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ABSTRACT: Medical care in the US is priced by commercial forces. The forces are not free-market, but rather are controlled and owned by specific private entities. The legally-mandated method to set medical care prices (the Relative Value Scale) mandates the use of specific, privately-owned commercial billing tools. Prices, and a pricing method, ultimately direct what kinds of medical care is available in the US, and the existing structure values less-needed and inappropriate care above needed shortage care. The pricing method’s origin, its designers’ market biases, and its use to enforce a specific private locus of control are examined. A critical perspective on the sanctioned scale’s validity, its consequences for US medical care services, and exclusive control by a specific technocratic elite are examined.