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. Author manuscript; available in PMC: 2019 Jan 1.
Published in final edited form as: Am J Manag Care. 2018 Jul;24(7):341–344.

Table.

Median MA-to-TM Price Ratios

Median MA-to-TM price ratio across all MSAs
Service Median Price Ratio N (# of MSAs)
Low-complexity E&M office visit with established patient (CPT 99213) 1.01 165
Routine electrocardiogram, complete (CPT 93000) 1.00 49
Low-complexity E&M office visit: Median MA-to-TM price ratio, by benchmark level
Range of Benchmark Ratios (relative to FFS) Mean Benchmark Ratio (relative to FFS) Median Price Ratio N (# of MSAs)
0.95 ≤ ratio ≤ 0.975 0.95 1.01 49
0.975 < ratio ≤ 1.025 1.00 1.01 39
1.025 < ratio ≤ 1.125 1.07 1.02 58
1.125 < ratio ≤ 1.15 1.15 1.02 19

MA indicates Medicare Advantage; TM, Traditional Medicare; MSA, Metropolitan Statistical Area; E&M, evaluation and management; CPT, Current Procedural Terminology; FFS, fee-for-service