What you are actually paid, vs what peers actually get.
Contracted rates are not what lands in the bank. Specula puts every real lens on each code side by side: your published rate, the local-peer median and P90 target, the Medicare-allowed floor, the CMS national reference, your measured paid from your own 835s, and what peers actually collect across the network. Local-peer, never national. Modeled, never a guarantee.
That sample location shows a documented opportunity of ~$403K/yr against its local-peer median. Drop your top provider's NPI to see your full gap breakdown by specialty. No PHI, no card.
| Code | Band | Contracted | Peer p50 | P90 | Medicare | Nat ref | Your paid | Network | $ left |
|---|---|---|---|---|---|---|---|---|---|
99214PublishedTop gap Office visit, established patient, moderate | $128.00 | $158.00 | PROp75 | $109.00 | — | 835s | n<11 | $184,800 | |
45380Published Colonoscopy w/ biopsy | $408.00 | $498.00 | PROp75 | $458.00 | — | 835s | n<11 | $87,040 | |
45385Published Colonoscopy w/ lesion removal (snare) | $498.00 | $612.00 | PROp75 | $561.00 | — | 835s | n<11 | $86,400 | |
90837Published Psychotherapy, 60 minutes | $118.30 | $152.60 | PROp75 | $141.90 | — | 835s | n<11 | $84,546 | |
93306Published Echocardiogram, complete w/ Doppler | $198.00 | $246.00 | PROp75 | $224.00 | — | 835s | n<11 | $81,840 | |
27447Published Total knee arthroplasty | $1,340.00 | $1,620.00 | PROp75 | $1,486.00 | — | 835s | n<11 | $38,400 |
Peer p50 and P90 are your LOCAL-peer benchmark (never national). Where no real local P90 is indexed for a code, the target falls back to your local p75 or local median and the cell is tagged with what it actually is — we never label a median “P90”. Nat ref is the CMS national per-code reference, shown separately and never as your peer median. Your paid = your own de-identified 835 median (n≥11, no PHI); Network = cross-practice paid median where n≥11 (anonymized aggregate). Dollars left = per-unit gap to that target on your real volume: documented opportunity, modeled, never guaranteed. Where we have no volume for a code we show the documented per-unit gap and ask you for the count. A dash means we hold no value, not a value of zero — we never print a $0.00 to stand in for a number we do not have, and a code with no Medicare allowed amount (labs, drugs, most DMEPOS) reads as a dash, never as “Medicare pays $0.00”.