Medical Procedure Costs in Massachusetts
Massachusetts Medicare physician rates are generally above the national average (+7.8%). CMS uses 2 localities here, so a ZIP matters.
Look up any CPT in Massachusetts
Featured table below is 59 procedures. Search covers 7,500+ fee-schedule codes.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. These Massachusetts averages are unweighted means of the state’s localities, not population-weighted.
How Medicare prices Massachusetts
Massachusetts is priced through two localities: metro Boston and the rest of the state. Boston's locality carries clearly higher geographic adjustments, reflecting some of the highest medical wages and office costs in the nation, while Worcester, Springfield, and the Cape share the lower rest-of-state factors. The split means the fee schedule itself acknowledges what everyone in the state already knows about Boston prices. Even so, rest-of-state Massachusetts still prices above most of the country.
Boston has arguably the densest concentration of academic medical centers anywhere, and its teaching hospitals pull referrals from all of New England and beyond. That prestige comes with a high-cost market structure that state policymakers have scrutinized for years. Western Massachusetts operates more like a regional market centered on Springfield, and Cape and islands residents contend with seasonal capacity strain.
Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
Massachusetts payment localities (GPCI)
| Locality | Work | PE |
|---|---|---|
| metropolitan boston | 1.041 | 1.194 |
| rest of massachusetts | 1.016 | 1.053 |
GPCI of 1.000 equals the national average. Higher PE GPCI raises office-based procedures more than hospital physician lines.
Featured physician rates in Massachusetts
Office (non-facility) physician rates. Open a row for the locality table and ZIP tool.
Other states
Medical costs in Massachusetts: questions
Across the 59 featured procedures on this page, Massachusetts sits above the national average by about 8%. Examples: incision & drainage of abscess $139, skin biopsy (tangential) $105, skin biopsy (punch) $133. Search any other CPT in the box above — those codes are in the tool, not as extra Massachusetts articles.
Massachusetts has 2 payment localities. Practice-expense GPCI runs from 1.053 to 1.194 (1.000 is the national average). Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
Medicare physician allowed amounts only — the professional fee after GPCI. They do not include hospital facility charges, anesthesia, or your plan’s contracted rate. Medicare patients typically owe 20% of the allowed amount after the Part B deductible, before Medigap.
Yes. The table is the featured set (59 procedures). The search box looks up 7,500+ payable codes from the 2026 fee schedule and applies Massachusetts’s locality when you enter a ZIP.