# Same code, different pay: what 7 payers publish for office visits

> The middle published rate for 99213, 99214 and 99215 at seven large payers, from their September 2026 Transparency in Coverage files: up to 45% apart between payers for the same visit, and wider still inside the national payers.

- Published: 2026-10-10
- Author: RateBench
- Human page: https://ratebench.health/blog/office-visit-rates-by-payer-2026
- This document: https://ratebench.health/blog/office-visit-rates-by-payer-2026.md
- Product (sign up / app): https://app.ratebench.health

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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](/payers/cigna) | $91.00 | $131.54 | $181.10 |
| [BCBS Mississippi](/payers/bcbsms) | $92.08 | $130.62 | $184.01 |
| [Aetna](/payers/aetna) | $76.71 | $119.54 | $180.00 |
| [UnitedHealthcare](/payers/uhc) | $78.43 | $115.27 | $155.75 |
| [Horizon BCBS New Jersey](/payers/horizon) | $73.17 | $107.66 | $143.69 |
| [Florida Blue](/payers/floridablue) | $68.78 | $98.18 | $139.48 |
| [BCBS Texas](/payers/bcbstx) | $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](/#check): six codes for your specialty, with no
account and no card. To see the codes you bill across your payers, see the
[fee schedule](/pricing).

## 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

1. Federal Register / U.S. Departments of the Treasury, Labor and HHS (November 12, 2020). "Transparency in Coverage, final rules (85 FR 72158)". https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage
2. CMS (accessed September 2026). "price-transparency-guide: technical implementation guide and in-network rates schema". https://github.com/CMSgov/price-transparency-guide
3. RateBench (generated September 23, 2026). "Typical-rates snapshot from seven payers’ September 2026 in-network files". https://ratebench.health/payers