Commercial rate index · metro cell
Utica-Rome healthcare rate index
Commercial contracted rates in Utica-Rome, NY run 0.78x the national Medicare fee schedule across the office-visit basket. Index 81.6, where 100 is the national standard.
Index 81.6
0.78x Medicare
4,322 verified rate points
8/8 basket codes
state index 83.5
The basket in Utica-Rome
as of 2026-07-15| CPT | Service | Metro median | vs Medicare | Rate points | Tier |
|---|---|---|---|---|---|
| 99202 | Office visit, new patient, 15-29 min | $69.86 | 0.98x | 897 | Benchmark |
| 99203 | Office visit, new patient, 30-44 min | $97.33 | 0.88x | 454 | Benchmark |
| 99204 | Office visit, new patient, 45-59 min | $134.66 | 0.81x | 359 | Benchmark |
| 99205 | Office visit, new patient, 60-74 min | $218.89 | 1.00x | 882 | Benchmark |
| 99212 | Office visit, established patient, 10-19 min | $42.96 | 0.76x | 473 | Benchmark |
| 99213 | Office visit, established patient, 20-29 min | $70.34 | 0.76x | 410 | Benchmark |
| 99214 | Office visit, established patient, 30-39 min | $64.92 | 0.49x | 434 | Benchmark |
| 99215 | Office visit, established patient, 40-54 min | $118.70 | 0.64x | 413 | Benchmark |
Medians across the full verified distribution of practice-level contracted rates in this CBSA (46540). Floor: 11 verified rate points per code, non-degenerate spread. Denominator: CMS PFS CY2026 national non-facility. Methodology v1.0.
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
The market around it.
Utica-Rome prints below its state cell (New York at 83.5) and below the national standard of 100.
Cite this page
Source: Reddenda Commercial Rate Atlas, Utica-Rome, NY. Reddenda. https://reddenda.health/atlas/ny/utica-rome-46540/
Derivation federally mandated TiC MRFs, verified to provider identityCBSA 46540 · metro grainas of 2026-07-15 · methodology v1.0