For the same procedure, the same insurer pays some Texas gastroenterologists $405.11 and others $663.53 — 84% of Medicare against 137%. Same code, same state, same payer. MedReveal shows you which one you are, before you sign the next renewal.
Below is the real distribution of what BCBS Texas pays for CPT 45380 — Colonoscopy with biopsy — across 364 rates held by Texas gastroenterology providers. Medicare pays $483.72 for the same procedure. A quarter of these practices are paid less than that. The top decile is paid 137% of it.
Negotiated rate · percentages are share of Medicare · 364 gastroenterology rates · whiskers are Tukey bounds (1.5×IQR) · axis truncated, highest on file $1,249.25
| Position | Rate | vs Medicare $483.72 |
|---|---|---|
| Lowest rate on file | $246.76 | 51% |
| 25th percentile | $405.11 | 84% |
| Median | $520.43 | 108% |
| Mean | $514.88 | 106% |
| 75th percentile | $537.47 | 111% |
| 90th percentile | $663.53 | 137% |
| 95th percentile | $705.55 | 146% |
Source: BCBS Texas published negotiated rates, professional billing class, filtered to gastroenterology taxonomies. Medicare reference: Medicare, Houston locality, non-facility, CMS Physician Fee Schedule 2026. Chart axis truncated at $750; the highest rate on file is $1,249.25.
Run this same query without filtering to a specialty and it becomes noise. CPT 99214 across every provider this payer publishes returns a median of $94.39 — below Medicare, and below what any physician practice is actually paid — because the population is dominated by social workers, counselors and psychologists billing the same visit code at their own, much lower rates. Filter to family medicine and the median is $119.24. A benchmark is only a benchmark if it compares you to providers like you.
Take CPT 99214 — Office visit, established patient, moderate complexity — same payer, same state, filtered to family medicine across 3,692 rates. Here is what moving off the 25th percentile is worth to a practice billing 6,000 of these visits a year.
| If your contract sits at | Per visit | Gap vs your rate | At 6,000/year |
|---|---|---|---|
| 25th percentileyour rate | $111.56 | — | — |
| Market median | $119.24 | +$7.68 | +$46,080 |
| 90th percentile | $130.76 | +$19.20 | +$115,200 |
Percentiles are real, queried from published negotiated rates and filtered to family medicine. The 6,000-visit annual volume is an illustration — substitute your own and the arithmetic holds.
Medicare prices CPT 45380 at two very different levels depending on where it is performed. The non-facility rate carries the practice expense; the facility rate does not. If you are weighing an ASC, an in-office suite, or a hospital arrangement, this difference is the decision.
Medicare Physician Fee Schedule 2026, Houston locality.
The payer knows every rate in your market. You know one — yours. Every renewal conversation starts with an information gap you did not choose, and "this is our standard rate" is impossible to challenge without the other numbers.
A contract three points under market does not trigger an alert. It shows up as a margin that never quite recovers, spread across every claim, for the full term of the agreement.
Staffing, supplies, and malpractice have all repriced since your contract was signed. A rate set three years ago is being paid in today’s dollars, and nothing renegotiates it automatically.
Start from the services you actually bill. Every CPT, HCPCS and MS-DRG we hold is organized by service group and by specialty, so you can pull your real code mix rather than guessing at a list.
For each code, get the full spread of what that payer pays every provider in your state — 25th, median, 75th, 90th percentile, and the provider count behind it.
Drop your contracted rate onto the distribution. The output is a percentile, not an opinion: you are at the 25th, the 60th, or the 90th, for each code that matters.
Weight the gaps by your annual volume. That converts a table of percentiles into a dollar figure per code, and a renewal ask you can put in front of a payer with the arithmetic attached.
Walk in with the market distribution for your top 20 codes and the volume-weighted value of closing the gap. A specific ask backed by data outperforms a percentage request every time.
Compare what each payer pays you for the same code. When one payer sits well below the others on high-volume services, that is a concrete renegotiation target rather than a hunch.
The same procedure prices very differently in the office and in a facility. Knowing both numbers before you move a service line tells you what the move is actually worth.
Before adding a procedure, see what it reimburses across payers in your market — not the national average, the rates providers near you are actually being paid.
No sign-up needed to look. Every code page carries the current Medicare amount and a state-by-state breakdown.
Send us your top codes and your payers. We will come back with the market distribution for each one and the volume-weighted value of closing the gap.