What is “charged” is usually based loosely based off of Medicare rates. For instance, my bills are all set to 225% of Medicare rates.

The insurance has their own, un published rate they are willing to pay, and their own set of rules. (Or if it is published it’s very deeply hidden and hard to find)

I can charge a 99213 (basically a low level office visit). Through UHC I’ve been paid as little as $60 to as much as $120 for the visit. It all depends on the patients actual plan through UHC. I can tell you how much I expect it to be. But the insurance sets the prices.

This is in a small, private practice where I’m in charge of everything. If your doctor is employed (which most are now a days) he’s going to have no idea how much you’ll get charged. But he’ll get like 10% of whatever you get charged (less if it was a surgery)