Healthtech companies
Build on each provider's negotiated rates, not the payer files.
PayerPrice is a healthcare price transparency platform for healthtech companies. Get each provider's negotiated rates by API or data share.
Not ready for a call?
A patient estimate needs the provider's own rate, not a market average.
Payers publish each provider's rates in JSON files of up to a terabyte a month. PayerPrice parses them into rows by provider, payer and code, so you don't run that pipeline.
CPT 73721 knee MRI | Texas imaging center | Sept. 2026 files
One imaging center: $259 below the Texas median with Aetna, $117 above with Cigna.
- This center, Aetna
- $165.90
- Texas median, Aetna
- $425.00
- This center, Cigna
- $500.00
- Texas median, Cigna
- $383.16
Source: payer in-network files, Sept. 2026. Global rate, professional claim. Medians across 1,145 (Aetna) and 1,338 (Cigna) Texas imaging Tax IDs. How we count
From the feature spec to the rate a user sees.
See the rates APIStart with what users will see.
An out-of-pocket estimate, a provider lookup or a benchmark. List the NPIs or Tax IDs, payers and codes it needs.
What does the feature need?
- ProvidersNPIs or Tax IDs, or a state and specialty
- PayersCommercial payers, and plans where it matters
- CodesCPT, HCPCS, revenue codes or DRGs
- BenchmarkPayer percentiles, if users compare providers
Providers, payers, codes and month
{
"providers": { "tins": [<TIN>] },
"payers": ["Cigna", "United"],
"billingCodeAndTypes": [
{ "code": "73721", "type": "CPT" }
],
"billingCodeModifiers": ["none"],
"serviceCodes": ["11"],
"yearMonths": [{ "year": 2026, "month": 9 }],
"groupBy": [
"payer", "billingCode",
"serviceCode", "negotiatedType"
]
}Get each provider's rates by payer, setting and rate type.
Call the negotiated rates API, or query the same rates in a Snowflake or Databricks share. No payer-file pipeline to run.
How does the data arrive?
- Provider rates APIPOST /api/v1/provider/rates
- SnowflakeShared tables in the team's own account
- DatabricksA data share to the team's workspace
- FilesExtracts for teams without a warehouse
Payer, place of service, billing class, rate type
[
{
"payer": "Cigna",
"billingCode": "73721",
"serviceCode": "11",
"negotiatedType": "negotiated",
"metrics": "tin_<TIN>",
"value": 500
},
{
"payer": "United",
"billingCode": "73721",
"serviceCode": "11",
"negotiatedType": "negotiated",
"metrics": "tin_<TIN>",
"value": 348.63
}
]Show users the provider's rate beside its market.
Use the provider's own rate for an estimate, and payer medians for a benchmark. Add the member's benefits to get what the patient owes.
CPT 73721 knee MRI | Sept. 2026 files
One Texas imaging center's rates against the Texas medians.
- Cigna
- $500This imaging center$383Texas median
- BCBS of Texas
- $426This imaging center$457Texas median
- UnitedHealthcare
- $349This imaging center$395Texas median
- Aetna
- $166This imaging center$425Texas median
Global rate, professional claim. Texas medians across 1,130 to 2,234 imaging Tax IDs per payer. How we count
Rate report
Rates by provider · 73721
| Provider | Payer | Setting | Rate |
|---|---|---|---|
| Center A | Cigna | Office | $500.00 |
| Center A | United | Office | $348.63 |
| Center A | Aetna | All settings | $165.90 |
| Center B | Aetna | All settings | 80% of charges |
Texas median by payer · 73721
Percentiles · BCBS of Texas
Fields per rate
- Place of service11 (office)
- Billing classProfessional
- Rate typeNegotiated
- Data monthSept. 2026
Check coverage for one feature.
Tell us the providers, codes and states. We'll query a sample live so you can check coverage and fields before you build.
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.
- Hospital files often list percent of charges, per diems or case rates, and can miss some payers. Each row carries its rate type.
- Internal use, showing rates to users and passing on source data are licensed separately. Agree the use up front.
Common questions
Where does the data behind PayerPrice's API and data shares come from?
From the Transparency in Coverage files commercial payers publish and from hospital price files. It refreshes monthly, about 30 days behind, back to August 2023. In the API you choose the month; in a data share each rate carries the date of the latest payer file that listed it. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
Can I build an out-of-pocket estimate from negotiated rates?
Yes, as one input. A negotiated rate is the in-network price a payer agreed with a provider for a code, not what a claim paid or what the patient owes. For the patient's share, add the member's deductible, copay and coinsurance from an eligibility or benefits source. PayerPrice doesn't supply member benefits.
Can I white-label PayerPrice rates or show them to my users?
It depends on your license. Internal use, showing rates to users and passing on source data are licensed separately, so tell us how users will see the rates before you build.
Is there a negotiated rates API, or a Snowflake data share?
Both. The API takes NPIs, Tax IDs or hospital CCNs, payers and codes, and returns each rate with its payer, place of service, billing class and rate type. Snowflake and Databricks shares hold the rates as tables you query in your own account, and file extracts suit teams without a warehouse.
Why pay for payer rate data if the files are public?
The files are public, but payers post JSON files of up to a terabyte each month. PayerPrice ingests and normalizes them, so you query rows by provider, payer and code instead of running that pipeline.
Can I look up rates by plan ID or payer ID?
The API can return the payer's normalized plan names with each rate. Data shares also include the plan IDs payers report, such as HIOS IDs or EINs. PayerPrice doesn't supply clearinghouse payer IDs or map member IDs to plans.
Test the data against one feature
Confirm coverage and fields before building on the data.