Billing & RCM firms
Rebuild client fee schedules and find underpaid claims.
PayerPrice is a healthcare price transparency platform for billing and RCM firms. Rebuild a client's fee schedule and find short pays.
Not ready for a call?
Many clients can't say what each payer agreed to pay.
Without a fee schedule, nobody can tell a short pay from a correct one. PayerPrice rebuilds it from the rates each payer publishes under the client's Tax ID.
CPT 90837 | 60-minute psychotherapy, office | Sept. 2026 files
One Texas psychology practice's published rates for the same session run $85 to $152.
- Aetna
- $152.01
- UnitedHealthcare
- $147.07
- BCBS of Texas
- $129.60
- Cigna
- $85.00
Source: payer in-network files, Sept. 2026. Rates published under one practice's Tax ID. BCBS of Texas sits below its $133.54 Texas median. How we count
Rebuild the fee schedule, find short pays, then benchmark.
See how claims repricing worksRebuild the fee schedule a client doesn't have.
Look up each payer's published rates under the client's Tax ID and NPIs, for every code it bills.
What should each payer pay?
- PayersEach commercial plan the client bills
- CodesThe services the client bills
- Tax ID & NPIThe client's Tax ID and NPIs
Rates by payer and code, exported to Excel
| Payer | 90837 | 90834 | 90791 |
|---|---|---|---|
| Aetna | $152.01 | $106.46 | $180.00 |
| UHC | $147.07 | $99.97 | $174.86 |
| BCBS TX | $129.60 | $93.03 | $149.07 |
| Cigna | $85.00 | $78.00 | $78.00 |
Find short pays: what the payer allowed vs. what it should pay.
Load the rebuilt rates into the billing system, or send claim files under a BAA and PayerPrice reprices each claim.
Which claims were paid short?
- Allowed amountFrom each claim, or paid plus the patient's share
- Published rateFor the claim's Tax ID, NPI, network, place of service and modifiers
- VarianceAllowed amount minus the expected amount: the published rate after multiple-procedure, assistant-surgeon and NCCI edits
Claims allowed below the published rate
| Claim | Allowed | Published | Variance |
|---|---|---|---|
| 90837 · BCBS TX | $118.00 | $129.60 | −$11.60 |
| 90834 · Aetna | $98.00 | $106.46 | −$8.46 |
| 90791 · UHC | $174.86 | $174.86 | $0.00 |
Show a client or prospect where its rates sit below the local median.
Benchmark before a renegotiation, or before the first call with a practice you want to sign.
CPT 90791 diagnostic evaluation | Sept. 2026 files
Two payers' rates for this practice sit below the Texas median.
- Aetna
- $180This practice$180Texas median
- UnitedHealthcare
- $175This practice$175Texas median
- BCBS of Texas
- $149This practice$157Texas median
- Cigna
- $78This practice$114Texas median
Texas medians by payer, psychologists. One Texas psychology practice. How we count
Fee schedule
Rebuilt fee schedule · one practice
| Payer | 90837 | 90834 | 90791 |
|---|---|---|---|
| Aetna | $152.01 | $106.46 | $180.00 |
| UHC | $147.07 | $99.97 | $174.86 |
| BCBS TX | $129.60 | $93.03 | $149.07 |
| Cigna | $85.00 | $78.00 | $78.00 |
Percent of Medicare · 90837
52–92%vs. Medicare $164.90, rest of Texas
Medicare = 100%
Practice vs. Texas · Cigna 90791
Short pays to review
- 90837 · BCBS TXAllowed $118.00 vs. $129.60−$11.60
- 90834 · AetnaAllowed $98.00 vs. $106.46−$8.46
- 90791 · CignaAllowed $72.00 vs. $78.00−$6.00
See a client's fee schedule, rebuilt.
Name a client and one payer. We'll show their fee schedule rebuilt from published rates, and how PayerPrice finds claims paid below it.
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.
- Payment also depends on contract terms, modifiers, place of service and carve-outs that aren't in the published files.
- Repricing eligible commercial claims requires enabled access, usable claim files and a BAA.
Common questions
Where does PayerPrice get the payer rates for client fee schedules?
From the in-network files commercial insurers publish by Tax ID and NPI, including Aetna, Cigna, UnitedHealthcare and Blues plans, plus hospital price files. Data refreshes monthly, about 30 days behind, back to August 2023. Medicare Advantage, Medicaid, workers' comp and out-of-network rates aren't included.
Will PayerPrice show a client's exact contracted rate?
Often, when the payer publishes it under the client's Tax ID. Rates can differ by network and place of service: one Texas psychology practice's BCBS of Texas rate for 90837 is $129.60 in the office and $127.81 in a hospital outpatient department. Start with one code where the client knows its rate.
Can I rebuild a fee schedule a client doesn't have?
Yes, for payers that publish rates under the client's Tax ID or NPIs. Look up every code the client bills, such as 90837, 90834 and 90791, and export the rates by payer and code to Excel.
How do I find short pays: what a claim paid vs. what it should pay?
Compare each claim's allowed amount, or what the payer paid plus the patient's share, with the published rate for the same code, payer, network and place of service. Load the rates into the billing system, or send claim files under a BAA (a HIPAA business associate agreement) and PayerPrice reprices each claim with NCCI and multiple-procedure edits.
Can I use PayerPrice to win new billing clients?
Yes. Look up a prospect's published rates by Tax ID before the first meeting and show where they sit below the local median. One Texas psychology practice's Cigna rate for CPT 90791 is $78, against a $114 median across 462 Tax IDs of Texas psychologists.
Are commercial rates lower than Medicare for CPT 90837?
Often, for psychotherapy in Texas. In Sept. 2026 files, Texas median published rates for psychologists billing 90837 run from $85 (Cigna) to $150.01 (Aetna), or 52% to 91% of the $164.90 Medicare rate for rest of Texas.
Rebuild a client's fee schedule
Rebuild a client's fee schedule from published rates and find underpayments faster.