Committees in both the House and Senate have advanced legislation that includes measures to address "surprise bills." A surprise bill results when a person unknowingly receives medical care from a provider that is not part of their insurer's network. Both pieces of legislation set a benchmark for out-of-network payments. Those benchmarks are determined based on the median in-network amount paid by an insurer for similar services. To understand how such a rate might vary across types of services and geographies, we calculated 2017 state level median and mean in-network rates paid for select services used by people with health insurance provided through their employer (ESI – employer sponsored insurance).

We examined the ESI in-network allowed amounts (the total payment negotiated between providers and insurers, including the amount paid by patients) for the most common anesthesia, emergency room, and radiology procedures. The amounts presented here only include the physician costs and do not include any facility fees or ancillary services. For each of these service categories we restricted to providers with the specialty that most commonly bills for these services. For anesthesia procedures we only included claims where an anesthesiologist provided the service; for ER procedures we looked at claims from emergency medicine specialists; and for radiology procedures we included only claims from radiologists.

We calculated the median and mean ESI allowed amounts for each service and procedure by state and where possible by urban and rural areas within states. We also include the average Medicare fee-for-service allowed amounts published by the Centers for Medicare and Medicaid Services (CMS). The mean commercial and Medicare rates can be compared to better understand the variation in the costs of these procedures across states and payers.