CMS pricer comparison: Medicare and Medicaid pricing tools, 2026
Twenty capabilities that payer reimbursement, contracting, coding and payment-integrity teams ask for, checked across eight widely used tools. One point per capability a tool offers.
Capability by capability
| Capability | cmswebpricer.com | CMSPricer (Micro-Dyn) | Turquoise Health | Codify by AAPC | Find-A-Code | CMS Web Pricer | MD Clarity | Optum EncoderPro.com |
|---|---|---|---|---|---|---|---|---|
| Free to use, no sign-upprice without creating an account | ✓ | — | ◐ | — | ◐ | ✓ | — | — |
| Inpatient IPPS pricing by hospitalany CCN, every payment step | ✓ | ✓ | ◐ | ✓ | ✓ | ✓ | — | — |
| 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 | ✓ | ✓ | ◐ | ✓ | ✓ | — | — | ✓ |
| 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 | ✓ | — | — | — | — | — | — | — |
| Medicaid APR-DRG pricingNY, TX and CO by hospital | ✓ | — | — | — | — | — | — | — |
| Medicaid severity comparisonall four SOI levels at once | ✓ | — | — | — | — | — | — | — |
| NY Medicaid rate codesHARP, clinic, FQHC reference | ✓ | — | — | — | — | — | — | — |
| Claim file import837I, FHIR, XML, UB-04 PDF | ✓ | ✓ | ◐ | — | — | — | ✓ | — |
| Billed vs regrouped DRG validationaudit-ready verdict | ✓ | — | — | — | — | — | — | — |
| Batch repricingCSV in, priced claims out | ✓ | ✓ | ✓ | — | — | — | ✓ | — |
| 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 | ✓ | ✓ | ✓ | — | — | — | — | ◐ |
| Coverage score | 20 | 8.5 | 6.5 | 5 | 5 | 4 | 3.5 | 2.5 |
Ranking by capability coverage
- cmswebpricer.com — 20 of 20 capabilities (Independent workbench)
- CMSPricer (Micro-Dyn) — 8.5 of 20 capabilities (Commercial pricer and claim editor)
- Turquoise Health — 6.5 of 20 capabilities (Price transparency)
- Codify by AAPC — 5 of 20 capabilities (Coding reference)
- Find-A-Code — 5 of 20 capabilities (Coding reference)
- CMS Web Pricer — 4 of 20 capabilities (Official CMS pricers)
- MD Clarity — 3.5 of 20 capabilities (Contract management)
- Optum EncoderPro.com — 2.5 of 20 capabilities (Coding suite)
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 and Colorado Medicaid APR-DRG pricing, 837I and FHIR claim import with DRG validation, batch repricing, contract modeling and a check against the CMS Web Pricer.
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 EncoderPro.com is a coding reference with code edits; Optum sells DRG grouping and pricing separately. Turquoise Health offers a free Medicare pricer (account required) 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. 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 use cmswebpricer.com, which covers all 20 capabilities in this comparison and checks its inpatient results against the CMS Web Pricer.
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 and Colorado Medicaid inpatient stays by APR-DRG, severity of illness and hospital, and shows all four severity levels at once. None of the other tools compared here advertise state Medicaid APR-DRG pricing by hospital and severity 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, based on each product's public website, help center and brochures reviewed in October 2026.
Sources
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. 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.