Medical groups & MSOs
See which payer contracts reimburse below market, state by state.
PayerPrice is a healthcare price transparency platform for multi-market medical groups and MSOs. Roll up rates by state and payer.
Not ready for a call?
A group that contracts state by state rarely sees each contract against its state's market.
A multi-state group bills under a Tax ID in each state, and each payer can reimburse it at a different rate in each one. Without each state's market, a payer can call any ask unrealistic.
Payers now publish those rates by Tax ID and code. PayerPrice compares each state with its own market, so the team sees where to focus.
CPT 99285 emergency department visit, professional fee | Aetna | Sept. 2026 files
Aetna's published rate for the group is below the state median in three of five states.
- LA · median $201.68
- $588.62
- CA · median $202.60
- $202.60
- KS · median $179.68
- $156.84
- KY · median $183.59
- $137.85
- AZ · median $184.19
- $132.94
Source: Aetna in-network files, Sept. 2026. One multi-state emergency medicine group, unnamed and unrelated to the case study below. Base-code rates only (no modifier; telehealth rates excluded). Each state median counts each emergency physician Tax ID once, at its highest rate (138 to 953 Tax IDs). How we count
Roll up every state, value the gaps, then price new markets.
See the rate benchmarking workflowSee which states and payers publish rates below market.
Add every Tax ID the group bills under. Compare each one's published rates with its own state's percentiles, payer by payer and code by code.
CPT 99285 emergency department visit, professional fee | Sept. 2026 files
In all three states, the group's Aetna rate is below the state median. Its UnitedHealthcare rate is about twice the median.
- AZ · Aetna
- $132.94This group$184.19State median
- AZ · UnitedHealthcare
- $489.67This group$269.70State median
- KS · Aetna
- $156.84This group$179.68State median
- KS · UnitedHealthcare
- $489.67This group$250.56State median
- KY · Aetna
- $137.85This group$183.59State median
- KY · UnitedHealthcare
- $503.17This group$217.62State median
State medians for emergency physicians across 138 to 308 Tax IDs per state and payer. How we count
Rank the renegotiations by what each gap is worth.
Model each state's revenue and mix at the 50th, 75th or 90th percentile, then compare the annual value.
Which renegotiation is worth the most?
- RevenueModeled at $12M to $25M a year per state
- Payer mixAetna at 8% of revenue
- Code mix99285 at 40% of Aetna revenue
- TargetEach state's median or 75th percentile
The annual value of each payer-state gap, ranked
| Aetna · 99285 | Revenue | To median / yr | To 75th / yr |
|---|---|---|---|
| Arizona | $25M | $793,080 | |
| Kentucky | $15M | $364,152 | |
| Kansas | $12M | $199,639 |
Price a new market before bidding on a hospital contract.
See each payer's median, 75th and 90th percentile in the new state, then build the pro forma on the rates payers there already publish.
What do payers reimburse in the new state?
- LocationA state, or the ZIP codes around the hospital
- Provider typeEmergency physicians (taxonomy 207P00000X)
- CodesEmergency department visits 99283 to 99285
- PayersEach commercial payer in the state
Median, 75th and 90th percentile by payer
| Colorado · 99285 | Median | 75th | 90th |
|---|---|---|---|
| UnitedHealthcare | $296.19 | $380.65 | $501.06 |
| Cigna | $284.67 | $410.79 | $525.05 |
| Aetna | $203.86 | $319.33 | $441.86 |
“I don’t have to take the payers’ word for it when they say you’re asking for rates that are unrealistic in this market. Now, I can say: ‘That’s not true!’”
Chip PorterVP of Managed Care, ApolloMDRead the ApolloMD case studyState roll-up
Group vs. AZ · Aetna 99285
Group vs. state median · 99285
| State · payer | Group | Median |
|---|---|---|
| AZ · Aetna | $132.94 | $184.19 |
| KY · Aetna | $137.85 | $183.59 |
| KS · Aetna | $156.84 | $179.68 |
| KY · Cigna | $284.88 | $272.46 |
Ranked renegotiations · to state median
- AZ · Aetna$51.25 below median+$308,410/yr
- KY · Aetna$45.74 below median+$159,269/yr
- KS · Aetna$22.84 below median+$55,920/yr
New market · Colorado 99285 medians
See one payer across a few states.
Tell us the group, one payer and a few states. We'll show where that contract sits against market in each, and how the full roll-up works.
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 published rate is not a payment. Carve-outs, escalators and side letters aren't in the files, and plan or modifier can change a rate.
- Payers publish rates by Tax ID and NPI, and a payer can set a rate by the state where the physician practices. Confirm which Tax ID each state bills under before comparing it with that state's market.
Common questions
Where do the state-by-state payer rates for medical groups come from?
From the in-network files commercial insurers publish by Tax ID and NPI, including Aetna, Cigna, UnitedHealthcare and Blues plans, plus hospital price files. They refresh monthly, about 30 days behind, back to August 2023. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
Will the published rates match our contract in every state?
Not always, so match one known rate in each state first. Payers publish rates under the billing Tax ID and NPI, and a rate can differ by plan, network, modifier and the state where the physician practices. Carve-outs, escalators and side letters aren't in the files.
Can we compare every Tax ID's rates with the market in each state?
Yes. Add each Tax ID, or paste a list of them, and compare each state's rates with that state's percentiles by payer and code. One multi-state emergency medicine group's Aetna rate for 99285 runs from $132.94 in Arizona, 28% below the state median, to $588.62 in Louisiana, almost three times the median.
How do we decide which payer renegotiation to do first?
Value each gap with the contract model: revenue × payer share × code share × the raise needed to reach the target percentile. Modeled on $25M a year in Arizona, with Aetna at 8% and 99285 at 40% of Aetna revenue, moving that group's Aetna 99285 rate to the state median is worth $308,410 a year. The model sizes a gap; it doesn't predict what a payer will agree to.
What rates should we model before entering a new market?
Look up each payer's median, 75th and 90th percentile for the state or the ZIP codes around the hospital. For 99285 in Colorado, Sept. 2026 medians for emergency physicians run $203.86 (Aetna) to $296.19 (UnitedHealthcare), and 90th percentiles $441.86 to $525.05. Use the median as a base case and the 75th or 90th as the upside.
Can we check each state's claims against the group's published rates?
Yes, with enabled access. Claims repricing compares each claim's allowed amount (what the payer allowed, or paid plus patient responsibility) with the group's own published rate, matched by Tax ID, NPI, place of service, modifiers and network. It needs usable claim files and a BAA (a HIPAA business associate agreement).
Roll up every state's rates
See which contracts sit below market in each state before renegotiating.