What an estimate on this site is
An estimate here is a range of what someone paying out of pocket is likely to be charged in a given area: a low figure (what the less expensive providers or public programs charge), a typical figure (the middle of the market) and a high figure (expensive providers, before negotiation). It is not a quote, and it is not what any particular provider will charge you. Our medical cost disclaimer explains the limits.
Medical services: the Medicare rate comes first
For doctor visits, imaging, emergency care, therapy and lab tests we start from what Medicare pays, because Medicare's fee schedules are the only complete, public and area-adjusted price list for U.S. medical services. CMS publishes the 2027 Physician Fee Schedule (PFS) with relative value units (RVUs) for every service and geographic practice cost indexes (GPCIs) for each of 109 payment localities.[1][2]
Medicare amount = (work RVU × work GPCI + practice-expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factorConversion factor for 2027: $32.6286. CY 2027 has two conversion factors; we use the general one ($32.6286) rather than the slightly higher rate for clinicians in qualifying alternative payment models ($32.9548). The work-GPCI floor of 1.0 expired, so rural work GPCIs fall below 1.0 in 2027.
Worked example. A lumbar spine MRI without contrast (72148) has 1.44 work RVUs, 4.25 non-facility practice-expense RVUs and 0.11 malpractice RVUs. At the national average (all GPCIs 1.0) Medicare pays (1.44 + 4.25 + 0.11) × $32.6286 = $189.25 to an independent imaging center. In Manhattan the GPCIs are 1.064, 1.158 and 1.517, so the same scan pays $216.02.
- Office vs hospital. When a service is done in a hospital outpatient department, the doctor is paid the lower facility rate and the hospital is paid separately under the Outpatient Prospective Payment System (OPPS).[4] For the MRI above, the hospital's APC 5523 payment plus the radiologist's reading fee comes to about $335 nationally.
- Hospital wage index. CMS adjusts 60% of an OPPS payment by the hospital's wage index. We do not ship the full wage-index file; we approximate it with the locality's practice-expense GPCI, which is built largely from the same local wage data.
- Lab tests use the Clinical Laboratory Fee Schedule national limit amounts, which are not adjusted by area.[5]
- Emergency visits add the hospital's emergency department APC (levels 1–5) to the emergency physician's fee for the matching visit level.
From the Medicare rate to a self-pay range
Self-pay prices sit above Medicare, but by how much depends on the setting. We use the multipliers below. Each one comes from studies of hospital price-transparency files, insurance claims and published cash prices; the "why" column names the evidence.
| Setting | Low | Typical | High | Evidence |
|---|---|---|---|---|
| doctor's office and urgent care services | 1.0 | 1.5 | 2.5 | Commercial insurers pay about 117% of Medicare for office visits and 124–143% for physician services overall[11][12]; hospital-posted cash prices for new-patient visits ran about 1.5–1.8× Medicare[6], and urgent care visits averaged $220 in employer claims in 2022[10]. |
| imaging at an independent center or doctor's office | 1.2 | 2.0 | 3.0 | Hospital outpatient imaging costs 2–4× what the same scan costs in a physician office or independent center[9]; office imaging prices in those claims sit roughly 2× the Medicare global fee. |
| MRI and CT in a hospital outpatient department | 2.8 | 4.7 | 7.1 | Median hospital cash prices for MRI and CT (e.g., lumbar MRI $1,625, IQR $968–$2,431) are about 4.7× the 2027 Medicare hospital amount, with an interquartile range of about 2.8–7.1×[6]; cash prices track commercial negotiated rates (median ratio 1.03)[7]. |
| ultrasound in a hospital outpatient department | 2.2 | 3.6 | 5.5 | The median hospital cash price for a complete abdominal ultrasound ($560) is about 3.6× the Medicare hospital amount[6]; the spread uses the MRI/CT interquartile range. |
| X-rays in a hospital outpatient department | 1.9 | 3.1 | 4.7 | The median hospital cash price for a lumbar spine X-ray series ($329) is about 3.1× the Medicare hospital amount[6], in line with commercial X-ray prices at 314% of Medicare[9]. |
| hospital emergency department visits | 1.0 | 1.8 | 3.1 | Median emergency department facility cash prices were 1.8–2.0× Medicare Advantage rates (which are capped at traditional Medicare) for level 3–5 visits in late 2022; adjusted for price growth they are about 1.6–1.9× the 2027 rates, with an interquartile range of roughly 1.0–3.1×[8]. |
| psychotherapy sessions | 0.9 | 1.3 | 2.1 | Private-practice therapists listed an average self-pay rate of $143 a session in late 2023[15], about 1.15× the 2027 Medicare rate for a 45-minute session; hospital cash prices for 45- and 60-minute sessions ran higher (medians $171 and $199)[6]. |
| lab tests | 1.5 | 4.0 | 10.0 | Hospital cash prices for routine panels run 5–10× the lab fee schedule (comprehensive metabolic panel: median $108 vs a $10.56 Medicare rate)[6]; independent and clinic labs charge much less, which sets the low end. |
Two things to keep in mind. First, hospital "gross charges" (the chargemaster) are much higher than these ranges: the average U.S. hospital charged about 3.4 times its costs in 2012, and some charged ten times[14]. Uninsured patients who do not ask for the cash price can be billed at that level, which is why the high end of a range is not a ceiling. Second, the studies behind the hospital multipliers use prices posted in 2021–2022; we compare them with 2027 Medicare rates, which assumes cash prices and Medicare have grown at broadly similar rates since then.
Dental care: ranges without a national fee database
There is no free, official national database of dental fees: the American Dental Association's fee survey is sold, not published, and Medicare does not cover routine dental care. We build each dental range from three kinds of public data and state them in 2026 dollars.
| Part of the range | Source | How we use it |
|---|---|---|
| Typical | Average and median dentist fees by procedure code: FAIR Health charge data reported by the ADA Health Policy Institute[19] and the ADA Survey of Dental Fees as quoted in peer-reviewed studies (2020 and 2022 editions)[20][21][22] | Converted to 2026 dollars with the BLS dental services price index[24] |
| Cross-check | What patients actually paid out of pocket per visit in the 2024 Medical Expenditure Panel Survey (our weighted tabulation of the public-use file)[23] | Exam-and-cleaning visits paid in full by the patient: median $188, 75th percentile $254; molar root canal and implant visits agree with the code-level fees |
| Low and high | The 10th–25th and 75th–90th percentile range of the same evidence | Low ≈ low-fee offices; high ≈ specialists and expensive metros |
| Codes without a direct fee study | VA Reasonable Charges v5.26 (2026): the 80th-percentile nationwide charge for every CDT code, built on FAIR Health dental data[17] | Low, typical and high = VA charge × 0.519 / 0.824 / 1.158, the median ratio of our independently sourced bands to the VA charge across 15 codes |
| Dental school price | University of Maryland School of Dentistry student-clinic fee schedule, revised August 2025[18] | Shown as a separate "dental school" figure, not mixed into the range |
| Public-payer floor | State Medicaid fee schedules: Medicaid pays about 39% of average dentist charges nationally[25] | A reference for how low a fee can go, not a price an uninsured patient is offered |
For codes with no published fee study (amalgam fillings, all-ceramic and gold crowns, buildups, 3D scans, dentures, full-arch implant bridges, sedation and some exams and X-rays) we use the VA's 2026 schedule of reasonable dental charges, a federal table of the 80th-percentile U.S. charge for each procedure code built on FAIR Health dental data.[17] Across the 15 codes where we have an independent fee source, our low, typical and high fees sit at a steady 0.519, 0.824, 1.158 times the VA charge, so we apply those ratios to the rest. Two benchmarks keep the results honest: insurers typically pay about 72% of dentists' list prices[26], and public contracts such as Washington State's 2026 denture schedule (about $1,320 per complete denture) mark the floor[29].
Orthodontic typical fees start from the median comprehensive treatment fee in the 2021 Journal of Clinical Orthodontics practice study ($5,750 for children, $6,200 for adults)[27], brought to 2026 dollars; low and high use the VA charge for comprehensive treatment (D8080, D8090) and the same ratios. Fee schedules bill braces and aligners under the same codes, so we give no separate price by appliance type. Clear-aligner manufacturers do not publish patient prices; Align Technology's revenue per case ($1,245 in 2025) is what the dentist pays the lab, not what the patient pays[28].
Geography. Dental fees are not published by area, so we scale each national figure by the area's Medicare geographic adjustment factor (GAF), which combines local wages, office rent and insurance costs, the same inputs that drive a dental office's overhead. GAFs run from 0.889 (Arkansas) to 1.252 (Alaska).
LASIK
Medicare does not cover LASIK, and insurers rarely do[32], so there is no fee-schedule anchor. Our per-eye range combines a peer-reviewed review that puts typical U.S. pricing at about $2,000 ± $1,000 per eye[30] with industry surveys of average prices (about $2,250–$2,630 per eye)[31]. Because the published LASIK figures are national averages, we do not adjust them by area. Treat it as the least precise range on the site. No independent source publishes PRK or SMILE prices, so we show none.
Rounding and what we leave out
- Ranges are rounded to $5 under $100, $10 under $1,000, $50 under $10,000 and $100 above.
- Estimates do not include anesthesia unless the page says so, follow-up visits, complications, prescriptions, lab fees not listed, or taxes.
- Where a procedure is usually done with other services (for example a crown after a root canal), pages show the combination separately.
- A posted cash price at a specific hospital can fall outside our range. Hospitals must publish their discounted cash prices; look them up and use them when you can.[16]
How we check the numbers
- Formula tests. Automated tests recompute Medicare amounts by hand from the CMS files for sample codes and localities, and check every calculator against hand-worked examples.
- Against published cash prices. Hospital imaging and emergency ranges are calibrated to the median hospital cash prices in the studies cited; dental ranges are checked against what self-paying patients reported in MEPS 2024.
- No unsourced ranges. Where no public source prices a procedure (PRK, SMILE, separate fees for braces by appliance type), we show no dollar range and point to the nearest sourced price instead.
Data files and dates
| Data | Version | Used for |
|---|---|---|
| Physician Fee Schedule RVUs | CY 2027, RVU27A (released Nov 10, 2026) | Doctor, therapy, imaging and visit fees |
| Geographic practice cost indexes | CY 2027 final rule Addendum D (109 localities) | Area adjustment; dental geographic factor |
| OPPS APC rates | CY 2027 final rule, Addenda A and B (Nov 10, 2026) | Hospital outpatient and emergency facility fees |
| Clinical Laboratory Fee Schedule | CY 2026 Q4 (26CLABQ4); CY 2027 rates not yet final | Blood work and other lab tests |
| Dental fees | 2026 dollars (BLS dental CPI, Jan–Oct 2026 average) | Dental procedure ranges |
| HHS poverty guidelines | 2026 | Sliding-fee and coverage calculators |
We update the data when CMS publishes new fee schedules (each November, effective January 1, with quarterly corrections), when states or dental schools post new fee lists, and when new price studies are published. Corrections are welcome through the contact page.
Sources
- Medicare Program; CY 2027 Payment Policies Under the Physician Fee Schedule (CMS-1848-F)
- PFS Relative Value Files: RVU27A (PPRRVU2027_Jan), released November 10, 2026
- CY 2027 PFS final rule addenda (Addendum D: geographic practice cost indices and GAFs)
- CY 2027 OPPS/ASC final rule with comment period (CMS-1850-FC) and Addenda A and B
- Clinical Laboratory Fee Schedule, CY 2026 fourth quarter release (26CLABQ4)
- Comparison of US Hospital Cash Prices and Commercial Negotiated Prices for 70 Services (Jiang, Makary, Bai)
- The Relationships Among Cash Prices, Negotiated Rates, and Chargemaster Prices for Shoppable Hospital Services (Wang et al.)
- Payer Type and Emergency Department Visit Prices (Morey et al.)
- Imaging Services are the Second Most Common Outpatient Service (issue brief)
- Urgent Care Spending Increased by 50% over 5 Years Driven by Higher Use
- The Prices That Commercial Health Insurers and Medicare Pay for Hospitals' and Physicians' Services
- How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature
- Prices Paid to Hospitals by Private Health Plans: Findings from Round 5.1 of an Employer-Led Transparency Initiative
- Extreme Markup: The Fifty US Hospitals With The Highest Charge-To-Cost Ratios (Bai, Anderson)
- Insurance acceptance and cash pay rates for psychotherapy in the US (Zhu et al.)
- 45 CFR Part 180: Hospital price transparency (standard charges, discounted cash price, shoppable services)
- Reasonable Charges v5.26, Table I: Outpatient Dental Professional Nationwide Charges (80th percentile of charges; FAIR Health dental data and other sources)
- Fee Schedule (Clinic Manual, Patient Administration), student clinic column
- Trends in Fees and Reimbursement Rates for the Most Common Procedures in Endodontics, Periodontics, Prosthodontics, and Oral Surgery
- Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment (fees from the 2020 ADA Survey of Dental Fees)
- Cost-effectiveness of tooth preservation versus implant for persistent periapical pathosis (fees from the 2022 ADA Survey of Dental Fees)
- Oral Health Impact and Cost-Effectiveness of Resealing First Permanent Molars (2022 ADA fee survey in 2024 dollars)
- MEPS HC-254B: 2024 Dental Visits public-use file
- Consumer Price Index, dental services, U.S. city average (series CUUR0000SEMC02)
- Dental Care in Medicaid Programs (with data tables)
- Pricing in commercial dental insurance and provider markets (Nasseh, Bowblis, Vujicic)
- Practice profiles of orthodontists in Taiwan (cites the 2021 JCO Orthodontic Practice Study median U.S. fees)
- Align Technology, Inc. Form 10-K for fiscal year 2025
- DOC Denture Services Fee Schedule, effective January 1, 2026
- The 25th Anniversary of Laser Vision Correction in the United States (Joffe)
- How Much Does LASIK Cost? (industry-funded council)
- When is LASIK not for me?