Independent providers
Plan for a sustainable practice with market rate data.
Compare your reimbursement with similar providers using PayerPrice. Identify rate gaps, focus your contract review, and prepare requests that reflect your practice's needs.
Explore the comparisons in a walkthrough with our team.
Illustrative market comparison
Same procedure. Different payer rates.
CPT 58661 | Tulsa, OK- Medicare
- $601.53
- Medicaid
- $579.57
- UnitedHealthcare
- $716
- Cigna
- $772
- Blue Cross
- $869
- Aetna
- $727
Your fee schedule shows your rates, but not how they compare.
Your reimbursement helps fund the staff and services your patients rely on. Reviewing payer agreements is part of planning for a sustainable practice.
Your fee schedule alone cannot show whether your rates are below, near, or above those of comparable providers. Market data gives you that reference.
Use market comparisons to prioritize your next rate request.
Compare rates for similar providers and services.
Rates for the same service can vary by plan, network, and provider group. Use PayerPrice to compare providers in your specialty, location, and care setting.
UnitedHealthcare | CPT 58100 | Tulsa, OK
A payer doesn't have one rate.
- Market median
- $115
- Middle 50%
- $101-$141
- Practices in market
- 64
Published rates vary across contracts. Review the providers, source period, and care setting before choosing a benchmark.
Prioritize rate gaps using your volume and payer mix.
A small rate gap on a common service can matter more than a large gap on a rarely billed code. Use your service volume and payer mix to decide which gaps to address first.
Choose which gaps to review first.
- Rate gap
- Difference from your comparison
- Service volume
- How often you bill the service
- Payer mix
- Share of your business affected
Support your rate request with evidence of your practice's value.
Use market rates to explain the gap you want to address. Support your request with evidence about patient access, coverage, quality, and demand for your services.
Practice-specific evidence
Your leverage supports the request.
Access
New-patient availability
Geography
Network adequacy
Coverage
Call and hospital coverage
Scope
Services and procedures
Quality
Objective measures
Cost
Staffing and practice costs
Demand
Volume and referrals
Relationship
Payer and network history
The benchmark identifies the gap. Your practice's value proposition supports the request.
Your payer review brief
Key services
Codes and volume that matter to your practice
Current comparisons
Your rates and the supporting market data
Practice value
Evidence of access, coverage, and quality
Requested rates
The specific changes you want reviewed
Prepare your rate request with data you can inspect.
Use PayerPrice to review published rates and comparable providers before choosing a target. Bring the supporting analysis into your payer conversation.
Your team or contracting adviser sets the request and handles the negotiation. Your costs, patient needs, and payer relationships guide that decision.
See how your rates compareCheck the providers, sources, and dates behind your benchmark.
Before using a published rate, check which provider, payer, service, and reporting period it represents.
Review the providers and care settings.
Geography, provider type, and care setting affect the relevance of a rate. Review the comparison before using it to set a target.
Check the source and reporting period.
Check the source dates before using a rate. Payer-published data can be incomplete or outdated and does not show what was paid on a claim.
Verify your current rates against your fee schedule.
Confirm which rate represents your agreement. Check payment records separately when investigating a possible payment error.
Know what to expect from a rate comparison.
Review how to choose a benchmark, interpret published rates, and prepare for a walkthrough.
How can market rate data help an independent practice?
It gives your own reimbursement a point of comparison. Use it to investigate rate gaps, prioritize payer conversations, and support a request with evidence. Your costs, service mix, and contribution to the payer's network still shape the decision.
What makes a useful comparison?
Start with the same service, relevant geography, and comparable providers. Check the payer, plan, care setting, billing entity, and reporting period. A broad average can hide differences that matter to your practice.
Does a published rate prove that we are being underpaid?
A published negotiated rate is a benchmark to investigate. It is not proof of a payment error or a substitute for your executed contract. Confirm your current fee schedule and payment records before drawing conclusions about what you are owed.
Does PayerPrice negotiate with payers for us?
PayerPrice provides data and analysis to support negotiation preparation. Your practice or contracting adviser decides what to request and conducts the negotiation. A market comparison does not guarantee a rate increase.
What should we bring to a walkthrough?
Start with one payer, your current rates, the services that matter most, and the market you serve. Your service volume and payer mix help put any rate gaps in business context. We can walk through the available comparisons and their limitations with you.
Walk through a rate comparison for your practice.
Bring one payer and your key services. Explore published rates and comparable providers with our team.