Enter your procedure and hospital. We'll show you exactly what Medicare pays — and how much more your hospital charged.
Uses CMS Medicare billing codes (APC/DRG), 2022. Now supports common names — try "colonoscopy," "cataract surgery," "gallbladder," or "heart bypass." Markup = hospital's avg submitted charge ÷ avg Medicare allowed amount.
Search your procedure in the Bill Check tool above. Enter your hospital name and the procedure (by name or CPT code). The tool compares the hospital's average submitted charge against the Medicare allowed amount for the same procedure. A markup ratio above 5× is worth investigating; above 10× is uncommon and may warrant a formal dispute.
The Medicare allowed amount is what CMS determines is a reasonable total payment for a service — including both Medicare's payment and the patient's cost-sharing portion (deductible/copay). It is set by CMS's fee schedule and is commonly used as a benchmark for "fair market" pricing of medical procedures.
Hospitals set a "chargemaster" — an internal price list — that is used as the starting point for negotiations with insurance companies. Inflated chargemaster prices give hospitals more leverage in those negotiations. The unintended consequence is that uninsured patients, who have no negotiated rate, are billed at or near these inflated chargemaster prices.
Yes. Ask the hospital billing department for their financial assistance policy (required under IRS 501(r) for nonprofits). Reference the Medicare rate in your negotiation. Many hospitals accept 20–40 cents on the dollar for uninsured patients who ask. Use AccountableHub's Dispute Letter Generator to create a formal dispute referencing the markup data.
AccountableHub's database covers procedures reported to CMS Medicare under the outpatient and inpatient hospital PPS (Prospective Payment System). Some procedures performed only in physician offices, ambulatory surgery centers, or by specialty providers may not appear. Try searching by the CPT code from your Explanation of Benefits (EOB), or a closely related procedure name.