I havn't worked with Medicaid for 10 years now so it may have changed. But when I did the fee comparisons were based on the geographical area the provider worked in. So, if the 75th percentile for an office visit in Seattle was $50, the Seattle provider got $50. If it was $75 in NY they got $75 in NY.

The problem remains that health care costs are skyrocketing and our ability to pay is not. There is a serious crunch coming no matter what system we use.