The out-of-network payment picture.
See how federal IDR disputes were decided. Explore dollar benchmarks by procedure and region, then compare reported outcomes across payers.
MedRes analysis of CMS public-use files · Released Jul 22, 2026 · Updated Sep 17, 2026
Sources & methodologyExplore reimbursement by CPT code
Historical out-of-network payment determinations, with initial payments shown separately. Dollar records do not identify the payer.
3,715 CPT codes · select a code to compare regions and payers
Scroll the table sideways to see all metrics.
| CPT / PROCEDURE | MEDIAN DETERMINATION | MIDDLE 50% | INITIAL PAYMENT | VALID AWARDS | Open code |
|---|---|---|---|---|---|
| 99284Emergency department visit, level 4 | $759n = 221,538 | $573 – $2,314 | $174n = 217,445 | 221,538 | |
| 99285Emergency department visit, level 5 | $970n = 127,082 | $762 – $1,609 | $268n = 124,894 | 127,082 | |
| 99283Emergency department visit, level 3 | $1,336n = 67,665 | $446 – $2,873 | $107n = 66,675 | 67,665 | |
| 71045Chest X-ray, single view | $57n = 22,369 | $36 – $122 | $11n = 22,656 | 22,369 | |
| 85025Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $268n = 20,260 | $128 – $309 | $24n = 19,367 | 20,260 | |
| 74177CT of the abdomen and pelvis with contrast | $1,100n = 19,950 | $429 – $1,876 | $136n = 19,688 | 19,950 | |
| 99291Critical care, first 30–74 minutes | $1,118n = 17,251 | $837 – $1,855 | $301n = 17,937 | 17,251 | |
| 80053Blood test, comprehensive group of blood chemicals | $606n = 16,683 | $180 – $824 | $30n = 15,962 | 16,683 | |
| 77067Screening mammography | $192n = 14,844 | $179 – $193 | $67n = 15,008 | 14,844 | |
| 71046Chest X-ray, two views | $127n = 13,810 | $52 – $348 | $13n = 13,658 | 13,810 |
1–10 of 3715
A determination is the selected out-of-network payment amount, not additional recovery or verified cash received. Initial-payment and determination medians may use different observations. Small cohorts are omitted; totals can exceed the visible rows. Read the methodology.
What this data can tell you
Compare the distribution of reported outcomes, the number of observations behind them, and differences between service settings. Every metric here comes from published federal IDR records; it is independent of MedRes client performance.
Keep the claim context in view
These are selected disputes that reached a determination. Awards are not verified collections. CPT codes alone do not establish eligibility, and professional, technical and other modifiers are pooled in this release.
Review eligibility factorsReading the benchmarks
What do these out-of-network benchmarks measure?
They summarize federal IDR payment determinations closed in Q4 2025. They are not contracted fee schedules, all out-of-network paid claims, expected recovery, or MedRes client results.
Why are dollar benchmarks and payer outcomes separate?
CMS publishes payer-named outcome records and a separate anonymous dollar file. The files do not share reliable dispute identifiers. We calculate each view independently and do not infer payer-specific dollar awards.
Why are some codes or cohorts missing?
The directory includes every explicitly reported CPT code in the Q4 2025 dollar and named emergency/non-emergency files. Codes with fewer than 11 usable dollar awards open in payer view. We exclude bundled primary and component records, and only display metrics supported by at least 11 valid observations. Missing or suppressed data are not zero.
Browse all 3,715 CPT codes
Emergency medicine 7 codes
Radiology 377 codes
Laboratory 447 codes
Anesthesiology 234 codes
Medicine 251 codes
Evaluation & management 68 codes
Surgery 2,325 codes
Category III 6 codes
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