Medical bill review & litigation support
Compare each line on a bill with the provider's in-network rates.
PayerPrice is a healthcare price transparency platform for medical bill reviewers and expert witnesses. Test a bill's reasonable value.
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A bill shows the provider's list price, not the rate it accepts from insurers.
Providers bill a list price, then accept a lower negotiated rate from each insurer as payment in full. Insurers now publish those rates, by provider and code.
CPT 99285 ER visit | BCBS of Texas | Sept. 2026 files
The bill lists $1,850. The provider accepts $301 from BCBS of Texas.
- Billed charge
- $1,850
- Provider's rate, BCBS of Texas
- $301
- Texas median, BCBS of Texas
- $312
Source: BCBS of Texas in-network file, Sept. 2026, for a Texas emergency physician group; median across 2,139 Texas emergency medicine Tax IDs. The billed charge is from the bill under review. How we count
Build a rate benchmark the other side can check.
See the rate benchmarking workflowStart with the lines on the bill.
Enter each code, setting, the billing provider's NPI or Tax ID, ZIP code and date of service.
What's on the bill?
- CodeCPT, HCPCS or DRG from the bill
- SettingOffice or facility; global, -26 or TC
- ProviderThe billing provider's NPI or Tax ID
- ZIP and dateService ZIP code; files go back to August 2023
The provider's published rates, by insurer
| Provider | Insurer | Code | Rate |
|---|---|---|---|
| ER group | BCBS of Texas | 99285 | $300.57 |
| ER group | UnitedHealthcare | 99285 | $260.47 |
| ER group | Cigna | 99285 | $350.46 |
| ER group | Aetna | 99285 | $180.88 |
See what the same provider accepts in-network.
Compare the bill with the billing provider's own rates with each insurer, or local in-network rates where it has none.
CPT 99285 ER visit | Sept. 2026 files
What this provider accepts from each insurer.
- BCBS of Texas
- $301This provider$312Texas median
- UnitedHealthcare
- $260This provider$226Texas median
- Cigna
- $350This provider$219Texas median
- Aetna
- $181This provider$189Texas median
A Texas emergency physician group beside Texas medians by insurer. How we count
Hand over figures the other side can check.
Export each rate with its insurer, provider, code, location and file date for a report, counter-affidavit or exhibit.
Where did each figure come from?
- BenchmarkPercentiles and rate counts, by insurer and code
- Source filesInsurer, provider, code, location and file date
- MedicareEach rate as a percent of the Medicare fee
- HistoryMonthly payer files back to August 2023
Figures you can trace to a payer's public file
- Bill benchmark.xlsxPercentiles and rate counts
- Source rows.csvInsurer, provider, code, file date
- Medicare comparisonPercent of fee by code
Bill review benchmark
Billed vs. in-network · 99285
- Billed chargeFrom the bill$1,850
- Provider's BCBS of Texas rateIts published in-network rate$300.57
- Billed ÷ provider's rate$1,850 ÷ $300.576.2×
- Billed ÷ Texas medianBCBS of Texas median, $3125.9×
Texas medians by insurer · 99285
Medicare $169
Provider's rates, % of Medicare · 99285
107–208%by insurer
Medicare = 100%
Percentiles · BCBS of Texas
Check a few lines from a bill.
Send a few codes, the provider and the setting, with no patient details. We'll show the provider's in-network rate for each line.
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.
- Medicare lines use the 2026 fee schedule for the area named on the chart.
- Rates are what insurers agreed to pay in-network providers, not billed charges, UCR amounts or what a given claim paid. Services before August 2023 have no file to match.
- The expert decides how the data fits the method and jurisdiction. Each row traces to a public payer file.
Common questions
Where does PayerPrice get the negotiated rates used for bill review?
From the in-network files commercial insurers publish under Transparency in Coverage, and from hospital price files. 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 provide UCR benchmarks for medical bill review?
No. It shows the rates insurers agreed to pay in-network providers, not usual-and-customary (UCR) amounts, billed charges or what a claim paid. Hospital price files add gross charges and cash prices for facility services.
How do bill reviewers use negotiated rates in personal injury and lien cases?
To show what insurers agreed to pay in-network for the same codes, often from the billing provider's own published rates, as one input to a reasonable value opinion in personal injury, auto, med-mal and lien cases. The method and the opinion stay with the expert.
What are commercial in-network rates for CPT 99285 in Texas?
In Sept. 2026 payer files, Texas medians for the emergency physician fee run $189.39 to $312.00 by insurer, against Medicare's $168.68 (2026, rest of Texas). The BCBS of Texas 75th percentile is $547.06 across 2,139 emergency medicine Tax IDs. These are in-network rates, not paid claims.
How is PayerPrice different from FAIR Health benchmarks?
FAIR Health benchmarks are built from claims data contributed by insurers and administrators. PayerPrice shows the in-network rates each insurer publishes for each provider, with the insurer, provider and file date on every row.
Can negotiated rate data be used as evidence of reasonable value in court?
That depends on the jurisdiction, the court and the expert's method, and PayerPrice does not decide it. Each rate traces to a public payer file, and the export lists the insurer, provider, code and file date.
Benchmark a bill
Compare each line on a bill with in-network rates, with the source behind each.