By Craig Gottwals – Mar 31, 2026
Most people assume that when a massive insurance company negotiates with a doctor, there is a single, disciplined price for a routine visit. We like to think that these billion-dollar entities use their size to ensure every patient gets a fair, standardized deal. The data recently shared by Josh Nakka and his team at PriceMedic proves that this is simply an illusion.
When you look at what UnitedHealthcare actually pays for basic office visits, the numbers are all over the map. There is no rhyme or reason to it. There is no market rate. There is only the price that a specific doctor was able to negotiate on a specific day.
How to Use This Chart
If you are looking at Josh Nakka’s data for the first time, it might look like a wall of numbers. Here is the simple way to read it so you can see the chaos for yourself.
Every number in those cells represents a gap in pay. It does not show the actual price. Specifically, it shows the spread between what the higher paid doctors get and what the lower paid doctors get for the exact same specialty in the exact same state. The chart measures this gap using the Medicare rate as a baseline.
Let us look at a specific example to make this crystal clear. Find Internal Medicine in Massachusetts, which is the MA column. The number in that cell is 117, and it is shaded dark red. This means the gap between the higher paid primary care doctors and the lower paid primary care doctors is 117 percentage points of the Medicare rate.
To put some real numbers to this math, imagine the baseline Medicare rate for a standard office visit is exactly one hundred dollars. A spread of 117 means the difference between the lower end of the pay scale and the higher end is one hundred and seventeen dollars. On average, primary care physician reimbursement hovers very close to the standard Medicare rate, unlike hospital facility fees which are astronomically higher. Therefore, UnitedHealthcare might be paying the doctors at the lower end a dismal 70 percent of Medicare, which is exactly seventy dollars. Meanwhile, they are paying the doctors at the higher end 187 percent of Medicare, which equals one hundred and eighty seven dollars.
If you subtract the lower rate from the higher rate, you get that exact 117 point spread. Both of these doctor groups are in the exact same network in the exact same state, yet one is taking a severe pay cut below the government rate while the other is paid significantly more for doing the exact same work.
In a functioning market, that spread should be very close to zero. A routine visit is a routine visit. Yet, the insurance carrier is paying wildly different rates right down the street from one another.
The colors make the price fragmentation easy to spot. The blue cells represent a spread of 20 to 40 points. That is still bad, but it is relatively stable. The dark red cells represent a spread of over 100 points. If you look at Massachusetts or Minnesota, you will see a sea of red. That is pure, unadulterated price manipulation in a commercial PPO network.
Why This Matters to You
If you are an employer providing health insurance, this lack of discipline is costing you a fortune. You are handing your credit card to a middleman who has no incentive to find the best price.
Imagine going to the grocery store for a gallon of milk. You expect to pay the price on the tag. Now imagine if the store looked at your wallet and decided to charge you ten dollars while charging the person behind you only four dollars. That is exactly how commercial insurance pricing works today. It is a system built on smoke and mirrors rather than actual value.
Transparency is the Antidote
We cannot fix what we cannot see. For decades, these contracted rates were treated like state secrets. Now that the data is finally becoming public, we can see the massive gaps between what different providers are paid.
This is why Reference Based Pricing is the most logical path forward for any organization that cares about its fiduciary duty. Instead of participating in a game where the prices are hidden and made up to begin with, Reference Based Pricing uses a transparent benchmark. We start with the Medicare rate, which is the most widely accepted and transparent price list in the world. Then, we add a fair profit margin on top of that.
A Better Way Forward
This approach removes the negotiation games. It ensures that every doctor is paid fairly and every employer knows exactly what they are paying for. Most importantly, it brings honesty back to a system that has been defined by confusion for far too long.
I want to give a huge thank you to Josh Nakka for highlighting this data. It is a perfect illustration of why the status quo is failing and why we need to move toward a model built on transparency and common sense. If you are still relying on a black box PPO network, it is time to ask why your rates vary so wildly for the same services. The era of the hidden price is ending. It is time to embrace a model that actually works for the people paying the bills.
And yes, I’m going to date myself
