What does uhc pay medical-oncology groups in CA?
Median published rate is 145.1% of Medicare across 1055 NPIs (September 2026 files).
Data as of the September 2026 payer files.
Across 200 procedure codes and 1 payer, the median published rate is 46 percent of locality-adjusted Medicare in the September 2026 payer files. UnitedHealthcare is the only payer with enough confirmed NPIs to publish here, at 46 percent of Medicare, so there is no spread to compare yet. The best-covered row rests on 1055 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
| Payer | Code | Site | n | p25 | p50 | p75 | % of Medicare |
|---|---|---|---|---|---|---|---|
| UnitedHealthcare | 99214 | professional | 1055 | 126.26 | 202.08 | 357.66 | 145.1% |
| UnitedHealthcare | 99215 | professional | 991 | 205.63 | 314.79 | 560.79 | 159.7% |
| UnitedHealthcare | 99205 | professional | 859 | 268.05 | 424.88 | 691.48 | 179.1% |
| UnitedHealthcare | 99213 | professional | 681 | 85 | 119 | 178.18 | 118.4% |
| UnitedHealthcare | 96372 | professional | 423 | 20.25 | 28.29 | 52 | 167.8% |
| UnitedHealthcare | 99204 | professional | 403 | 175.29 | 261.78 | 377.8 | 141.1% |
| UnitedHealthcare | 96413 | professional | 371 | 180.42 | 275.45 | 513.45 | 177.6% |
| UnitedHealthcare | 96365 | professional | 329 | 82.97 | 136.22 | 247.32 | 173.3% |
| UnitedHealthcare | 96367 | professional | 291 | 34.96 | 51.47 | 105.71 | 144.8% |
| UnitedHealthcare | 96375 | professional | 277 | 24.6 | 49.43 | 85.92 | 264.7% |
| UnitedHealthcare | 96417 | professional | 242 | 89.66 | 167.98 | 327.9 | 194.6% |
| UnitedHealthcare | 96415 | professional | 235 | 37.8 | 59.99 | 107.64 | 185.4% |
| UnitedHealthcare | 96402 | professional | 175 | 46.26 | 88.55 | 202.84 | 187.2% |
| UnitedHealthcare | 96361 | professional | 154 | 17.31 | 38.94 | 69.24 | 262.9% |
| UnitedHealthcare | 96366 | professional | 144 | 28.46 | 75.02 | 113.2 | 309.2% |
| UnitedHealthcare | 96360 | professional | 138 | 45.03 | 100.06 | 186.98 | 259.9% |
| UnitedHealthcare | 96523 | professional | 129 | 42.94 | 82.18 | 148.57 | 241.6% |
| UnitedHealthcare | 99212 | professional | 97 | 52.83 | 85 | 118.52 | 113.1% |
| UnitedHealthcare | 96401 | professional | 93 | 115.44 | 195.17 | 419.8 | 237.8% |
| UnitedHealthcare | 96368 | professional | 89 | 27.58 | 35.2 | 72.59 | 155.6% |
| UnitedHealthcare | 36591 | professional | 80 | 41.41 | 76.37 | 106.26 | 212.4% |
| UnitedHealthcare | 96374 | professional | 79 | 52.14 | 116.18 | 191.79 | 262.8% |
| UnitedHealthcare | 99203 | professional | 70 | 116.62 | 155.48 | 279.07 | 124.3% |
| UnitedHealthcare | 96411 | professional | 63 | 88.67 | 152.66 | 316.39 | 219.5% |
| UnitedHealthcare | 38222 | professional | 52 | 183.88 | 290.73 | 551.33 | 144.9% |
| UnitedHealthcare | 99497 | professional | 38 | 143.06 | 271.2 | 355.16 | 288.3% |
| UnitedHealthcare | 96377 | professional | 27 | 56.08 | 59.83 | 67.44 | 276.9% |
| UnitedHealthcare | 96416 | professional | 27 | 210.52 | 268.32 | 1268 | 146.3% |
| UnitedHealthcare | 51720 | professional | 20 | 91.82 | 226.49 | 481.83 | 220.5% |
| UnitedHealthcare | 99490 | professional | 18 | 54.23 | 61.22 | 61.22 | 89.3% |
| UnitedHealthcare | 36430 | professional | 16 | 51.15 | 108.53 | 108.53 | 193.6% |
| UnitedHealthcare | 38221 | professional | 16 | 134.4 | 160.35 | 270.95 | 95.7% |
| UnitedHealthcare | 36593 | professional | 14 | 40.05 | 51.36 | 51.36 | 124.2% |
| UnitedHealthcare | 38220 | professional | 12 | 115.46 | 141.41 | 166.11 | 87.2% |
| UnitedHealthcare | 99439 | professional | 11 | 47.28 | 47.28 | 47.28 | 90.1% |
| UnitedHealthcare | 31575 | professional | 8 | 97.78 | 115.54 | 237.5 | 124.7% |
| UnitedHealthcare | 20550 | professional | 7 | 44.66 | 52.23 | 58.08 | 157.2% |
| UnitedHealthcare | 43239 | professional | 7 | 249.93 | 250.49 | 368.05 | 50.3% |
| UnitedHealthcare | 45380 | professional | 7 | 331.6 | 349.74 | 450.01 | 53.3% |
| UnitedHealthcare | 51728 | professional | 7 | 130.15 | 275.7 | 364.43 | 168.4% |
| UnitedHealthcare | 52000 | professional | 7 | 136.76 | 147.45 | 164.13 | 47.5% |
| UnitedHealthcare | 52277 | professional | 7 | 289.78 | 366.88 | 405.2 | 21.3% |
| UnitedHealthcare | 60500 | professional | 7 | 987.78 | 1106.4 | 1324.52 | 36.6% |
| UnitedHealthcare | 60502 | professional | 7 | 1158.96 | 1478.02 | 1596.43 | 48.9% |
| UnitedHealthcare | 62325 | professional | 7 | 164.21 | 170.33 | 205.05 | 35.6% |
| UnitedHealthcare | 64620 | professional | 7 | 174.98 | 198.6 | 233.43 | 40.9% |
| UnitedHealthcare | 69641 | professional | 7 | 919.45 | 1203.66 | 1338.75 | 39.8% |
| UnitedHealthcare | 10005 | professional | 6 | 98.42 | 104.18 | 132.09 | 26.8% |
| UnitedHealthcare | 10021 | professional | 6 | 80.54 | 102.48 | 108.5 | 161.5% |
| UnitedHealthcare | 11640 | professional | 6 | 156.8 | 176.38 | 223.77 | 124.2% |
| UnitedHealthcare | 11641 | professional | 6 | 189.29 | 213.44 | 267.91 | 134.7% |
| UnitedHealthcare | 11642 | professional | 6 | 218.46 | 246.7 | 307.6 | 143% |
| UnitedHealthcare | 11643 | professional | 6 | 264.67 | 299.37 | 370.21 | 156.5% |
| UnitedHealthcare | 14040 | professional | 6 | 660.54 | 776.18 | 941.17 | 68.8% |
| UnitedHealthcare | 14041 | professional | 6 | 824.15 | 951.76 | 1151.65 | 84.3% |
| UnitedHealthcare | 14060 | professional | 6 | 684.46 | 809.72 | 976.99 | 71.7% |
| UnitedHealthcare | 14061 | professional | 6 | 888.83 | 1021.88 | 1237.51 | 90.5% |
| UnitedHealthcare | 15823 | professional | 6 | 551.03 | 656.89 | 795.81 | 58.2% |
| UnitedHealthcare | 19296 | professional | 6 | 1558.78 | 1955.79 | 2907.56 | 43.8% |
| UnitedHealthcare | 19298 | professional | 6 | 603.95 | 730.8 | 911.39 | 12.6% |
| UnitedHealthcare | 20526 | professional | 6 | 65.3 | 72.62 | 88.95 | 139.6% |
| UnitedHealthcare | 20551 | professional | 6 | 46.68 | 52.6 | 64.34 | 156.7% |
| UnitedHealthcare | 20552 | professional | 6 | 45.15 | 49.34 | 62.11 | 175% |
| UnitedHealthcare | 20553 | professional | 6 | 51.4 | 56.28 | 71.21 | 171.1% |
| UnitedHealthcare | 20600 | professional | 6 | 42.37 | 48.79 | 56.13 | 151.4% |
| UnitedHealthcare | 20604 | professional | 6 | 59.34 | 62.44 | 78.07 | 114.1% |
| UnitedHealthcare | 20605 | professional | 6 | 44.02 | 50.84 | 58.96 | 156.1% |
| UnitedHealthcare | 20606 | professional | 6 | 65.78 | 70.17 | 87.75 | 121.5% |
| UnitedHealthcare | 20610 | professional | 6 | 53.17 | 62.44 | 71.16 | 160.3% |
| UnitedHealthcare | 20611 | professional | 6 | 74.53 | 80.32 | 99.98 | 125.3% |
| UnitedHealthcare | 20680 | professional | 6 | 503.57 | 568.26 | 704.42 | 45.5% |
| UnitedHealthcare | 21315 | professional | 6 | 175.59 | 179.03 | 279.43 | 27.2% |
| UnitedHealthcare | 21320 | professional | 6 | 179.74 | 181.91 | 257.65 | 12.3% |
| UnitedHealthcare | 21555 | professional | 6 | 357.58 | 401.99 | 489.27 | 54.2% |
| UnitedHealthcare | 22510 | professional | 6 | 991.85 | 1050.61 | 1478.01 | 63.9% |
| UnitedHealthcare | 22511 | professional | 6 | 968.77 | 1026.23 | 1448.02 | 62.4% |
| UnitedHealthcare | 22513 | professional | 6 | 2703.94 | 3483.57 | 4958.49 | 94.3% |
| UnitedHealthcare | 22514 | professional | 6 | 2667.01 | 3443.07 | 4916.05 | 93.2% |
| UnitedHealthcare | 22551 | professional | 6 | 1713.12 | 1965.47 | 2182.87 | 21.8% |
| UnitedHealthcare | 22558 | professional | 6 | 1470.49 | 1755.23 | 1980.15 | 8.7% |
| UnitedHealthcare | 22600 | professional | 6 | 1266.28 | 1495.06 | 1669.26 | 11.4% |
| UnitedHealthcare | 22612 | professional | 6 | 1526.32 | 1820.67 | 2052.4 | 13.5% |
| UnitedHealthcare | 22630 | professional | 6 | 1513.32 | 1788.55 | 2009.95 | 8.6% |
| UnitedHealthcare | 22633 | professional | 6 | 1829.91 | 2096.2 | 2368.96 | 10.1% |
| UnitedHealthcare | 22800 | professional | 6 | 1318.78 | 1564.07 | 1766.31 | 11.6% |
| UnitedHealthcare | 22802 | professional | 6 | 2037.73 | 2420.47 | 2726.78 | 17.4% |
| UnitedHealthcare | 22804 | professional | 6 | 2337.38 | 2778.92 | 3134.98 | 19.9% |
| UnitedHealthcare | 22810 | professional | 6 | 1944.9 | 2303.89 | 2586.54 | 16.5% |
| UnitedHealthcare | 22812 | professional | 6 | 2100.94 | 2513.42 | 2894.49 | 18% |
| UnitedHealthcare | 22849 | professional | 6 | 1261.27 | 1498.15 | 1678.56 | 16.3% |
| UnitedHealthcare | 22850 | professional | 6 | 712.11 | 840.98 | 948.43 | 22.8% |
| UnitedHealthcare | 22852 | professional | 6 | 685.99 | 808.25 | 912.67 | 21.9% |
| UnitedHealthcare | 22855 | professional | 6 | 1074.52 | 1279.89 | 1429.16 | 34.6% |
| UnitedHealthcare | 22856 | professional | 6 | 1597.41 | 1882.56 | 2096.78 | 14.4% |
| UnitedHealthcare | 22861 | professional | 6 | 2223.17 | 2527.96 | 2876.92 | 21.6% |
| UnitedHealthcare | 23472 | professional | 6 | 1391.39 | 1672.58 | 1917.01 | 12% |
| UnitedHealthcare | 24500 | professional | 6 | 338.16 | 399.45 | 476.2 | 294.7% |
| UnitedHealthcare | 24505 | professional | 6 | 465.3 | 545.62 | 644.58 | 62.5% |
| UnitedHealthcare | 25600 | professional | 6 | 320.2 | 376.56 | 451.27 | 277.8% |
| UnitedHealthcare | 25605 | professional | 6 | 516.27 | 612.23 | 717.76 | 70.1% |
| UnitedHealthcare | 25607 | professional | 6 | 716.14 | 848.36 | 988.84 | 17.1% |
| UnitedHealthcare | 25608 | professional | 6 | 799.9 | 948.79 | 1104.18 | 19% |
| UnitedHealthcare | 25609 | professional | 6 | 1013.07 | 1203.54 | 1399.99 | 24% |
| UnitedHealthcare | 26055 | professional | 6 | 428.15 | 457.5 | 578.54 | 52.4% |
| UnitedHealthcare | 26160 | professional | 6 | 448.05 | 480.31 | 610.59 | 55% |
| UnitedHealthcare | 26600 | professional | 6 | 285.17 | 337.38 | 402.11 | 248.9% |
| UnitedHealthcare | 27130 | professional | 6 | 1313.56 | 1537.19 | 1778.63 | 16% |
| UnitedHealthcare | 27134 | professional | 6 | 1819.3 | 2179.76 | 2501.79 | 23.4% |
| UnitedHealthcare | 27236 | professional | 6 | 1144.43 | 1366.32 | 1577.87 | 28% |
| UnitedHealthcare | 27245 | professional | 6 | 1212.86 | 1406.68 | 1623.22 | 29.1% |
| UnitedHealthcare | 27278 | professional | 6 | 4928.68 | 5795.18 | 9102.17 | 38.5% |
| UnitedHealthcare | 27279 | professional | 6 | 749.64 | 803.71 | 912.38 | 5.5% |
| UnitedHealthcare | 27280 | professional | 6 | 1276.23 | 1414.02 | 1716.29 | 10.2% |
| UnitedHealthcare | 27446 | professional | 6 | 1095.33 | 1294.84 | 1518.08 | 14.1% |
| UnitedHealthcare | 27447 | professional | 6 | 1345.82 | 1579.29 | 1787.74 | 16.8% |
| UnitedHealthcare | 27486 | professional | 6 | 1343.92 | 1606.59 | 1852.78 | 23.6% |
| UnitedHealthcare | 27487 | professional | 6 | 1674.88 | 2005.13 | 2305.63 | 14.4% |
| UnitedHealthcare | 27750 | professional | 6 | 326.24 | 386.54 | 460.09 | 285.2% |
| UnitedHealthcare | 27752 | professional | 6 | 501.46 | 588.1 | 695.24 | 67.4% |
| UnitedHealthcare | 27786 | professional | 6 | 293.18 | 347.32 | 416.03 | 256.2% |
| UnitedHealthcare | 27808 | professional | 6 | 311.72 | 368.94 | 441.62 | 272.2% |
| UnitedHealthcare | 27816 | professional | 6 | 302.31 | 353.51 | 424.91 | 260.8% |
| UnitedHealthcare | 28470 | professional | 6 | 204.13 | 241.81 | 293.05 | 178.4% |
| UnitedHealthcare | 29515 | professional | 6 | 58.33 | 66 | 81.3 | 119.2% |
| UnitedHealthcare | 29540 | professional | 6 | 25.28 | 27.94 | 30.21 | 193.6% |
| UnitedHealthcare | 29580 | professional | 6 | 41.12 | 42.81 | 60.11 | 99.6% |
| UnitedHealthcare | 29805 | professional | 6 | 453.02 | 539.88 | 634.44 | 32.8% |
| UnitedHealthcare | 29806 | professional | 6 | 1017.85 | 1214.87 | 1405.22 | 32.9% |
| UnitedHealthcare | 29807 | professional | 6 | 993.73 | 1185.23 | 1373.58 | 32.1% |
| UnitedHealthcare | 29819 | professional | 6 | 567.29 | 674.85 | 782.87 | 41% |
| UnitedHealthcare | 29820 | professional | 6 | 515.95 | 616.23 | 719.54 | 16.7% |
| UnitedHealthcare | 29821 | professional | 6 | 572.42 | 681.12 | 790.5 | 41.4% |
| UnitedHealthcare | 29822 | professional | 6 | 542.17 | 638.27 | 762.48 | 38.8% |
| UnitedHealthcare | 29823 | professional | 6 | 590.82 | 697.56 | 830.61 | 42.4% |
| UnitedHealthcare | 29824 | professional | 6 | 653.83 | 778.43 | 902.92 | 47.3% |
| UnitedHealthcare | 29825 | professional | 6 | 566.07 | 673.77 | 779.93 | 41% |
| UnitedHealthcare | 29827 | professional | 6 | 1026.26 | 1227.65 | 1410.43 | 33.2% |
| UnitedHealthcare | 29828 | professional | 6 | 881.07 | 1052.63 | 1216.25 | 28.5% |
| UnitedHealthcare | 29870 | professional | 6 | 481.74 | 552.75 | 674.14 | 33.6% |
| UnitedHealthcare | 29873 | professional | 6 | 520.14 | 613.18 | 715.86 | 37.3% |
| UnitedHealthcare | 29874 | professional | 6 | 520.68 | 619.3 | 719.31 | 37.7% |
| UnitedHealthcare | 29875 | professional | 6 | 480.84 | 571.42 | 666.43 | 34.7% |
| UnitedHealthcare | 29876 | professional | 6 | 630.65 | 751.58 | 877.18 | 45.7% |
| UnitedHealthcare | 29877 | professional | 6 | 599.99 | 714.51 | 832.9 | 43.4% |
| UnitedHealthcare | 29879 | professional | 6 | 639.08 | 761.02 | 885.8 | 46.3% |
| UnitedHealthcare | 29880 | professional | 6 | 553.96 | 651.67 | 757.07 | 39.6% |
| UnitedHealthcare | 29881 | professional | 6 | 533.23 | 626.87 | 729.71 | 38.1% |
| UnitedHealthcare | 29882 | professional | 6 | 664.74 | 794.95 | 930.12 | 48.3% |
| UnitedHealthcare | 29888 | professional | 6 | 936.51 | 1122.48 | 1301.95 | 23.3% |
| UnitedHealthcare | 29889 | professional | 6 | 1175.82 | 1397.53 | 1621.79 | 14.1% |
| UnitedHealthcare | 29891 | professional | 6 | 649.88 | 779.73 | 903.03 | 47.4% |
| UnitedHealthcare | 29894 | professional | 6 | 486.31 | 583.16 | 662.79 | 35.5% |
| UnitedHealthcare | 29895 | professional | 6 | 461.67 | 542.32 | 630.82 | 33% |
| UnitedHealthcare | 29914 | professional | 6 | 994.46 | 1149.62 | 1312.44 | 31.1% |
| UnitedHealthcare | 29915 | professional | 6 | 1014.12 | 1175.5 | 1346.52 | 31.8% |
| UnitedHealthcare | 29916 | professional | 6 | 1013.36 | 1172.47 | 1352.95 | 31.7% |
| UnitedHealthcare | 30115 | professional | 6 | 442.92 | 522.14 | 596.41 | 35.3% |
| UnitedHealthcare | 30130 | professional | 6 | 392.57 | 464.15 | 533.83 | 31.4% |
| UnitedHealthcare | 30140 | professional | 6 | 267.1 | 326.02 | 379.34 | 22.1% |
| UnitedHealthcare | 30420 | professional | 6 | 1383.55 | 1634.55 | 1850.93 | 54% |
| UnitedHealthcare | 30450 | professional | 6 | 1649.16 | 1903.52 | 2109.11 | 62.9% |
| UnitedHealthcare | 30465 | professional | 6 | 980.39 | 1161.99 | 1318.7 | 38.4% |
| UnitedHealthcare | 30468 | professional | 6 | 1199.36 | 1455.15 | 2259.76 | 34.8% |
| UnitedHealthcare | 30469 | professional | 6 | 1044.04 | 1238.19 | 1920.93 | 30.6% |
| UnitedHealthcare | 30520 | professional | 6 | 643.55 | 754.44 | 852.56 | 51% |
| UnitedHealthcare | 30801 | professional | 6 | 177.2 | 210.54 | 254.33 | 31.9% |
| UnitedHealthcare | 30802 | professional | 6 | 232.42 | 273.86 | 328.21 | 41.5% |
| UnitedHealthcare | 30903 | professional | 6 | 144.49 | 146.81 | 194.88 | 199.7% |
| UnitedHealthcare | 30905 | professional | 6 | 186.59 | 197.51 | 291.36 | 268.6% |
| UnitedHealthcare | 30906 | professional | 6 | 218.13 | 229.66 | 319.66 | 177.3% |
| UnitedHealthcare | 31231 | professional | 6 | 120.37 | 131.82 | 174.52 | 120.1% |
| UnitedHealthcare | 31237 | professional | 6 | 210.07 | 258.32 | 286.53 | 30.6% |
| UnitedHealthcare | 31238 | professional | 6 | 215.88 | 267.34 | 290.34 | 31.7% |
| UnitedHealthcare | 31239 | professional | 6 | 584.99 | 726.62 | 835.42 | 42.8% |
| UnitedHealthcare | 31240 | professional | 6 | 151.57 | 183.22 | 208.56 | 21.7% |
| UnitedHealthcare | 31253 | professional | 6 | 489.31 | 562.43 | 645.77 | 22.9% |
| UnitedHealthcare | 31254 | professional | 6 | 320.6 | 337.86 | 430.25 | 13.8% |
| UnitedHealthcare | 31255 | professional | 6 | 338.52 | 404.09 | 428.55 | 16.5% |
| UnitedHealthcare | 31256 | professional | 6 | 179.11 | 213.93 | 236.73 | 12.6% |
| UnitedHealthcare | 31257 | professional | 6 | 435.84 | 501.44 | 575.65 | 20.5% |
| UnitedHealthcare | 31259 | professional | 6 | 461.22 | 530.47 | 609.65 | 21.6% |
| UnitedHealthcare | 31267 | professional | 6 | 270.61 | 327.05 | 350.81 | 13.3% |
| UnitedHealthcare | 31276 | professional | 6 | 416.3 | 489.41 | 504.51 | 20% |
| UnitedHealthcare | 31287 | professional | 6 | 204.24 | 244.21 | 265.82 | 10% |
| UnitedHealthcare | 31288 | professional | 6 | 236.94 | 283.7 | 308.46 | 11.6% |
| UnitedHealthcare | 31295 | professional | 6 | 802.47 | 1062.4 | 1428.81 | 34.2% |
| UnitedHealthcare | 31296 | professional | 6 | 829.72 | 1090.22 | 1460.71 | 72.9% |
| UnitedHealthcare | 31297 | professional | 6 | 786.81 | 1049.7 | 1410.59 | 33.7% |
| UnitedHealthcare | 31298 | professional | 6 | 1451.8 | 1825.39 | 2652.99 | 74.5% |
| UnitedHealthcare | 31535 | professional | 6 | 179.56 | 217.07 | 247.31 | 12.8% |
| UnitedHealthcare | 31536 | professional | 6 | 199.36 | 241.27 | 274.32 | 14.2% |
| UnitedHealthcare | 31540 | professional | 6 | 228.68 | 276.8 | 313.93 | 16.3% |
| UnitedHealthcare | 31541 | professional | 6 | 249.46 | 302.15 | 342.25 | 17.8% |
| UnitedHealthcare | 31576 | professional | 6 | 184.97 | 187.23 | 258.58 | 22.2% |
| UnitedHealthcare | 31577 | professional | 6 | 201.73 | 202.29 | 273.59 | 94.2% |
| UnitedHealthcare | 31578 | professional | 6 | 225.37 | 230.91 | 302.47 | 13.6% |
| UnitedHealthcare | 31579 | professional | 6 | 154.81 | 179.57 | 204.8 | 141.9% |
| UnitedHealthcare | 31600 | professional | 6 | 327.21 | 388.5 | 418.23 | 26.2% |
| UnitedHealthcare | 32555 | professional | 6 | 222.44 | 292.44 | 296.41 | 84.9% |
| UnitedHealthcare | 33206 | professional | 6 | 448.52 | 518.58 | 586.42 | 7.1% |
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.
- Payer files: 2026-09
Questions
Is this what the practice was paid?
No. These are contracted rates as published by the payer, not allowed or paid amounts.
Why are some cells blank?
Ghost rates are removed using Medicare utilization. A row appears only if that NPI billed the code.
What is an episode total?
Professional plus facility when both exist. We never average them or invent a total from one side.
Saran Siva
Co-founder & CTO, Insight Health · September 2026 files