[colbyh]

I work in the industry. Fee schedules are an upper bound, but the lower bound is very hard to get numbers on and often approaches 0.

If I go in for a procedure at a medium sized specialist clinic they are going to take the fee schedule for this CPT, discount by my 20% expected contribution (or whatever), and then hope that the insurer pays them > 50% of the remainder.

A lot of the time my insurer will, but not always. Bigger systems negotiate their own fees and many doctors at larger clinics only track RVUs for each procedure (specifically because the clinics realize that paying based on insurance payout isn't fair or scalable, in that way RVU allocations act as a pool). But overall it's not a transparent system for the majority of people working within in.