Payer contracting consultants
Benchmark client payer rates against comparable practices.
PayerPrice is a healthcare price transparency platform for payer contracting consultants. See where a client stands, payer by payer.
Not ready for a call?
A client wants to know where it stands in the community.
Before a renewal, the client asks what payers reimburse comparable practices nearby, and whether a request will pass the payer's sniff test.
Cigna's published rate for the client is $115.39 for CPT 99214, below the Texas median.
CPT 99214 | Office visit, office setting | Cigna, Texas family medicine
- 25th percentile
- $108.28
- Median
- $122.20
- 75th percentile
- $136.80
- 90th percentile
- $183.32
Source: Cigna in-network file, Sept. 2026. Percentiles across 3,767 Texas family medicine Tax IDs. Client: a Houston family medicine group's published rate.
Client $115.39; $108.28 to $183.32 across Texas Cigna percentiles.
Build the ammunition for a rate request the payer can check.
See the payer negotiation workflowCompare the client with comparable practices.
Pick the groups the client competes with by Tax ID, then see each one's published rate beside the client's, by payer and code.
CPT 99214 office visit | Cigna | Sept. 2026 files
Three of four nearby peers have higher published Cigna rates than the client.
- Client
- $115.39
- Peer A
- $144.67
- Peer B
- $134.62
- Peer C
- $128.21
- Peer D
- $105.13
Source: Cigna in-network file, Sept. 2026. Published office rates for five Houston-area primary care groups, unnamed. How we count
Put a dollar value on moving to the 75th percentile.
Model the annual value of moving below-target rates to the 50th, 75th or 90th percentile, from the client's revenue and its payer and code mix.
What is the client's gap worth?
- RevenueThe client's annual commercial revenue
- Payer and code mixEach payer's and code's share of that revenue
- Client rateThe client's published rate, highest across its Tax IDs
- TargetThe 50th, 75th or 90th percentile of the market
Modeled on $300,000 a year of Cigna 99214 revenue at $115.39
| Target | Cigna · 99214 | Annual value |
|---|---|---|
| 50th percentile | $122.20 | |
| 75th percentile | $136.80 | |
| 90th percentile | $183.32 |
Turn the analysis into the client deliverable.
Export the model workbook and a draft payer letter, and trace any rate back to the payer file it came from.
What goes to the client?
- Model workbookClient and peer rates, percentiles and the model in Excel
- Payer letterA draft negotiation letter for each payer, in Word
- Rate rowsThe published rates behind each figure, in Excel or CSV
A rate request backed by published rates
- Contract model.xlsxRates, peers, percentiles, model
- Payer negotiation letter.docxDraft rate request to Cigna
- Rate rows.csvPayer, Tax ID, code, rate
Client benchmark
Client vs. peers · Cigna 99214
Texas median $122
Payer parity · client 99214
Value of each target · Cigna 99214
- Move to the 50th$122.20+$18K/yr
- Move to the 75th$136.80+$56K/yr
- Move to the 90th$183.32, a 59% raise+$177K/yr
Rate rows
| Payer | Code | Provider | Rate |
|---|---|---|---|
| Cigna | 99214 | Client | $115.39 |
| Aetna | 99214 | Client | $106.56 |
| UHC | 99214 | Client | $89.68 |
| Cigna | 99213 | Client | $81.90 |
Try a benchmark on one client.
Bring a client and one payer. We'll show where a few of their codes sit against comparable practices, and what the full benchmark covers.
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.
- Carve-outs and side agreements aren't in the files, and plan or modifier can change a rate.
- Check how source data and derived figures can appear in client deliverables under the license agreement.
Common questions
Where do the payer rates in a client benchmark come from, and how current are they?
From commercial insurers' in-network files, including Aetna, Cigna, UnitedHealthcare and Blues plans, and hospital price files. They refresh monthly, about 30 days behind, with history back to August 2023. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
Why might a published rate differ from my client's contract?
The search may mix office and facility rates, components (global, -26, TC) or networks, or the contract may have carve-outs the payer file doesn't show. Start with one code the client knows.
Can I compare a client's payer rates with comparable practices?
Yes. Rates are published by Tax ID and NPI, so you pick the groups the client is compared with. For CPT 99214 in the office, a Houston family medicine group has a published Cigna rate of $115.39, while three of four nearby primary care groups have $128.21 to $144.67.
How do I check payer parity for a client?
Compare the client's published rates for the same code and setting across payers. For CPT 99214 in the office, the same Houston group's published rates are $115.39 with Cigna, $106.56 with Aetna and $89.68 with UnitedHealthcare. Rates can also show as a percentage of Medicare.
How do I put a dollar value on a client's rate request?
The contract model takes the client's commercial revenue and its payer and code mix, then values moving each below-target rate to the 50th, 75th or 90th percentile. On $300,000 a year of Cigna 99214 revenue, moving from $115.39 to the Texas 75th percentile, $136.80, is worth about $55,700.
Can I resell PayerPrice benchmarks as my own client deliverable?
Exports include the model workbook, a draft payer negotiation letter and the rate rows behind each figure. How source data and derived figures can appear in client deliverables depends on the license agreement, so confirm the use up front.
Benchmark the next client
Show a client where each payer sits against comparable practices.