospital price transparency files every hospital must post under 2026 federal rules.
Choosing where to have an outpatient procedure, a hospital or a freestanding surgical center, can change what you pay out of pocket under Original Medicare. Since 2018, Medicare.gov has published a free Procedure Price Lookup tool built to make that cost difference visible before you schedule anything.
CoveredUSA's breakdown below covers what the Medicare Procedure Price Lookup tool actually shows in 2026, what it leaves out, whether it works if you have Medicare Advantage, and where to find pricing information the tool does not cover. For a deeper look at a specific procedure's Medicare coverage, see does Medicare cover cataract surgery, and use the Medical Bill Analyzer if you already have a bill in hand and want to check it against Medicare's approved rates.
Coverage Breakdown
Coverage by type
Price Tool
Works for Original Medicare
Works for Medicare Advantage
What It Shows (2026)
Medicare Procedure Price Lookup
Yes
No
National average cost at a hospital outpatient department vs. an ambulatory surgical center for about 3,900 procedures
CMS Physician Fee Schedule (PFS) Look-up Tool
Yes
Reference only
Medicare-approved amount for a specific CPT or HCPCS billing code by geographic locality
Hospital price transparency files
Yes
Yes
Each hospital's full standard charges, including payer-specific negotiated rates, in a machine-readable file
Private cost-estimator tools (FAIR Health Consumer, Healthcare Bluebook)
Yes
Yes
ZIP-code-level estimated costs across a broader range of procedures than the government tools
CMS updates the Procedure Price Lookup and Physician Fee Schedule data annually. Hospital price transparency files must be refreshed at least once a year under the CY 2026 OPPS/ASC Final Rule. None of these tools guarantee your final bill; always confirm your specific price with the facility's billing office before a scheduled procedure.
Yes. Medicare.gov runs a free Procedure Price Lookup tool that compares 2026 national average out-of-pocket costs for about 3,900 outpatient procedures at a hospital outpatient department versus an ambulatory surgical center. It works for Original Medicare only, not Medicare Advantage, and excludes anesthesia and physician fees. It is separate from CMS's Physician Fee Schedule Look-up Tool and hospital price transparency files.
How the Medicare Procedure Price Lookup Tool Works
Medicare's Procedure Price Lookup tool covers roughly 3,900 common outpatient procedures in 2026, from cataract surgery to colonoscopies to joint injections. For each procedure, the tool shows two numbers: the national average total amount Medicare pays the facility, and the national average copayment a beneficiary with no supplemental (Medigap) coverage would owe under Original Medicare's standard 20% Medicare Part B coinsurance. CMS updates the underlying pricing data every year, so the 2026 figures reflect the current Medicare Part B deductible of $283 and the standard Part B premium of $202.90 a month. Unlike Medicare Part A hospital inpatient stays, every procedure in the tool is billed under Part B as an outpatient service.
The tool exists specifically to compare two sites of service: a hospital outpatient department (HOPD) and an ambulatory surgical center (ASC). CMS pays these two settings under separate payment systems, so the same procedure, a knee arthroscopy or a cataract removal, can carry a different national average copayment depending on where it happens. That gap is the entire point of the tool: it lets you weigh a lower-cost ASC against a hospital setting before you schedule.
What the Tool Does Not Show
The Procedure Price Lookup tool has real limits, and knowing them prevents surprises. It shows national averages only, not the price at your specific hospital or surgical center, and it does not adjust for Medigap, Medicare Advantage, or Medicaid dual-eligible cost sharing. A Brookings Institution review found that for nearly 90% of the roughly 3,900 procedures in the tool, the 2026 average copayment gap between an HOPD and an ASC is under $500, so the tool is more useful for a handful of higher-cost procedures than for routine visits.
Anesthesia charges
The surgeon's or anesthesiologist's separate professional fee
Lab, pathology, and imaging charges billed separately
Your specific hospital's or ASC's actual negotiated price
Medicare Advantage, Medigap, or Medicaid cost-sharing adjustments
Does It Work If You Have Medicare Advantage?
No. The Procedure Price Lookup tool only reflects Original Medicare's fee-for-service payment rates and standard 20% Part B coinsurance. Medicare Advantage plans negotiate their own rates with in-network hospitals and ambulatory surgical centers, and cost sharing (copays, coinsurance, and out-of-pocket maximums) varies by plan. If you have a Medicare Advantage plan in 2026, call the member services number on your plan card or check your plan's own cost-estimator tool for an accurate quote, since Medicare's national averages will not match your plan's actual copay.
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The Procedure Price Lookup tool is not the only government price resource. CMS's Physician Fee Schedule (PFS) Look-up Tool shows the Medicare-approved amount for a specific CPT or HCPCS code by geographic locality, information mainly used by providers and billing staff but open to the public. Separately, every U.S. hospital must post a machine-readable file of its standard charges under the federal Hospital Price Transparency rule. A revised CY 2026 OPPS/ASC Final Rule tightened those requirements starting January 1, 2026, with CMS delaying enforcement to April 1, 2026, requiring hospitals to use a Type 2 National Provider Identifier and a signed attestation naming the person who verified the data, a response to Executive Order 14221's February 2025 directive for more standardized, comparable pricing.
Private tools fill in gaps that the government sites leave open. FAIR Health Consumer and Healthcare Bluebook both let you search by ZIP code for estimated costs across a broader range of procedures, and they work whether you have Original Medicare, Medicare Advantage, or private insurance, though their estimates are not guarantees. For Medicare Part D prescription drug prices specifically, the Medicare Plan Finder at medicare.gov is the correct tool, not the Procedure Price Lookup tool, which covers outpatient procedures only.
How to Use the Medicare Procedure Price Lookup Tool
Using the tool takes about two minutes if you already know the name of your procedure.
Step 1: Go to medicare.gov/procedure-price-lookup and type the procedure name or its billing code into the search box.
Step 2: Select the exact procedure from the list of matches that appears as you type.
Step 3: Compare the national average total cost and copayment shown for a hospital outpatient department against an ambulatory surgical center.
Step 4: Note the 2026 Part B deductible ($283) and 20% coinsurance already built into the copayment estimate.
Step 5: Call the facility's billing office to confirm your specific price before scheduling, since the tool shows national averages, not local prices.
Cost Context: What the Numbers Actually Mean
The dollar figures in the tool connect directly to Original Medicare's standard cost-sharing rules. In 2026, Part B carries a $283 annual deductible and a $202.90 standard monthly premium, and once you meet the deductible, Original Medicare pays 80% of the Medicare-approved amount for most outpatient procedures while you pay the remaining 20% coinsurance shown in the tool. If you carry a Medigap policy, it typically covers some or all of that 20% share, which is why the tool's copay estimate (built for someone without Medigap) usually runs higher than what a Medigap policyholder actually pays.
Frequently Asked Questions
What is the Medicare Procedure Price Lookup tool?
It is a free tool at medicare.gov/procedure-price-lookup that shows the 2026 national average total cost and copayment for about 3,900 outpatient procedures, comparing a hospital outpatient department against an ambulatory surgical center. It only reflects Original Medicare's fee-for-service payment rates, and CMS has updated it annually since it launched in 2018.
Does the Medicare Procedure Price Lookup tool work for Medicare Advantage plans?
No. It only shows Original Medicare's standard 20% Part B coinsurance and national average payment rates. Medicare Advantage plans set their own negotiated rates and cost sharing, so the tool's figures will not match your Medicare Advantage copay. Call your plan's member services line or use your plan's own cost-estimator tool instead.
What does the tool not include?
The tool leaves out anesthesia charges, the surgeon's or anesthesiologist's separate professional fee, lab and imaging charges billed separately, and your specific hospital's actual negotiated price, since it only shows 2026 national averages. It also does not adjust for Medigap, Medicare Advantage, or Medicaid cost sharing.
How is my out-of-pocket cost calculated in the tool?
The copayment shown assumes you have already met the 2026 Part B deductible of $283 and reflects Original Medicare's standard 20% coinsurance, calculated for a beneficiary with no Medigap coverage. If you have Medigap, your actual cost is usually lower because Medigap typically covers some or all of that 20% share.
What's the difference between the Procedure Price Lookup tool and the Physician Fee Schedule Look-up Tool?
The Procedure Price Lookup tool compares patient costs for about 3,900 outpatient procedures at a hospital outpatient department versus an ambulatory surgical center. CMS's separate Physician Fee Schedule (PFS) Look-up Tool shows the Medicare-approved payment amount for a specific CPT or HCPCS billing code by geographic locality, and it is used mainly by providers and billing staff.
Do hospitals have to post their own prices too?
Yes. Under the federal Hospital Price Transparency rule, every U.S. hospital must publish a machine-readable file of its standard charges, including payer-specific negotiated rates. A revised CY 2026 OPPS/ASC Final Rule tightened those requirements starting January 1, 2026, with CMS enforcement beginning April 1, 2026, including a required Type 2 National Provider Identifier and a signed attestation.
Are there other price-lookup tools besides Medicare's?
Yes. FAIR Health Consumer and Healthcare Bluebook let you search by ZIP code for estimated costs across a broader range of procedures than the Medicare tool covers, and they work for Original Medicare, Medicare Advantage, and private insurance alike, though their figures are estimates, not guarantees of your final bill.
Is the price shown in the tool exactly what I will pay?
No. The tool shows 2026 national averages, not your local hospital's or ASC's actual price. A Brookings Institution review found that for nearly 90% of the roughly 3,900 procedures covered, the average copayment gap between the two settings is under $500, so always confirm your specific price with the facility's billing office.
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3. CMS: Hospital Price Transparency — CMS hub for the federal Hospital Price Transparency rule, including the CY 2026 OPPS/ASC Final Rule requirements taking effect in 2026.
