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.
Your payers vs practices like yours: are they undercutting you? Drop your NPI — 30 seconds, no PHI, no card — and see it code by code against your local-peer median.
| 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 | $137,280 | |
99213Published Office visit, established patient, low | $92.00 | $112.00 | PROp75 | $76.00 | — | 835s | n<11 | $122,090 | |
99204Published Office visit, new patient, moderate-high | $192.00 | $234.00 | PROp75 | $168.00 | — | 835s | n<11 | $58,800 | |
99396Published Preventive visit, established, 40-64 yrs | $158.00 | $196.00 | PROp75 | — | — | 835s | n<11 | $33,920 | |
99203Published Office visit, new patient, low-moderate | $138.00 | $168.00 | PROp75 | $122.00 | — | 835s | n<11 | $30,960 | |
99385Published Preventive visit, new, 18-39 yrs | $152.00 | $188.00 | PROp75 | — | — | 835s | n<11 | $20,500 |
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”.