What do payers pay cardiology groups in OR?

Across 206 NPIs, the median published rate is 205.6% of locality-adjusted Medicare (September 2026 files).

Data as of the September 2026 payer files.

Across 72 procedure codes and 3 payers, the median published rate is 236 percent of locality-adjusted Medicare in the September 2026 payer files. Cigna publishes the highest median at 258 percent and Aetna the lowest at 159 percent, a spread of 99 points on identical work. 3 of 3 payers sit at or above Medicare. The best-covered row rests on 206 confirmed NPIs, and any combination under five is withheld rather than shown thin. These are contracted amounts the payer published, not what a practice was paid, and every row clears the ghost-rate filter, so each NPI counted here actually billed the code in the Medicare utilization file.

Published rates

Median rate by payer, percent of Medicare

Solid line 100% of Medicare.

How this is measured

Rates come from each payer's published Transparency in Coverage machine-readable file, filtered to this specialty's codes and to NPIs the CMS Medicare utilization file shows billing that code. Percentiles are computed per payer, code and site of service across those NPIs, then divided by the locality-adjusted Medicare amount for the same code and place. Full methodology.

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