Healthcare investors and acquirers
See if a target is reimbursed above or below market before the data room opens.
PayerPrice is a healthcare price transparency platform for investors and acquisition teams. See a target's rates without its data.
Not ready for a call?
Check a target's rates against peers before you rely on the operator's numbers.
Payers publish the rates they've negotiated with each Tax ID. See which payers reimburse a target above or below market before the data room opens.
CPT 45380 in an ASC | Texas gastroenterologists | Sept. 2026 files
One Texas GI group: 2.1 times the median from United, below it from BCBS.
- Target, UnitedHealthcare
- $623.49
- Texas median, UnitedHealthcare
- $294.63
- Target, BCBS of Texas
- $344.80
- Texas median, BCBS of Texas
- $402.58
Source: payer in-network files, Sept. 2026, professional fee. Target: a Texas GI group, unnamed. Medians across 486 (United) and 823 (BCBS) Texas gastroenterology Tax IDs. How we count
De-risk the acquisition before you set the price.
See the market overviewPull a target's rates without asking the operator.
Search the target's Tax IDs. Payers publish its rates by code and setting, so you don't need its data or to name the deal.
How does each payer reimburse the target?
- Tax IDThe target's Tax IDs or NPIs
- CodesThe target's top codes
- PayersCommercial payers in its state
- SettingOffice, ASC or hospital outpatient
Each payer's rate for the target, by code
| Payer | Code | Setting | Rate |
|---|---|---|---|
| UnitedHealthcare | 45380 | ASC | $623.49 |
| BCBS of Texas | 45380 | ASC | $344.80 |
| Cigna | 45380 | ASC | $311.38 |
| Aetna | 45380 | ASC | $226.91 |
See if the target is reimbursed above or below market.
Place each of the target's rates among peers in the same specialty, setting and state, one payer at a time.
CPT 45380 in an ASC | Texas gastroenterologists | Sept. 2026 files
The target's rate beside the Texas median, by payer.
- UnitedHealthcare
- $623Target$295Texas median
- BCBS of Texas
- $345Target$403Texas median
- Cigna
- $311Target$273Texas median
- Aetna
- $227Target$232Texas median
Professional fee. Texas medians across 464 to 823 Tax IDs per payer. How we count
Check whether the rates have held.
Files go back to August 2023. A rate far above peers, or one that moved sharply, is a question for the operator.
Will the rates last?
- Rate historyMonthly payer files back to August 2023
- Source filesPayer, provider, code, location and file date
- ClaimsAllowed amounts matched to published rates, under a BAA
Which rates held and which moved. Shown: Mar. to Sept. 2026; check any payer whose file format changed
| Payer | Mar. 2026 | Sept. 2026 | Change |
|---|---|---|---|
| UnitedHealthcare | $623.49 | $623.49 | 0.0% |
| BCBS of Texas | $353.28 | $344.80 | −2.4% |
| Cigna | $311.38 | $311.38 | 0.0% |
Size the post-close upside and the revenue at risk.
Apply the target's revenue and payer mix to see the upside below a percentile and the risk far above peers.
What is the gap to market worth?
- RevenueThe target's annual commercial revenue
- Payer mixEach payer's share of that revenue
- Code mixEach code's share of that revenue
- BenchmarkThe 50th, 75th or 90th peer percentile
Upside where rates sit below the benchmark, and the revenue share far above it
| Payer | Revenue share | Percentile | Upside to median |
|---|---|---|---|
| BCBS of Texas | 45% | 43rd | +$75.4K |
| UnitedHealthcare | 30% | 95th | $0 |
| Cigna | 15% | 65th | $0 |
| Aetna | 10% | 48th | +$2.4K |
Target benchmark
Target vs. market · BCBS 45380
Target vs. market · UHC 45380
Revenue by payer · 45380
Upside and risk · assumed $1.0M from 45380
- Upside to medianBCBS and Aetna up to the median+$77.8K/yr
- Upside to the 75thMostly BCBS, an 81% raise to its 75th+$419K/yr
- Revenue above the 90thUnited, about the 95th percentile30%
See how a target benchmark works.
Name a group you're looking at. We'll show where one payer's rates sit against local peers, and what a full diligence review covers.
Where the numbers come from
Every rate here comes from a file a payer or hospital is required by federal law to publish.
Data from Sept. 2026 payer files · Updated Nov. 2026
Federal price transparency files
Commercial payers' in-network rate files, required since July 2022, and hospital price files.
Kept with its source
Every rate keeps its payer, provider, code and file month, and exports to Excel with its source rows.
Where the data comes from
Commercial in-network rates, refreshed monthly back to August 2023. A published rate is the agreed rate, not what a claim paid. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
How we count and limits to know
- How we count. Each Tax ID counts once, at its highest published rate for the code. This is configurable: in the app you can group by NPI, by Tax ID or by both.
- Payers list some providers who rarely bill a code, which can stretch the high end.
- A negotiated rate isn't what the target collected. Volumes, denials, carve-outs and value-based payments aren't in the files.
- Files show the rates payers report each month, about 30 days behind, and can lag contract changes. They don't show contract end dates or future rate changes.
Common questions
What data does PayerPrice use for acquisition diligence?
The in-network files commercial insurers publish under Transparency in Coverage, plus hospital price files, refreshed monthly about 30 days behind, back to August 2023. Each benchmark counts every Tax ID once, at its highest published rate. The files contain some errors and placeholder rates, so tie out a few codes against the target's contracts.
Can PayerPrice benchmark a behavioral health target that relies on Medicaid?
Only its commercial book. Medicaid and Medicare Advantage rates aren't in the files, and many behavioral health and substance use treatment targets earn most of their revenue there. Size the commercial share of revenue first, then benchmark those payers.
How can I tell if a physician practice is reimbursed above or below market?
Compare its rates with peers in the same specialty, setting and state, one payer at a time. For colonoscopy with biopsy (CPT 45380) in a Texas ASC, one Texas GI group's UnitedHealthcare rate is $623.49, about the 95th percentile. Its BCBS of Texas rate, $344.80, is below the $402.58 median.
Can I see a target's rates without taking the operator's word?
Yes. Payers publish rates under the target's own Tax IDs, so you can look them up in the self-serve trial before the data room opens, without naming the target to anyone. Export the source rows to tie out what the operator reports.
Will a target's above-market rates last after the deal closes?
Published rates can't predict a renewal. They show each payer's rates for the target in monthly files back to August 2023, so you can see which rates held and which moved. With the payer mix, you can see how much revenue rests on rates far above peers.
Can I screen tuck-ins against a buy box?
Yes. Search Tax IDs by specialty and state, then place each group's rates among its peers, payer by payer. A group paid below the median by its largest payers shows the upside of moving it onto a platform's stronger contracts, if those contracts can extend to it.
Benchmark the next target
Size a target's reimbursement against its market before diligence.