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Paying for treatment in the US: how each route pays

Treatment in the US is paid for through Original Medicare, Medicaid, employer or Marketplace insurance, or by paying the provider yourself. This section sets out what each route covers and what it pays or charges, treatment by treatment, using only what federal agencies and providers publish. Each figure carries its source and the date it was read. Where a route publishes nothing, or this site has not read it, the page says so rather than estimating.

The four routes

Original Medicare

Medicare pays a set amount for each billing code under its national fee schedules. Treatment pages show what Medicare pays per code. This is what Medicare pays under its national fee schedule, before geographic adjustment. It is not a price charged to patients or to anyone without Medicare.

After the Part B deductible, the patient usually pays 20% of the Medicare-approved amount for each covered service, where the provider accepts that amount as full payment.

The Part B deductible is $283 for calendar year 2026.

Source: Medicare.gov: Medicare costs, In force (statutory share; not set annually), read 26 October 2026.

Source: CMS: 2026 Medicare Parts A & B Premiums and Deductibles, Calendar year 2026, read 26 October 2026.

Source: CMS Physician Fee Schedule relative value file RVU26D, 2026 national amounts, read 26 October 2026.

Hospital outpatient rates are not shown: CMS publishes them behind a licence agreement that this site has not accepted (checked 26 October 2026). For choosing a plan within Medicare, see Medicare.gov.

Medicaid

Each state runs its own Medicaid program within federal rules, so coverage and cost-sharing differ by state. The only state-by-state Medicaid rules read so far are for fertility treatment, compiled by KFF as of January 2020 and shown on the state insurance pages. For other treatments, the pages say Medicaid rules are not tracked.

Source: KFF: Coverage and Use of Fertility Services in the U.S., Appendix 2 (State Medicaid Coverage of Infertility Services), as of January 2020, read 26 October 2026.

Employer or Marketplace insurance

Described here as a mechanism only. TreatCompare does not name, compare, rank or price any insurer, plan or premium.

For plan year 2026, a Marketplace plan's out-of-pocket limit for an individual is no more than $10,600. A Marketplace plan’s out-of-pocket limit for an individual is capped by federal rule; it excludes premiums, uncovered services and out-of-network care.

71% of covered workers are in self-funded employer plans (KFF Employer Health Benefits Survey 2026). Most workers with employer coverage are enrolled in self-funded plans, where the employer pays for enrollees’ health services from its own funds rather than buying health insurance.

Source: HealthCare.gov glossary: out-of-pocket maximum/limit, Plan year 2026, read 26 October 2026.

Source: KFF: 2026 Employer Health Benefits Survey, KFF Employer Health Benefits Survey 2026, read 26 October 2026.

Self-pay

Self-pay prices come from hospitals' own standard-charge files and from fertility clinics' own fee pages. Treatment pages read hospital files one billing code at a time, and never pool a cash price with a negotiated rate. Each hospital's file is linked with the date it was read. Providers and facilities must give uninsured and self-pay patients a Good Faith Estimate of expected charges when a service is scheduled or on request.

103 of 145 hospitals in the file register have a readable price in their standard-charge file, in 28 of 51 states.

13 of 452 fertility clinics publish a readable base IVF cycle fee.

Source: eCFR: 45 CFR 149.610, In force (45 CFR 149.610, text as of 2026-10-01), read 26 October 2026.

Source: CDC: Assisted Reproductive Technology clinic summary (2022 reporting year), 2022 reporting year, read 24 October 2026.

Treatments, A to Z

Each page sets the four routes side by side for one treatment.

  • Cataract surgery

    Removal of the clouded lens and insertion of an intraocular lens.

  • Colonoscopy

    Examination of the bowel with a flexible camera, diagnostic or screening.

  • CT scan

    Computed tomography of the head, chest, spine or abdomen.

  • IVF

    A stimulated IVF cycle at a fertility clinic.

  • Mammogram

    Screening or diagnostic breast imaging, including tomosynthesis.

  • MRI scan

    Magnetic resonance imaging of the brain, spine, joints or abdomen.

  • Ultrasound

    Abdominal, pelvic, transvaginal or retroperitoneal ultrasound.

  • Upper endoscopy

    Examination of the esophagus, stomach and duodenum (EGD).

What is not shown, and why

  • Waiting times: no official US source publishes waiting times for elective care.
  • Medicare hospital outpatient rates: published by CMS behind a licence agreement this site has not accepted.
  • The patient's share under Medicare: it depends on the deductible already paid, the setting and any separate facility charge, so it is not calculated.
  • Insurer-by-insurer negotiated rates: hospital files name the payer beside each rate. Pages show the spread of negotiated rates with no payer or plan named.
  • Premiums, and any comparison of insurers or plans.

Sources