Life sciences & market access
Commercial reimbursement for a product's codes, by payer and facility.
PayerPrice is a healthcare price transparency platform for medical device, diagnostics and drug companies. See each payer's rates by code.
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A Medicare rate doesn't show how commercial payers reimburse an account.
Each payer agrees its own rate with each hospital and surgery center. PayerPrice collects the published rates by code, facility and state.
Texas hospitals' median rates for a spinal cord stimulator lead implant run $3,776 to $12,993 by payer.
CPT 63650 | Spinal cord stimulator electrode implant, percutaneous | Hospital outpatient facility rate, median by payer, Texas
- BCBS of Texas
- $12,993
- UnitedHealthcare
- $10,076
- Aetna
- $3,776
Source: payer in-network files, Sept. 2026. Negotiated dollar rates at 96 to 241 Texas hospital Tax IDs per payer. Some contracts reimburse the implant separately.
$3,776 to $12,993 across payers.
Use commercial reimbursement to plan a launch, steer field teams and answer objections.
Read a device reimbursement exampleSee how commercial payers reimburse facilities for a code.
Search a CPT, HCPCS, Category III or PLA code for each payer's hospital and ASC rates. Surgeon fees show separately, as professional rates.
BCBS of Texas | Hospitals | Sept. 2026 files
CPT 63650 hospital facility rates across Texas.
- 25th percentile
- $10,209
- Median
- $12,993
- 75th percentile
- $18,933
Dashed lines mark the 25th and 75th percentiles. 243 hospital Tax IDs with a dollar rate; the lowest and highest rates fall off the axis. How we count
Steer field teams to accounts where reimbursement supports adoption.
Compare hospitals and surgery centers in a territory by each payer's rate for the code, then export the list for the field team.
Which accounts are reimbursed well for the procedure?
- FacilitiesHospitals and ASCs, by Tax ID, NPI or CCN
- SettingHospital outpatient or surgery center
- PayersEach commercial payer's rate for the code
Facilities compared by rate, in Excel
| Account | BCBS TX | UHC |
|---|---|---|
| Hospital A | $7,400 | |
| Hospital B | $9,550 | |
| Hospital C | $6,998 | |
| ASC D | $3,500 |
Answer "it doesn't pay" with the account's own published rates.
Show what each payer agreed to reimburse the facility for the procedure, with the file and date, within company compliance policy.
How is this account reimbursed?
- FacilityThe account's Tax ID, NPI or CCN
- Rate typeDollar rate, percent of charges or case rate
- Source filePayer file and month
Rows the account's finance team can check
| Payer | Terms at Hospital C | Rate | File |
|---|---|---|---|
| BCBS of Texas | Dollar | $8,847.60 | Sept. 2026 |
| BCBS of Texas | % of charges | 76.9% | Sept. 2026 |
| UnitedHealthcare | Dollar | $6,998.00 | Sept. 2026 |
| Aetna | Dollar | $1,871.00 | Sept. 2026 |
Reimbursement report
Median by site of care · 63650
UHC hospital median by state · 63650
BCBS of Texas hospital terms · 63650
- Dollar rateMedian, 243 hospital Tax IDs$12,993
- Percent of chargesMedian, 242 hospital Tax IDs66%
Source rows
| Payer | Facility | Rate | File |
|---|---|---|---|
| BCBS TX | Hospital A | $11,260.58 | Sept. 2026 |
| UHC | Hospital B | $9,550.00 | Sept. 2026 |
| Aetna | Hospital C | $1,871.00 | Sept. 2026 |
See how one product code is paid.
Tell us the code and a target state. We'll show commercial rates by payer and facility.
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 a payer agreed to reimburse a provider. It doesn't show claim volume, denials or whether a payer covers the service.
- Each rate is published for a named provider. Check with compliance how provider-level comparisons can be shared with accounts.
Common questions
Where does PayerPrice get commercial reimbursement rates for device, diagnostic and drug codes?
From the in-network files commercial insurers publish each month and from hospital price files. Data refreshes monthly, about 30 days behind, back to August 2023. Medicare Advantage, managed Medicaid, workers' comp and out-of-network rates aren't included.
Does a hospital's published rate include payment for the device?
Not always. Some contracts reimburse implants separately, for example at invoice cost plus a markup, and a published rate for the procedure code doesn't show carve-outs or side terms. Check implant terms with the account.
Do payers publish rates for new Category III, PLA or HCPCS codes?
Only once a payer loads a rate for the code. Search it to see which payers and facilities have one; new codes often show few rates at first, or a percent of billed charges.
How do commercial rates for a buy-and-bill drug compare with ASP?
Reports can show each rate as a percentage of Medicare's Part B payment limit, which is ASP plus 6%. For bevacizumab (J9035) in Texas oncology practices, Sept. 2026 payer medians ran $74.82 to $84.39 per 10 mg, or 100% to 113% of the $74.82 limit (about ASP + 6% to ASP + 20%).
How do field teams find accounts where reimbursement supports adoption?
Search the product's codes for the hospitals and surgery centers in a territory, compare each payer's rate for the code, and export the list. Percent-of-charge and case-rate terms keep their method instead of being read as a fixed price.
Can I compare a facility's commercial rate with Medicare's outpatient or ASC payment?
Yes, in reports. Add Medicare's hospital outpatient (APC) or ASC payment as a column to see each dollar rate as a percentage of it. Percent-of-charge rates can't be converted without the facility's charges.
See how a code is reimbursed commercially
Know how commercial payers reimburse a product's codes before the value discussion.