Not the chargemaster sticker price — the negotiated rate every payer actually reimburses. MedReveal shows you the full market distribution for any CPT or HCPCS code, by payer, by state, so you can run payer rate benchmarking instead of guessing at it.
A hospital price list is what nobody actually pays. We index what each payer negotiated and actually reimburses — the number that determines your revenue.
UHC, Aetna, Cigna, BCBS and more, for the same code, in the same market — so "what does insurance pay for this" has a real, comparable answer.
A single average hides the spread. See the 25th, median, 75th and 95th percentile so you know if a rate is typical or an outlier before you act on it.
Every rate is shown against the current Medicare amount for that code and locality — the one benchmark every payer, provider and consultant already speaks in.
CPT 99213, 99214 and 99215 — the established-patient office visit codes behind most "how much does a doctor visit cost" searches. Family Medicine, professional claims, Texas. Every figure below is a live MedReveal query result.
| Code | Min | Q1 | Median | Mean | Q3 | P95 | Medicare | Median % of Medicare |
|---|---|---|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity (20 min) | $31.40 | $51.13 | $62.15 | $70.15 | $79.96 | $129.69 | $96.33 | 65% |
| 99214Office visit, established patient, moderate complexity (30 min) | $48.29 | $77.49 | $92.50 | $104.50 | $116.69 | $190.54 | $137.41 | 67% |
| 99215Office visit, established patient, high complexity (40 min) | $68.21 | $107.72 | $127.60 | $144.30 | $159.20 | $262.52 | $195.13 | 65% |
Source: UHC published negotiated rates, professional billing class, filtered to Family Medicine taxonomies, TX. Medicare reference: Medicare, Houston locality, non-facility, CMS Physician Fee Schedule 2025.
Medicare pays $137.41 for CPT 99214 in Houston. The UHC median for the same code, same specialty, same state is $92.50 — 67% of Medicare. Primary care office visits are one of the few code families where commercial insurers routinely pay below the Medicare rate, which is exactly the kind of fact a benchmark surfaces and an average hides.
Same code, CPT 99214 — Office visit, established patient, moderate complexity. An illustrative provider rate of $95.00 lands at the 53rd percentile on UHC but only the 7th on BCBS — the same rate reads very differently payer to payer.
Family Medicine, professional rates, TX · whiskers are Tukey bounds (1.5×IQR) · full figures in the table below
| Payer | Client rate | Percentile | Min | Q1 | Median | Mean | Q3 | P95 | Count | vs Median |
|---|---|---|---|---|---|---|---|---|---|---|
| UHC | $95.00 | 53rd | $48.29 | $77.49 | $92.50 | $104.50 | $116.69 | $190.54 | 3,930 | +$2.50 |
| Aetna | $95.00 | 20th | $25.00 | $111.93 | $116.82 | $132.64 | $126.44 | $243.47 | 3,656 | $-21.82 |
| Cigna | $95.00 | 36th | $57.90 | $87.19 | $105.15 | $115.72 | $123.56 | $202.61 | 4,054 | $-10.15 |
| BCBS | $95.00 | 7th | $88.56 | $111.56 | $119.24 | $123.56 | $130.76 | $140.24 | 3,874 | $-24.24 |
Search by CPT, HCPCS, specialty or service group — the codes that actually drive your volume, not a generic sample.
For each code and payer, get the full spread of negotiated rates: min, 25th, median, 75th, 95th percentile, and the Medicare amount.
Drop your contracted rate onto the distribution. The result is a percentile, not an opinion — you are at the 20th or the 80th, for each payer.
A rate sitting below the 25th percentile is a renewal target. One above the 75th is a rate worth defending. Either way, you know before you walk in.
Walk into a payer renewal with the market distribution for your top codes, not a percentage increase you cannot defend.
Setting a new fee schedule or master rate? Benchmark it against real market data before you commit to it, code by code.
Sizing the reimbursement landscape in a new market before committing capital to a new location or service line.
See where your rates sit against every payer in your specialty and state — not just the one contract in front of you.
Benchmarking rates on behalf of clients or a provider network? See MedReveal for consultants or MSOs and IPAs.
Look up any CPT or HCPCS code for free, or send us your code mix and payer set for a full benchmarking pass.