Every health plan now has to publish the rates it has agreed to pay providers, under the federal Transparency in Coverage rule. In September 2026 RateBench took a snapshot of the published rates of seven large payers. Here is what their September 2026 files show for the three office visits independent practices bill most: 99213, 99214 and 99215.
The middle rate differs by up to 45% between payers
For 99214, the 30–39 minute established-patient visit, the middle published rate in each payer's September 2026 files was:
| Payer | 99213 | 99214 | 99215 |
|---|---|---|---|
| Cigna | $91.00 | $131.54 | $181.10 |
| BCBS Mississippi | $92.08 | $130.62 | $184.01 |
| Aetna | $76.71 | $119.54 | $180.00 |
| UnitedHealthcare | $78.43 | $115.27 | $155.75 |
| Horizon BCBS New Jersey | $73.17 | $107.66 | $143.69 |
| Florida Blue | $68.78 | $98.18 | $139.48 |
| BCBS Texas | $61.95 | $90.75 | $121.18 |
Middle published rate, September 2026 files. Source: RateBench typical-rates snapshot of each payer's in-network files.
The gap between the highest and lowest middle rate is $40.79 for a single 99214, or 45%.
Inside one payer, the spread can be wider than between payers
The middle rate hides a lot. Look at the middle half of each payer's published rates for 99214 (the 25th to 75th percentile), September 2026 files:
| Payer | Middle half for 99214 | Width |
|---|---|---|
| Aetna | $89.71 to $166.75 | $77 |
| Cigna | $102.07 to $179.60 | $78 |
| UnitedHealthcare | $96.15 to $147.69 | $52 |
| BCBS Texas | $64.83 to $100.87 | $36 |
| Florida Blue | $94.51 to $112.20 | $18 |
| Horizon BCBS New Jersey | $107.66 to $123.49 | $16 |
At the national payers, two practices billing the same code to the same plan can sit $77 apart and both be in the middle half. The regional Blue plans in this set are tighter.
What this means for a practice
- The "going rate" for a code is not one number. Knowing the middle rate for your payer tells you little about your own contract.
- Your own rate is in the same files. Each payer's file lists the rate for your NPI or your group, the same source these figures come from.
- Check before renewal. If your rate sits at the low end of the band, that is worth knowing before you renegotiate.
Look up your own rates free: six codes for your specialty, with no account and no card. To see the codes you bill across your payers, see the fee schedule.
Method and limits
Every figure comes from RateBench's typical-rates snapshot, generated on 23 September 2026 from each payer's September 2026 in-network files. These are the same figures the payer pages show as "middle rates".
- What "middle" means: the median of the negotiated rates published for that code across the provider groups in the payer's files, picked by the same rule a lookup uses. The "middle half" is the 25th to 75th percentile.
- Seven payers only: Aetna, Cigna, UnitedHealthcare, BCBS Texas, Florida Blue, Horizon BCBS New Jersey and BCBS Mississippi, the payers in that September snapshot. They aren't a sample of all US payers.
- Not weighted by visits: every provider group counts once, however many patients it sees.
- Published rate isn't paid amount: what a practice is actually paid can differ (patient cost sharing, modifiers, place of service, claim edits).
- BCBS Mississippi comes from a single file, so its band is narrow by construction. It's left out of the band comparison.
- Dated: every figure is as of the September 2026 files.
- No individual provider is named or identifiable.
Common questions
- How much do commercial payers pay for a 99214?
- In their September 2026 published files, the middle negotiated rate for 99214 ranged from $90.75 at BCBS Texas to $131.54 at Cigna across seven large payers. Inside one payer the spread is wide: at Aetna, the middle half of published 99214 rates ran from $89.71 to $166.75.
- Where do these figures come from?
- From each payer’s own in-network rate files, which federal Transparency in Coverage rules require health plans to publish. RateBench read the September 2026 files of seven payers and took the middle rate across the provider groups listed for each code.
Sources
- Transparency in Coverage, final rules (85 FR 72158) — Federal Register / U.S. Departments of the Treasury, Labor and HHS, November 12, 2020
- price-transparency-guide: technical implementation guide and in-network rates schema — CMS, accessed September 2026
- Typical-rates snapshot from seven payers’ September 2026 in-network files — RateBench, generated September 23, 2026