Procedures with the highest commercial-to-Medicare ratio
Metric: median as % of Medicare.
What the data shows
CPT 51700 (Irrigation of bladder) ranks first at 296.50; CPT 11104 (Punch bx skin single lesion) ranks last of 25 at 212.10.
The spread between first and last is 1.40× (84.40 points on this metric).
The median value across the 25 items is 255.30.
How to read this ranking
Each row is a procedure code. Ratios compare the national median commercial rate with the Medicare physician fee schedule (or the spread between payers or states), so a higher number means a larger commercial premium or a wider gap.
Procedures with the highest commercial-to-Medicare ratio
| Rank | Item | Value | Level |
|---|---|---|---|
| 1 | CPT 51700 Irrigation of bladder | 296.50 | |
| 2 | CPT 52000 Cystourethroscopy | 295.60 | |
| 3 | CPT 51720 Treatment of bladder lesion | 292.20 | |
| 4 | CPT 52648 Laser surgery of prostate | 285.40 | |
| 5 | CPT 43239 Egd biopsy single/multiple | 282.70 | |
| 6 | CPT 51702 Insert temp bladder cath | 268.20 | |
| 7 | CPT 43235 Egd diagnostic brush wash | 265.90 | |
| 7 | CPT 64566 Neuroeltrd stim post tibial | 265.90 | |
| 9 | CPT 45380 Colonoscopy and biopsy | 264.50 | |
| 10 | CPT 52224 Cystoscopy and treatment | 261.20 | |
| 11 | CPT 43255 Egd control bleeding any | 259.00 | |
| 12 | CPT 52332 Cystoscopy and treatment | 258.00 | |
| 13 | CPT 45384 Colonoscopy w/lesion removal | 255.30 | |
| 14 | CPT 45378 Diagnostic colonoscopy | 247.70 | |
| 15 | CPT 52287 Cystoscopy chemodenervation | 246.60 | |
| 16 | CPT 43248 Egd guide wire insertion | 245.90 | |
| 17 | CPT 45385 Colonoscopy w/lesion removal | 245.50 | |
| 17 | CPT 43251 Egd remove lesion snare | 245.50 | |
| 19 | CPT 52281 Cystoscopy and treatment | 244.40 | |
| 20 | CPT 52310 Cystoscopy and treatment | 235.80 | |
| 21 | CPT 20611 Drain/inj joint/bursa w/us | 232.70 | |
| 22 | CPT 52601 Prostatectomy (turp) | 224.50 | |
| 23 | CPT 11102 Tangntl bx skin single les | 215.70 | |
| 24 | CPT 26055 Incise finger tendon sheath | 213.40 | |
| 25 | CPT 11104 Punch bx skin single lesion | 212.10 |
Frequently asked questions
What does this ranking measure?
median as % of Medicare. Each row is a procedure code. Ratios compare the national median commercial rate with the Medicare physician fee schedule (or the spread between payers or states), so a higher number means a larger commercial premium or a wider gap.
Who ranks first?
CPT 51700 (Irrigation of bladder), at 296.50.
How often is this updated?
It is rebuilt from each monthly snapshot of the payers' published files; this page uses August 2026.
Methodology
- 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.
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