Medical Procedure Costs in New York
New York Medicare physician rates are generally above the national average (+10.1%). CMS uses 5 localities here, so a ZIP matters.
Look up any CPT in New York
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 New York averages are unweighted means of the state’s localities, not population-weighted.
How Medicare prices New York
New York has one of the most complex locality maps in the country, with around five payment areas: Manhattan is its own locality, Queens is separately priced, the NYC suburbs and Long Island form another high-cost locality, the Poughkeepsie area has its own, and the rest of the state, including Buffalo, Rochester, Syracuse, and Albany, shares a distinctly lower-priced upstate locality. The spread between Manhattan and upstate adjustments is among the widest within any state. A knee MRI or office visit is approved at meaningfully different amounts in Manhattan, Mineola, and Rochester. Upstate New York prices closer to the Midwest than to the five boroughs.
New York City is a global medical capital with world-famous academic medical centers competing within blocks of each other, while upstate cities each center on their own regional academic hubs. Long Island and the lower Hudson Valley support dense suburban hospital markets of their own. The upstate-downstate divide runs through everything in New York health care, including what providers charge and what patients can access locally.
New York's multiple localities make a ZIP-level check essential: compare Manhattan, Queens and the outer boroughs, Long Island, the Hudson Valley near Poughkeepsie, and upstate cities like Buffalo, Rochester, Syracuse, and Albany.
New York payment localities (GPCI)
| Locality | Work | PE |
|---|---|---|
| manhattan | 1.064 | 1.162 |
| nyc suburbs/long island | 1.064 | 1.189 |
| poughkpsie/n nyc suburbs | 1.045 | 1.095 |
| queens | 1.064 | 1.182 |
| rest of new york | 1.000 | 0.950 |
GPCI of 1.000 equals the national average. Higher PE GPCI raises office-based procedures more than hospital physician lines.
Featured physician rates in New York
Office (non-facility) physician rates. Open a row for the locality table and ZIP tool.
Other states
Medical costs in New York: questions
Across the 59 featured procedures on this page, New York sits above the national average by about 10%. Examples: incision & drainage of abscess $142, skin biopsy (tangential) $106, skin biopsy (punch) $134. Search any other CPT in the box above — those codes are in the tool, not as extra New York articles.
New York has 5 payment localities. Practice-expense GPCI runs from 0.950 to 1.189 (1.000 is the national average). New York's multiple localities make a ZIP-level check essential: compare Manhattan, Queens and the outer boroughs, Long Island, the Hudson Valley near Poughkeepsie, and upstate cities like Buffalo, Rochester, Syracuse, and Albany.
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 New York’s locality when you enter a ZIP.