Procedures with the lowest commercial-to-Medicare ratio
Metric: median as % of Medicare.
What the data shows
CPT 93298 (Rem interrog dev eval scrms) ranks first at 50.70; CPT 13121 (Cmplx rpr s/a/l 2.6-7.5 cm) ranks last of 25 at 95.10.
The spread between first and last is 0.53× (-44.40 points on this metric).
The median value across the 25 items is 91.20.
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 lowest commercial-to-Medicare ratio
| Rank | Item | Value | Level |
|---|---|---|---|
| 1 | CPT 93298 Rem interrog dev eval scrms | 50.70 | |
| 2 | CPT 99212 Office o/p est sf 10 min | 82.60 | |
| 3 | CPT 92004 Compre oph exam new pt 1/> | 82.80 | |
| 4 | CPT 99487 Cplx chrnc care 1st 60 min | 84.20 | |
| 5 | CPT 92242 Fluorescein&icg angiography | 85.50 | |
| 6 | CPT 93297 Rem interrog dev eval icpms | 86.00 | |
| 7 | CPT 88342 Imhchem/imcytchm 1st antb | 86.40 | |
| 8 | CPT 88313 Special stains group 2 | 87.50 | |
| 9 | CPT 88312 Special stains group 1 | 88.80 | |
| 10 | CPT 92235 Fluorescein angrph mltiframe | 89.10 | |
| 11 | CPT 99213 Office o/p est low 20 min | 90.40 | |
| 12 | CPT 99490 Chrnc care mgmt staff 1st 20 | 91.00 | |
| 13 | CPT 17110 Destruction b9 les up to 14 | 91.20 | |
| 14 | CPT 17261 Dstrj mal les t/a/l .6-1.0cm | 91.30 | |
| 15 | CPT 99215 Office o/p est hi 40 min | 91.40 | |
| 16 | CPT 99214 Office o/p est mod 30 min | 92.30 | |
| 17 | CPT 99202 Office o/p new sf 15 min | 92.50 | |
| 17 | CPT 17111 Destruction b9 lesions 15/> | 92.50 | |
| 19 | CPT 12052 Intmd rpr face/mm 2.6-5.0 cm | 92.70 | |
| 20 | CPT 12042 Intmd rpr n-hf/genit2.6-7.5 | 93.40 | |
| 21 | CPT 12032 Intmd rpr s/a/t/ext 2.6-7.5 | 93.50 | |
| 22 | CPT 17262 Dstrj mal les t/a/l 1.1-2.0 | 93.70 | |
| 23 | CPT 17004 Destroy premal lesions 15/> | 94.60 | |
| 24 | CPT 11602 Exc tr-ext mal+marg 1.1-2 cm | 94.80 | |
| 25 | CPT 13121 Cmplx rpr s/a/l 2.6-7.5 cm | 95.10 |
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 93298 (Rem interrog dev eval scrms), at 50.70.
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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