How Medicare Data Reveals What Healthcare Should Actually Cost

Every year, the Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Physician Fee Schedule — a detailed breakdown of what Medicare pays for every medical procedure in America. This data is public, but it's buried in spreadsheets that most patients will never see.

TrueCost makes this data accessible. Here's how our pricing calculator works.

Every procedure has a CPT code and three components of value: Work RVUs (the physician's time and skill), Practice Expense RVUs (overhead like equipment, staff, and supplies), and Malpractice RVUs (liability insurance). These Relative Value Units are the building blocks of Medicare pricing.

But costs aren't the same everywhere. A procedure in San Francisco costs more to deliver than the same procedure in rural Alabama. CMS accounts for this with Geographic Practice Cost Indexes (GPCIs) — multipliers that adjust each RVU component for your specific area.

The formula: (Work RVU × Work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × Conversion Factor = Medicare Payment.

For 2026, the conversion factor is $33.40. This gives us the Medicare rate — what the government considers a fair payment for the procedure in your area.

Our fair cash price applies a 140% multiplier to the Medicare rate. Why 140%? Because cash-pay patients eliminate the 15-25% billing overhead that comes with insurance claims — no prior authorizations, no claim denials, no collections. Providers can profitably accept 140% of Medicare while patients pay far less than the typical hospital chargemaster price.

This is the number you bring to the negotiation. And it works.