Preventive visit, new patient, 18-39CPT 99385Clinic
Median commercial negotiated rate by hospital, from each hospital's own disclosure file.
The same procedure spans a 14.7× price range across 17 Colorado hospitals.
How to read “% of Medicare”: Medicare’s payment is a hospital-specific
benchmark built from CMS files — adjusted for local wages and case complexity, and roughly pegged to the
cost of care. A commercial rate at 300% means a private plan pays about triple that benchmark for the same care
at the same hospital. The gap is negotiation, not quality. Full methodology →
Median commercial negotiated rateMedicare benchmark
*Cost estimates use hospital-level cost-to-charge ratios from federal cost reports and are approximate;
~ marks categories (imaging, labs) where they are least precise. "Plan rows" is how many distinct plan rates the
hospital published; medians over more rows are sturdier.
Rexroad Analytics · Data: hospital machine-readable files (45 CFR 180, schema v3.0) retrieved August 21–22, 2026;
Medicare benchmarks from CMS claims data and fee schedules; cost estimates from FY2026 CMS cost-report ratios, labeled as estimates.
Not medical, legal, or benefits advice. Full methodology →