5,144 CPT×payer combinations where commercial insurers pay less than Medicare — a rate that should be the floor for commercial contracts. UHC alone has 458 below-Medicare CPT codes. Aetna has 535. These represent immediate renegotiation targets for Megan's contracting team.
The same payer pays different HVP practices wildly different rates for identical CPT codes. UHC pays PSC $2,927 for a cardiac cath (93458) but pays CHC only $878 — a $2,049 gap per claim. This gives Megan concrete leverage: "You pay our other practice 3.3× more for the same procedure."
| Payer | CPT | Procedure | Best Rate | Worst Rate | Spread | Gap |
|---|---|---|---|---|---|---|
| UHC | 93458 | Coronary angiography | $2,927 | $878 | $2,049 | CHC→PSC |
| BCBS | 93458 | Coronary angiography | $3,040 | $1,205 | $1,835 | ACS TX→CSC |
| UHC | 93458 | Coronary angiography | $2,927 | $1,308 | $1,619 | CSC→PSC |
| Aetna | 93458 | Coronary angiography | $1,862 | $849 | $1,014 | CHC→PSC |
| Cigna | 93458 | Coronary angiography | $1,862 | $973 | $889 | SLHV→PSC |
| UHC | 93351 | Stress echo complete | $416 | $191 | $225 | CHC→SLHV |
| UHC | 93306 | TTE w/Doppler | $368 | $169 | $199 | CHC→SLHV |
| Cigna | 93306 | TTE w/Doppler | $305 | $190 | $115 | SLHV→AFRIDI |
| Aetna | 93306 | TTE w/Doppler | $245 | $158 | $87 | CHC→AFRIDI |
| Aetna | 99214 | Office visit E/M | $153 | $89 | $63 | SLHV→ACS TX |
| Payer | CPTs Below MC | Avg % of MC | Worst Example |
|---|---|---|---|
| OK Health Network | 743 | 90% | Systematic 90% cap across all codes |
| Blue Advantage | 596 | 88% | 93298 @ AFRIDI: $23 vs MC $102 |
| Aetna | 535 | 80% | 93616 @ SLHV: $82 vs MC $460 |
| UHC | 458 | 77% | 37247 @ ASRS: $114 vs MC $3,149 |
| BCBS Traditional | 291 | 86% | 93298 @ ACS TX: $30 vs MC $93 |
| Meridian | 270 | 48% | 37226 @ AHG: $294 vs MC $7,550 |
| Cigna | 217 | 64% | 92978-TC @ CSC: $9 vs MC $160 |
This means below-Medicare commercial rates are even worse than they appear — the total expected collection (insurance + patient) is below what Medicare alone would pay.
If worst-rate practices matched best-rate practices for each payer×CPT combination, the per-occurrence uplift is $27,921 across top CPT codes. At ~100 cardiac caths per practice per year, the cath code alone represents $200K+ in annual rate gap.
1. Pull claim volume by CPT per practice to annualize per-occurrence gaps
2. Prioritize renegotiation: start with UHC cardiac caths ($2,049/claim gap)
3. Use cross-practice rates as leverage: "You pay our Colorado practice 3.3× more"
4. Flag all below-Medicare commercial rates for immediate contract review
5. Compare against PayerPrice platform data for regional market benchmarks
6. Provide ERA/835 export from Waystar to run full underpayment verification