The 2x office visit: what the same visit pays across America

The same established-patient office visit, CPT 99213, prices from $57.62 in North Carolina to $124.57 in Wisconsin across state medians. Rochester, Minnesota clears 2.0x the national standard while Texas sits at 0.92x Medicare. And nationally, the median established-visit contract pays under Medicare parity, while new-patient visits price above it. One code, one country, two different economies.

By the Reddenda desk July 2026 Methodology v1.0

How this was measured. Every figure is a contract median drawn from federally mandated Transparency-in-Coverage machine-readable files, verified to provider identity, and priced against the CMS Physician Fee Schedule CY2026 national non-facility rate. A cell publishes only when it clears the suppression floor: at least 11 verified rate points and a non-degenerate spread. Multiples are ratios of the commercial median to the Medicare rate for the same code. Documented reimbursement opportunity, modeled not guaranteed.

The spread

One code. A 2.2x gap between the top state and the bottom.

This is 99213, the most common office visit in American medicine, ranked by state median contract rate. North Carolina sits at the bottom at $57.62. Wisconsin tops the ladder at $124.57. The Medicare non-facility anchor sits at $92.42.

99213 · state median contract rate

As of July 2026

Medicare 99213 non-facility anchor: $92.42. Wisconsin state median tops the ladder at $124.57. Bars scale to the top state. Pre-baked anchors as of July 2026; the ladder hydrates live.

Loading the 51-state ladder.Reading verified 99213 medians from the corpus. If this stays, the view has not cleared the publication floor for your session.

Derived from federally mandated Transparency-in-Coverage MRFs, ingested 2026-07; methodology v1.0. States below the suppression floor are shown thin or withheld. Documented reimbursement opportunity, modeled not guaranteed.

Source: Reddenda Newsroom · https://reddenda.health/newsroom/the-two-x-office-visit/

The index

Read as an index, the country runs from 0.69x to 1.62x.

The same picture, normalized. Each state’s office-visit basket, expressed against the national standard, where 100 is the country’s middle. The span runs from 0.69x at the bottom to 1.62x at the top.

State reimbursement index · office-visit basket

As of July 2026

100 = the national standard. The state index spans 0.69x to 1.62x (index 69 to 162) as of July 2026. Bars scale to the top state; the ladder hydrates live.

Loading the state index ladder.Reading published state cells from the Atlas. If this stays, the grain has not cleared the publication floor for your session.

Index level 100 equals the national median of the office-visit basket. Derived from the Rate Atlas, 51 of 51 states published; methodology v1.0. Open the Rate Atlas →

Source: Reddenda Rate Atlas · https://reddenda.health/atlas/

The parity gap

New-patient visits beat Medicare. Established visits trail it by ~13%.

The office-visit basket splits cleanly. The four new-patient codes price at or above Medicare parity. The four established-patient codes are compressed below it, all clustered near 0.87x to 0.88x.

Office-visit basket · commercial median vs Medicare

RCRI print 001 · vintage 2026-07

Code	Visit type	Description	× Medicare	Position
99202	New	New patient, straightforward, 15–29 min	1.0971×	Above parity
99203	New	New patient, low complexity, 30–44 min	0.9877×	Below parity
99204	New	New patient, moderate, 45–59 min	1.0388×	Above parity
99205	New	New patient, high, 60–74 min	1.0704×	Above parity
99212	Established	Established, straightforward, 10–19 min	0.8783×	Below parity
99213	Established	Established, low complexity, 20–29 min	0.8656×	Below parity
99214	Established	Established, moderate, 30–39 min	0.8727×	Below parity
99215	Established	Established, high, 40–54 min	0.8759×	Below parity

Multiples are commercial contract medians against CMS PFS CY2026 national non-facility rates, frozen RCRI print 001, methodology v1.0. Sample per code ranges 1.0M to 2.25M verified rate points; every row is benchmark-grade. Documented reimbursement opportunity, modeled not guaranteed.

A practice weighted toward new patients collects above Medicare parity on its evaluation work; a practice built on established-patient follow-ups collects roughly thirteen percent below parity on the same codes. The payer mix, not the specialty, decides which side of parity a contract lands on.

Multiples are contract medians against CMS PFS CY2026 national non-facility rates, methodology v1.0. Documented reimbursement opportunity, modeled not guaranteed.

Take the data

Download it. Embed it. Carry the source.

The state-level dataset behind these charts is public under CC BY-NC-ND 4.0. Reproduce the figures and embed the ladder. Attribution required: Source: Reddenda.

Download the dataset

State medians, sample sizes, and index levels for the office-visit basket, July 2026 vintage. CSV, CC BY-NC-ND 4.0.

Download atlas-states-2026-07.csv ↓

Cite this story

Reddenda Newsroom (2026). "The 2x office visit: what the same visit pays across America." Published 2026-07-15. Source: Reddenda. https://reddenda.health/newsroom/the-two-x-office-visit/

Embed the ladder

<iframe src="https://reddenda.health/newsroom/the-two-x-office-visit/embed/the-spread" width="640" height="480" title="99213 state median ladder, Source: Reddenda" loading="lazy" style="border:1px solid #e5e5e5;border-radius:12px"></iframe>

99213 state ladder · Source: Reddenda

The loop

Is your contract on the wrong side of this chart?

The national ladder is only useful next to your own rates. Run your NPI and see where your 99213 lands against your local peers and your own payers.

Run your NPI free Book a discovery call

RateScore is computed against your local peer median and your own payers. Documented reimbursement opportunity, modeled not guaranteed. No PHI required.