Medical Record Fees by State: 2026 Attorney Guide

Most attorneys assume HIPAA caps all medical record fees at $6.50. That figure applies only to patient-directed requests for electronic copies, a narrow exception under the 2016 HHS guidance. Attorney-initiated requests, whether by authorization or subpoena, are governed by state law. The difference is significant: state fees range from $0.25 per page in California to over $1.00 per page in Florida, Ohio, and Pennsylvania, with search fees, certification costs, and rush charges stacked on top. Law firms managing requests in-house spend an average of $144 per request, including $76 in labor costs and $68 in provider fees.

For a typical PI case requiring records from 6-8 providers, those per-request costs add up to $800-$1,100 before a demand letter is even drafted. According to the 2026 Clio Legal Trends Report, 49% of personal injury firms cite managing expenses as an ongoing challenge. Medical records rank among the top three cost categories.

The HIPAA Fee Misconception

The $6.50 figure comes from a 2016 HHS clarification allowing covered entities to charge a flat fee for electronic copies of protected health information. The option was designed to simplify compliance for patient-directed requests. It was never intended as a universal cap.

The distinction turns on who initiates the request. When a patient asks a provider for their own records, HIPAA's "reasonable, cost-based" fee standard applies, and the $6.50 flat fee satisfies that standard. When an attorney submits a request through authorization, subpoena, or court order, state law governs the fee schedule. State fees are almost always higher.

State Fee Reference: 2026 Rates

Fee schedules vary widely. Many states adjust rates annually based on the Consumer Price Index, so the figures below reflect 2026 rates where available and late-2025 rates otherwise.

The $1,000 Invoice Problem

The table above shows what providers are legally allowed to charge. What they actually charge is often different.

Firms managing retrieval in-house regularly encounter invoices that exceed statutory limits. A hospital billing department in Texas sends a $400 charge for 200 pages of records. A Georgia imaging center bills $150 for a disc of radiology films. A Pennsylvania provider tacks on a "processing fee" that no statute authorizes. These invoices arrive weeks after the request, often after a paralegal has already moved on to other cases.

ChartSquad's analysis of the true per-request cost captures only the average. For multi-provider cases spanning multiple states, total record costs of $500-$1,000 are routine. On a contingency-fee case that settles for $50,000, that expense is real money.

The harder problem is not the cost itself. It is the time spent auditing invoices, calling billing departments, and disputing charges that should never have been billed in the first place.

How LlamaLab Handles Provider Fees

Most retrieval services charge a processing fee and then pass provider invoices through to the firm. The firm still pays per-page fees, search fees, certification costs, and whatever else the provider decides to bill. The service coordinates the request. The firm absorbs the cost.

LlamaLab works differently. All additional provider fees are covered. Page fees, search fees, rush charges, certification costs. If a provider sends an inflated invoice or charges above the statutory rate, LlamaLab's team audits the charges against the state fee schedule, disputes incorrect amounts, and pays the balance. The firm never receives a separate provider bill.

The practical result: no more $1,000 surprises. No more paralegals spending an afternoon arguing with a hospital billing department about whether a "records processing surcharge" is legitimate. One predictable cost per request, and the firm's staff stays focused on case work instead of provider invoices.

For firms handling cases across multiple states, this eliminates a layer of administrative complexity that compounds with every new jurisdiction. A California case at $0.25 per page and a Pennsylvania case at $2.00 per page both cost the same to retrieve through LlamaLab.

Cost Recovery at Settlement

Medical record expenses are generally recoverable, but what qualifies depends on the jurisdiction and practice area.

Proper documentation makes cost recovery straightforward. Every request should be logged with the provider name, date submitted, date received, page count, and fees charged. For firms using LlamaLab, the retrieval invoice itself serves as the itemized expense record for settlement documentation.

The Bottom Line

Medical record fees are not uniform, not simple, and not capped at $6.50 for attorney requests. The true cost per request depends on the state, the provider, the request structure, and how much time staff spends fighting billing departments. For firms handling hundreds of cases across multiple states, the difference between predictable retrieval costs and ad hoc invoice management adds up to tens of thousands of dollars annually.

The firms that have solved this problem stopped treating retrieval as an overhead cost to absorb. They moved to a model where provider fees, overcharges, and billing disputes are someone else's problem.

Sources: HHS HIPAA Access Guidance, HHS Flat Rate Copy Fee Clarification, ChartSquad Hidden Costs Analysis, Clio PI Law Statistics 2026, BSW HIPAA Fee Analysis, PA Dept. of Health Medical Record Fees, Ohio Revised Code § 3701.741, Georgia DCH Retrieval Rates, Illinois 735 ILCS 5/8-2001, NC Gen. Stat. § 90-411.