Life care planners
Price future medical needs at current costs from published payer and hospital files.
PayerPrice is a healthcare price transparency platform for life care planners. Price each service with a sourced, current rate.
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Every cost in a life care plan has to be defensible.
PayerPrice ties each figure to a named payer, provider and file, including hospitals' gross charges and cash prices.
CPT 72148 lumbar MRI, facility fee | A Texas hospital | Sept. 2026 file
One hospital file, four published figures for the same MRI.
- Gross charge
- $3,650
- Discounted cash price
- $2,190
- BCBS of Texas, BlueChoice PPO
- $1,613
- BCBS of Texas, Blue Advantage HMO
- $762
Source: the hospital's published price file, Sept. 2026. Facility fee only; the radiologist bills separately. How we count
Price each service in the plan, with the source behind it.
See the cost research workflowFind the local range for each service in the plan.
Search each code by ZIP code, county or state near the patient. See percentiles and how many Tax IDs have a published rate.
BCBS of Texas | Physical therapists | Sept. 2026 files
CPT 97110: most Texas rates sit near $24 per 15-minute unit.
- Median
- $24.18
- 75th percentile
- $27.31
The dashed line marks the 75th percentile. 2,725 Tax IDs. How we count
Use the cost basis the plan's method calls for.
Use negotiated rates or hospital charges. Physician billed-charge percentiles need another source.
Which figure fits the method?
- ProfessionalInsurers' negotiated rates for each provider
- FacilityHospital gross charge, cash price or negotiated rate
- Charge percentilesPhysician usual-and-customary: not included
One stated basis for each line of the plan
| PT 97110, per unit | Basis | Figure |
|---|---|---|
| Texas therapists | BCBS of Texas median | $24.18 |
| Texas hospital | BCBS of Texas PPO rate | $203.15 |
| Texas hospital | Discounted cash price | $125.24 |
| Texas hospital | Gross charge | $208.73 |
Show the payer, provider and file behind every figure.
Each figure exports to Excel with its payer or hospital, provider, code, location and file date, so a reader can find the same row.
Where did this number come from?
- PayerNamed commercial insurer
- ProviderPractice or hospital, Tax ID and NPI
- LocationZIP code and county
- File datePublished file and month
A source row behind each figure in the plan
| Code | Source | Area | File |
|---|---|---|---|
| 72148 | Hospital price file | Texas | Sept. 2026 |
| 97110 | Hospital price file | Texas | Sept. 2026 |
| 97110 | BCBS of Texas file | Texas | Sept. 2026 |
Cost report
Lumbar MRI, Texas hospital · 72148
- Gross chargeHospital price file$3,650
- Discounted cashSelf-pay price$2,190
- BCBS of Texas PPONegotiated rate$1,613
Lumbar MRI, Texas radiology groups, global rate · BCBS TX
PT 97110: hospital prices vs. therapists' BCBS rates
Source rows
| Code | Source | File |
|---|---|---|
| 72148 | Hospital price file | Sept. 2026 |
| 72148 | BCBS of Texas file | Sept. 2026 |
| 97110 | BCBS of Texas file | Sept. 2026 |
Price a few lines from a plan.
Send a few codes and a ZIP code. We'll price them and show the published file behind each one.
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 is what an insurer agreed to pay an in-network provider, not what the provider bills. PayerPrice does not provide physician usual-and-customary charge benchmarks.
- Rates come from the latest monthly files. How current costs carry into future years is part of the planner's method.
Common questions
Where does PayerPrice get the medical cost data for life care plans?
From the in-network rate files commercial insurers must publish and the price files hospitals must publish. Data refreshes monthly, about 30 days behind, with history back to August 2023. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
Does PayerPrice have usual-and-customary charges for pricing reasonable charges in a plan?
Not for physician services. If a plan prices physician care at the 70th or 80th percentile of billed charges, you'll need another source for those lines. PayerPrice fits plans priced on what insurers pay, and has hospitals' own gross charges and cash prices for facility care.
Does PayerPrice show a hospital's gross charges and cash prices?
Yes, from each hospital's published price file, beside the rates it negotiated with each insurer. For a lumbar MRI (CPT 72148), one Texas hospital's Sept. 2026 file lists a $3,650 gross charge, a $2,190 discounted cash price and a $1,613 BCBS of Texas PPO rate.
Can I look up medical costs by ZIP code for a life care plan?
Yes. Search by ZIP code, county or state and narrow to providers and settings near the patient. For physical therapy (CPT 97110), the BCBS of Texas median is $24.18 per 15-minute unit across 2,725 Tax IDs.
Can PayerPrice replace FAIR Health in a life care plan?
For some lines. FAIR Health benchmarks are built from claims data, including billed-charge percentiles. PayerPrice shows the rate each named insurer publishes for each provider, and hospitals' own charges. For physician billed-charge percentiles, keep a charge source.
Can I cite PayerPrice figures in a life care plan?
Each figure exports with the payer or hospital, provider, code, location and file date, so a reader can find the same row in the published file. Whether a figure is accepted is up to the court; confirm permitted use under the license agreement.
See the data for a life care plan
Get sourced local rates for a plan's codes in one session.