Comparison
CMS pricer comparison: Medicare and Medicaid pricing tools, 2026
Twenty-four capabilities that payer reimbursement, contracting, coding and payment-integrity teams ask for, checked across eight widely used tools, including the ones where cmswebpricer.com is weaker. One point per capability a tool offers, half a point when partly offered.
Capability by capability
- offered
- partly or paid add-on
- not advertised in public materials
| Capability | cmswebpricer.com | CMSPricer (Micro-Dyn) | Turquoise Health | Optum RevenueCyclePro.com (Facility Encoder) | Find-A-Code | Codify by AAPC | CMS Web Pricer | MD Clarity |
|---|---|---|---|---|---|---|---|---|
| Free to use, no sign-upprice without creating an account | — | — | — | — | ||||
| Inpatient IPPS pricing by hospitalany CCN, every payment step | — | |||||||
| Medicare payment systems pricedY = 10 or more; P = 1 to 9 | 11: IPPS, OPPS, ASC, physician, SNF, home health, and LTCH, IRF, IPF, hospice and ESRD | 20+ listed | 8 stated | 2: MS-DRG, APC | 3: DRG, APC, ASC | IPPS | 8 | — |
| As-of pricing by date of serviceY = 3 or more rate years; P = fewer, or older years separately | IPPS FY2023–FY2027, SNF FY2025–FY2027; professional by date of service | — | — | code detail by discharge date | — | — | older years in the PC Pricer archive | — |
| Step-by-step payment buildbase, IME, DSH, capital, outlier, quality | — | — | — | |||||
| Medicare Advantage out-of-network figurenext to Original Medicare | — | — | — | — | — | — | — | |
| Matched to the CMS Web Pricerside-by-side check on demand | — | — | — | — | — | — | ||
| Outpatient APC and ASC side by sidesite-of-service difference | — | — | ||||||
| Outpatient claim editsNCCI pairs, MUE units, packaging | — | — | ||||||
| Coverage editsLCD, NCD, MCE, medical necessity | — | LCD, NCD, ABN; MCE | — | MCE, medical necessity | — | — | — | — |
| MS-DRG grouping from ICD-10 codeswith the grouping path | — | — | — | |||||
| Group and price in one stepcodes to payment at a hospital | — | — | — | |||||
| CDI documentation-gap reviewnote evidence, compliant query text | — | — | — | — | — | — | — | |
| State Medicaid APR-DRG by hospitalNY, TX, CO, VA and WA, all four severity levels; Maryland at HSCRC rates, separately | — | — | — | — | — | — | — | |
| Claim file import837I, FHIR, XML, UB-04 PDF | — | — | — | — | ||||
| Billed vs regrouped DRG validationaudit-ready verdict | — | — | — | — | — | — | — | |
| Batch repricingCSV in, priced claims out | — | — | — | — | ||||
| Bulk volume per runY = 10,000 or more claims stated; P = lower or unpublished limit | 10 rows free, 200 with an API key, 1,000 top tier | volume tiers, limits not published | 10,000 claims a month free | — | — | — | — | 837 and 835 files, limit not published |
| sFTP or claim-system integrationfiles or connectors, not only a browser | —API and upload only | sFTP; core claims systems | — | — | — | — | — | practice management connectors, flat files |
| Contract scenario modelingpercent of Medicare, case rate, per diem | — | — | — | — | ||||
| Hospital payment factorswage index, teaching, case mix, FY2027 impact | — | — | — | — | ||||
| Shareable links and pricing memosreproduce any result | — | — | — | — | — | |||
| Developer APIsame engine over HTTPS | — | — | — | — | — | |||
| BAA availablebusiness associate agreement for patient data | —no; terms say not to upload patient data | — | — | — | — | — | — | — |
| Coverage score | 20.5 | 12 | 8.5 | 6.5 | 5.5 | 5 | 5 | 5 |
A dash means we could not find the capability in the product’s public website, help center or brochures when we checked them in October 2026; each is from the sources below. Report a wrong cell and we will check it and correct it.
Where each tool is strongest
- cmswebpricer.com — 20.5 of 24 (Independent workbench): Medicare Advantage out-of-network figure, state Medicaid APR-DRG by hospital, CDI review, billed vs regrouped validation and an on-demand check against the CMS Web Pricer, free with no sign-up. Weaker on payment-system breadth beyond its 11, rate years, volume, coverage edits and procurement (no sFTP, no BAA).
- CMSPricer (Micro-Dyn) — 12 of 24 (Commercial pricer and claim editor): the widest list of Medicare payment systems (20+), LCD, NCD and ABN coverage edits, sFTP and core claims-system integration.
- Turquoise Health — 8.5 of 24 (Price transparency): 10,000 claims a month free after sign-up, NCCI, MUE, 340B and multi-procedure edits, contract scenarios.
- Optum RevenueCyclePro.com (Facility Encoder) — 6.5 of 24 (Facility encoder): hospital-specific MS-DRG and APC grouping and pricing with MCE, OCE and medical-necessity edits.
- Find-A-Code — 5.5 of 24 (Coding reference): DRG, APC and ASC payment calculators on a subscription, code edits.
- Codify by AAPC — 5 of 24 (Coding reference): MS-DRG grouper with hospital pricing on a paid plan, NCCI edit checker.
- CMS Web Pricer — 5 of 24 (Official CMS pricers): the official free estimators for eight payment systems, including IRF, IPF, LTCH, hospice and ESRD.
- MD Clarity — 5 of 24 (Contract management): underpayment detection from 837 and 835 files, practice management connectors, contract modeling.
Where others lead
CMSPricer prices far more Medicare payment systems than cmswebpricer.com: its solutions page lists IPPS, OPPS, ASC, ESRD, SNF, IRF, IPF, LTCH, hospice, home health, physician, DME, lab, ambulance and more, with LCD and NCD coverage edits, and it supports sFTP workflows and core claims systems. Turquoise Health lets a signed-up user price 10,000 claims a month for free by file upload; cmswebpricer.com caps a run at 10 rows free, 200 with an API key and 1,000 on the top tier. cmswebpricer.com prices inpatient claims at FY2023 to FY2027 rates, by discharge date. Optum RevenueCyclePro.com adds MCE, OCE and medical-necessity edits to its grouping and pricing; Optum EncoderPro.com, its coding reference, is a separate product. Not in the matrix because we did not check every row against its materials: Milliman Medicare Repricer lists IPPS, OPPS and APC, ASC, SNF, physician RBRVS, DME-POS, clinical lab, ambulance, ASP and PEN fee schedules with percent-of-Medicare comparisons, and Milliman describes bulk repricing with historical pricing factors "as of" a previous date.
cmswebpricer.com does not offer a business associate agreement; its terms ask users not to upload patient data.
The tools at a glance
cmswebpricer.com is an independent Medicare and Medicaid pricing workbench: inpatient IPPS pricing by hospital with every payment step, Original Medicare and Medicare Advantage out-of-network totals, hospital outpatient vs ASC rates, an MS-DRG grouper with CDI assist, New York, Texas, Colorado, Virginia and Washington Medicaid APR-DRG pricing (Maryland hospital claims at HSCRC rates, separately), 837I and FHIR claim import with DRG validation, batch repricing, contract modeling and a check against the CMS Web Pricer. It also prices LTCH, IRF, IPF, hospice and ESRD claims on its post-acute pricer. Inpatient rates cover FY2023 to FY2027; it does not apply LCD or NCD coverage edits, or offer sFTP or a BAA.
CMS Web Pricers are CMS's own free estimators for eight Medicare payment systems (IPPS, IPF, IRF, LTCH, SNF, home health, hospice and ESRD). The IPPS pricer prices a claim from a DRG and provider number; there is no outpatient or ASC web pricer, and it does not group codes, model contracts or price Medicaid or Medicare Advantage.
CMSPricer, now part of Micro-Dyn, is a paid claim grouping, editing and pricing service with 837 and CSV import, batch pricing, a contract rate manager and a REST API. Codify by AAPC and Find-A-Code are coding references whose paid plans add an MS-DRG grouper with hospital-specific pricing and code edits. Optum RevenueCyclePro.com (Facility Encoder) adds hospital-specific MS-DRG and APC grouping and pricing with MCE, OCE and medical-necessity edits; it is an add-on to Optum's encoder, and EncoderPro.com is Optum's coding reference. Turquoise Health offers a free Medicare pricer (account required, 10,000 claims a month) and payer contract modeling, and MD Clarity focuses on contract management and underpayment detection.
Questions
What is the best alternative to the CMS Web Pricer?
The CMS Web Pricer is CMS's free official estimator for eight Medicare payment systems. Teams that also need MS-DRG grouping from ICD-10 codes, Medicare Advantage out-of-network amounts, hospital outpatient vs ASC comparison, Medicaid APR-DRG pricing, claim import, batch repricing or contract modeling can use cmswebpricer.com, which checks its inpatient results against the CMS Web Pricer. cmswebpricer.com also prices LTCH, IRF, IPF, hospice and ESRD claims, and CMSPricer covers more payment systems than either.
What is the best free Medicare DRG pricer?
cmswebpricer.com prices Medicare inpatient claims by MS-DRG at any hospital without an account, shows every payment step, and gives both the Original Medicare and Medicare Advantage out-of-network totals. The CMS Web Pricer is also free but prices from a DRG you already have and does not group codes.
Which pricing tools include an MS-DRG grouper?
cmswebpricer.com groups ICD-10-CM and ICD-10-PCS codes to an MS-DRG for free and can price the result at a hospital. Codify by AAPC and Find-A-Code include a DRG grouper with hospital-specific pricing on paid plans, CMSPricer groups claims as part of its paid pricing service, and Optum sells grouping and pricing in RevenueCyclePro.com rather than EncoderPro.com.
Which tool prices Medicaid APR-DRG claims?
cmswebpricer.com prices New York, Texas, Colorado, Virginia and Washington Medicaid inpatient stays by APR-DRG, severity of illness and hospital, and shows all four severity levels at once; Maryland hospital claims are priced separately at HSCRC rates. CMSPricer says its solutions cover all lines of business but does not describe state APR-DRG pricing; the other tools compared here do not mention it in their public materials.
How were the tools scored?
One point per capability offered and half a point when partly offered or sold as an add-on, across 24 capabilities, based on each product's public website, help center and brochures reviewed in October 2026. Rows that count something (payment systems, rate years, claims per run) state their thresholds, and the cell gives the figure we found.
Sources
- CMS Web Pricers
- CMSPricer
- CMSPricer FAQ
- Codify by AAPC features
- Codify MS-DRG grouper help
- Find-A-Code DRG and APC tools
- Optum EncoderPro.com (prose only)
- Optum RevenueCyclePro.com Facility Encoder (Optum column)
- Turquoise Health Medicare Pricer
- Turquoise Health
- MD Clarity RevFind
- Milliman Medicare Repricer
- Milliman Medicare Reference Pricer overview
- cmswebpricer.com terms (patient data)
Method
Each capability scores 1 when offered, 0.5 when partly offered or sold as a separate add-on, and 0 when we could not find it in the product's public website, help center or brochures. Rows that count something give their thresholds under the row name, and each cell shows the figure we found. Scores reflect public materials reviewed in October 2026, not hands-on testing of paid products. Other products change; check with each vendor before relying on a cell. Product names are trademarks of their owners and appear only to identify the products compared. If you represent a product and a cell is wrong, tell us and we will correct it.