Payer Negotiated Rate Benchmarks by CPT Code — 2026 Data

20 procedures · 17 payers · 56states and territories · from 36M+ negotiated rates

Most published rate ranges for CPT procedures are billing blog guesses — MGMA survey averages, Medicare allowed amounts, or fee schedule conversions that haven’t been verified against actual contracts. This page is different: every figure is measured directly from insurer-published Transparency in Coverage Machine-Readable Files (45 CFR Part 147) — the same filings insurers are required by federal law to release monthly. CareCost Explorer ingests those files at scale, normalizes rates to a comparable dollar basis, and computes payer-level and national medians you can actually act on.

The 20procedures below cover the most-queried CPT codes across evaluation & management, surgery, imaging, cardiology, therapy, labs, and emergency. Each code page shows the national median, interquartile range, payer spread, and a full payer-by-payer breakdown sorted by median. Rates are vintage 2026-Q2. A median is a summary, not a quote — treat these figures as orientation, then verify with your payer.

New to negotiated-rate data? Start with the complete guide to machine-readable files.

Cardiology

Cardiology procedures

Cardiology CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
93306	EchocardiogramTte w/doppler complete	$279	17	56

E/M

E/M procedures

E/M CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
99203	New Patient Visit, 30mOffice o/p new low 30 min	$118	16	56
99204	New Patient Visit, 45mOffice o/p new mod 45 min	$181	16	56
99213	Office Visit, 20 minOffice o/p est low 20 min	$84	16	56
99214	Office Visit, 30 minOffice o/p est mod 30 min	$122	16	56

Emergency

Emergency procedures

Emergency CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
99284	ER Visit, Level 4Emergency dept visit mod mdm	$670	16	56

Imaging

Imaging procedures

Imaging CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
70553	Brain MRIMri brain stem w/o & w/dye	$368	17	56
72148	Lumbar Spine MRIMri lumbar spine w/o dye	$224	17	56
74177	CT Abdomen/PelvisCt abd & pelvis w/contrast	$331	17	56
76700	Abdominal UltrasoundUs exam abdom complete	$119	17	56

Labs

Labs procedures

Labs CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
80053	Metabolic Panel (CMP)Comprehen metabolic panel	$18	17	56
85025	CBC Blood TestComplete cbc w/auto diff wbc	$12	17	56

Surgery

Surgery procedures

Surgery CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
27447	Knee ReplacementTotal knee arthroplasty	$4,544	17	56
29881	Knee ArthroscopyArthrs kne srg mnisectmy m/l	$1,833	17	56
43239	Upper EndoscopyEgd biopsy single/multiple	$835	17	56
45378	ColonoscopyDiagnostic colonoscopy	$828	17	56
45380	Colonoscopy + BiopsyColonoscopy and biopsy	$859	17	56
47562	Gallbladder RemovalLaparoscopic cholecystectomy	$2,506	16	56
66984	Cataract SurgeryXcapsl ctrc rmvl w/o ecp	$1,726	17	56

Therapy

Therapy procedures

Therapy CPT code reimbursement benchmarks
Code	Procedure	National median	Payers	States
97110	Therapeutic ExerciseTherapeutic exercises	$33	17	56

Methodology note

National medians use a median-of-state-medians method to prevent high-volume states from dominating the national figure. State cells with fewer than 5 underlying rates are suppressed. All figures are derived from Transparency in Coverage MRF filings; percent-of-charge and per-diem contract artifacts may inflate or deflate individual payer medians. Professional rates reflect clinician fee schedules; institutional rates reflect facility fee schedules — they are not directly comparable for the same code. For full details, see our methodology page.

State medians are computed from payer-level medians; cells with fewer than 5 underlying rates are suppressed.

Frequently Asked Questions

How are these benchmarks different from Medicare fee schedules?

These are measured commercial negotiated rates from payer Transparency in Coverage filings — not administered Medicare prices. Medicare is a single national price set by CMS; the figures here show what private insurers actually contracted to pay, which varies by payer and region. Where valid, we show both the commercial median and the Medicare average allowed amount side by side on each procedure page.

Why do rates vary so much between payers?

Negotiated rates are set individually between each payer and each provider network, reflecting different contract structures, provider mixes, and market leverage. Some payers also use percent-of-billed-charge or per-diem structures rather than fee schedules; medians from those contracts can look dramatically different from fee-schedule rates even for the same procedure. Rows that diverge sharply from the national range are flagged on individual code pages.

How often is this data updated?

We ingest payer Machine-Readable Files on a quarterly basis. The data vintage is shown on every page — currently 2026-Q2. Payers are required by federal regulation (45 CFR Part 147) to publish updated MRFs monthly; our ingest cycle captures the most recent quarterly snapshot.

These benchmarks are the floor, not the ceiling.

36M+ rates by payer, code, and state — measured from actual TiC filings, not billing blog averages.

Explore the full data →View methodology