The State of Private-Practice Rates
Inaugural Edition · Summer 2026 · v1.0 · living page; the frozen PDF edition prints on the quarterly RCRI calendar (November 17, 2026).
This is the live edition. It reads from the same corpus the tools read from, and it updates as the corpus updates. The frozen PDF edition follows the quarterly print calendar. The numbers on this page are the numbers that print.
Five findings, one baseline. Every figure is sourced to federal transparency data and stated against Medicare. Below the floor, we publish nothing.
Private practice is paid 0.9608 times Medicare.
One number carries the whole market. Across the eight office-visit codes that make up most of a practice’s revenue, commercial payers pay a hair under Medicare. Parity is the exception, not the rule.
The full index
The RCRI is the standing series behind this finding. Methodology v1.0, all 51 jurisdictions.
Open the RCRI →https://reddenda.health/reports/state-of-rates/#the-standard
The same code swings from 0.69x to 1.62x by state.
A visit is a visit. The code does not change. The state does. In the top metro, Rochester, Minnesota, one office visit pays close to two times Medicare. The floor sits near two-thirds. Geography, not medicine, sets the price.
State multiples, one code, full range
99213 · as of 2026-07Highest-paying states, ranked
loadinghttps://reddenda.health/reports/state-of-rates/#the-spread
New patients price above Medicare. Established patients get cut.
The gap is structural. New-patient visits clear parity, and three of the four price above it. Every established-patient visit is compressed, roughly thirteen percent below Medicare. Most practice volume is established-patient. The compression is where the market lives.
Office E/M basket, multiple of Medicare
8 codes · as of 2026-07| Code | Visit | Multiple of Medicare | Sample |
|---|---|---|---|
| 99202 | New patient, level 2 | 1.0971x | 1.0M+ |
| 99203 | New patient, level 3 | 0.9877x | 2.25M+ |
| 99204 | New patient, level 4 | 1.0388x | 2.1M+ |
| 99205 | New patient, level 5 | 1.0704x | 1.2M+ |
| 99212 | Established, level 2 | 0.8783x | 1.4M+ |
| 99213 | Established, level 3 | 0.8656x | 2.25M+ |
| 99214 | Established, level 4 | 0.8727x | 2.2M+ |
| 99215 | Established, level 5 | 0.8759x | 1.1M+ |
A practice that reads only its headline rate misses this. The mix of new versus established visits moves realized reimbursement more than the headline multiple does.
https://reddenda.health/reports/state-of-rates/#the-parity-gap
645,062 practices have a renewal window we can already see.
A renewal window is the moment a contract can be reopened. We read those windows out of federal filings, strictly in the future. The calendar is not flat, and the crowded months are the ones worth knowing.
Renewal windows, by month
strictly future · as of 2026-07Windows run from August 2026 through March 2028. The live figures below name the heaviest month.
https://reddenda.health/reports/state-of-rates/#the-renewal-wall
1,392 markets graded. Rich or thin, by specialty and state.
We graded 1,392 specialty-and-state markets against the rate distribution inside each specialty. The grade answers one question: for this specialty, in this state, is the money rich or thin.
How to read a Market Grade
2026 Edition · frozenEach cell is scored on its multiple of Medicare against the percentile of its own specialty, then banded A+ through F, with a confidence read of High, Medium, or Directional set by sample depth.
Version one grades commercial rate richness only. Payer-mix breadth joins in a later edition; until it does, a high grade means rich rates, not a broad payer roster. That distinction is disclosed on every grade.
https://reddenda.health/reports/state-of-rates/#the-grades
How this edition is built.
Sources
Federally mandated Transparency-in-Coverage machine-readable files, verified to provider identity through NPPES. Medicare comparisons use the CMS Physician Fee Schedule CY2026, national non-facility. Renewal windows are read from the same federal filings.
Publication floor
One definition, everywhere. A cell publishes only at n of 11 or more verified rate points with a non-degenerate spread. Directional covers 11 to 24 points and shows a median only. Standard covers 25 to 99 and adds the P25 to P75 band. Benchmark-grade is 100 or more and carries the full band. A cell below the floor gets no number and no share card.
Denominator and as-of dates
Every multiple is stated against the CMS PFS CY2026 non-facility rate. MRFs ingested 2026-07. RCRI vintage 2026-07. Renewal windows are strictly future, August 2026 through March 2028.
Framing
Dollar and rate figures are documented reimbursement opportunity, modeled not guaranteed. No PHI is used or required. Reddenda takes no payer money.
Request the frozen PDF edition
The frozen PDF edition ships on the quarterly print calendar. The next print is November 17, 2026. Request it from a work email and we send it when it prints.