Do commercial insurers pay more than Medicare?

Not always. Across 149 of the most common procedures, the median commercial contracted rate is about 1.01 times Medicare, and 45.6% of those procedures pay a commercial median below Medicare, per Reddenda's analysis of 438,897,528 published rate observations from federal Transparency-in-Coverage filings.

Do the most common office visits pay below Medicare?

Yes. CPT 99213, 99214, and 99215, the most common established-patient office visits, each show a median commercial rate below the Medicare rate in this data. Modeled from public filings, not guaranteed.

Where does this data come from?

From the machine-readable files insurers are federally required to publish under the Transparency in Coverage Rule (45 CFR 147.212), joined to the CMS Medicare Physician Fee Schedule. These are aggregate national distributions across payers, not any individual provider's rate, and no patient data is used.

Reddenda · Data Report · 2026-07-23

What commercial insurers actually pay, versus Medicare

Name: US Commercial Reimbursement Report 2026
Creator: Reddenda
License: https://reddenda.com/methodology

Across 438,897,528 published commercial rate observations for 149 of the most common U.S. medical procedures, the median commercial contracted rate is about 1.01 times Medicare, and 45.6% pay a commercial median below Medicare. Even the most common office visits (99213, 99214, 99215) pay below Medicare. Documented from federal Transparency-in-Coverage filings, modeled and not guaranteed.

45.6%of common procedures pay a commercial median below Medicare

1.01xmedian commercial rate vs Medicare, on average

3xtypical spread (25th to 90th percentile) for the same code

438,897,528published commercial rate observations analyzed

The most common office visits pay below Medicare

The established-patient office visit is the most-billed service in American medicine. In this data, 5 of the 6 common office-visit codes show a median commercial rate at or below the Medicare rate for the same code.

CPT 99203Office visit, new patient, 30-44 min

Commercial median

$116.74

Medicare

$117.57

CPT 99204Office visit, new patient, 45-59 min

Commercial median

$180.91

Medicare

$177.36

CPT 99212Office visit, established patient, 10-19 min

Commercial median

$52.81

Medicare

$59.45

CPT 99213Office visit, established patient, 20-29 min

Commercial median

$92.75

Medicare

$95.19

CPT 99214Office visit, established patient, 30-39 min

Commercial median

$127.96

Medicare

$135.61

CPT 99215Office visit, established patient, 40-54 min

Commercial median

$185.97

Medicare

$192.39

Procedures paying furthest below Medicare

CPT	Procedure	Commercial median	Medicare	% of Medicare
64636	Lumbar facet RFA, each additional	$120.41	$251.51	48%
64634	Cervical/thoracic facet RFA, each additional	$132.98	$266.54	50%
45386	Colonoscopy w/ balloon dilation	$382.94	$670.36	57%
82947	Glucose, quantitative	$3.54	$6	59%
43245	EGD w/ dilation gastric outlet	$392.66	$654.99	60%
11300	Shaving lesion, trunk/arms/legs, ≤0.5cm	$64.29	$96.53	67%
62323	Lumbar epidural injection w/ imaging guidance	$197.28	$273.22	72%
11305	Shaving lesion, scalp/neck/hands/feet, ≤0.5cm	$73.29	$101.20	72%

Observed national medians across payer filings. Source: 45 CFR 147.212 (Transparency in Coverage) and the CMS Medicare Physician Fee Schedule.

The same procedure, paid very differently

For a given CPT code, the 90th-percentile commercial rate is typically about 3 times the 25th-percentile rate. In the widest cases the same procedure is paid many times over depending on the payer contract.

CPT	Procedure	25th pct	90th pct	Spread
95819	EEG, awake & asleep	$107.91	$944.58	8.8x
95816	EEG, awake & drowsy	$109.25	$815.90	7.5x
11055	Paring of corn or callus, single	$20.72	$130.95	6.3x
93970	Extremity venous duplex, complete bilateral	$65.24	$399.43	6.1x
64636	Lumbar facet RFA, each additional	$79.52	$483	6.1x
93971	Extremity venous duplex, limited or unilateral	$42.80	$255.37	6x

Key findings (cite-ready)

Across 438,897,528 published commercial rate observations for 149 of the most common U.S. medical procedures, the median commercial contracted rate is about 1.01 times Medicare.

45.6% of these common procedures (68 of 149) have a median commercial rate that is below Medicare's rate for the same code.

The most common office visits, CPT 99213, 99214, and 99215, all show a median commercial rate below the Medicare rate.

For the same procedure, the 90th-percentile commercial rate is typically about 3 times the 25th-percentile rate, so two providers holding different payer contracts can be paid multiples apart for identical work.

The widest gap below Medicare in the set is CPT 64636 (Lumbar facet RFA, each additional), paid a median of $120.41, about 48% of Medicare's $251.51.

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Methodology

Reddenda indexes the machine-readable rate files insurers are federally required to publish under the Transparency in Coverage Rule (45 CFR 147.212), joins them to the public NPI Registry, and benchmarks against the CMS Medicare Physician Fee Schedule. The figures here are aggregate national distributions across payers for 149 high-volume CPT codes, computed live from 438,897,528 rate observations and refreshed with the data. They are observed distributions across payer filings, not a local peer median and not any individual provider's rate. No protected health information is used. Every figure is documented from public rates and modeled, not guaranteed. Reddenda indexes toward a universe of 314M+ records, 500+ payers, 50 states, and 9.2M+ NPIs; the live-indexed subset powers these figures.

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Free to cite as: Reddenda, US Commercial Reimbursement Report 2026. As of 2026-07-23. Press and data inquiries: info@reddenda.com.