Benchmarks
Commercial reimbursement benchmarks and rankings
Rankings of states, payers, specialties and procedures on negotiated rates.
Snapshot Aug 2026
About the benchmarks
Rankings built from the same data as the code, payer, state and specialty pages: reimbursement indexes by state and specialty, the procedures with the highest and lowest commercial-to-Medicare ratios, and the widest gaps between payers and between states.
All benchmarks
Each ranking and its metric
| Benchmark | Metric | Items |
|---|---|---|
| Reimbursement index by state: cardiology | index_vs_national (100 = specialty national median) | 51 |
| Procedures with the highest commercial-to-Medicare ratio | median as % of Medicare | 25 |
| Procedures with the lowest commercial-to-Medicare ratio | median as % of Medicare | 25 |
| Procedures with the widest gap between payers | highest payer median / lowest payer median | 25 |
| Procedures with the widest gap between states | highest state median / lowest state median | 25 |
| Reimbursement index by state: dermatology | index_vs_national (100 = specialty national median) | 50 |
| Reimbursement index by state: diagnostic radiology | index_vs_national (100 = specialty national median) | 51 |
| Reimbursement index by state: gastroenterology | index_vs_national (100 = specialty national median) | 50 |
| Reimbursement index by state: internal medicine | index_vs_national (100 = specialty national median) | 51 |
| Reimbursement index by state: ophthalmology | index_vs_national (100 = specialty national median) | 50 |
| Reimbursement index by state: orthopedic surgery | index_vs_national (100 = specialty national median) | 51 |
| Commercial reimbursement index by state | index_vs_national (100 = national median) | 51 |
| Reimbursement index by state: urology | index_vs_national (100 = specialty national median) | 50 |
Methodology
How these numbers are calculated
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your own rates
See where your contracts sit against these rankings.