CMS Transparency in Coverage · Live Data

Negotiated Rates for
Every Major Payer.

PayerBenchmark indexes Machine-Readable Files from Cigna, Aetna, UnitedHealth, BCBS, Humana, and more — giving you instant API access to negotiated rates, OON amounts, and CPT benchmarks across all networks.

Explore the API → View Coverage

2B+

Negotiated Rate Rows

50+

Payer Networks

<50ms

Median API Latency

99.9%

Uptime SLA

GET /v1/rates · Response

{
  "procedure_code": "99213",
  "description": "Office Visit, Est. Patient",
  "payer": "UnitedHealth",
  "network": "UHC|CHOICE PLUS",
  "billing_class": "professional",
  "negotiated_type": "negotiated",
  "rates": [
    {
      "npi": 1234567890,
      "tin": "12-3456789",
      "negotiated_rate": 134.20,
      "expiration_date": "2025-12-31",
      "last_updated": "2025-01-01"
    }
  ],
  "p50_benchmark": 119.00,
  "p90_benchmark": 162.50,
  // cross-payer percentiles from 2B+ rows
  "cheapest_in_network": 87.20
}

Platform Capabilities

Everything you need to
query negotiated rates by payer, CPT code & NPI.

We handle multi-gigabyte MRF parsing across every major carrier so you don't have to. Query structured, indexed rate data via a clean REST API in milliseconds.

⚡

Negotiated Rate Lookup

Retrieve any payer's exact contracted rate for any CPT/HCPCS code by NPI, TIN, or network. Filtered to current, non-expired rates.

🗂️

Out-of-Network Actuals

Access real allowed-amounts from OON files across all carriers — billed charges, allowed amounts, and payment breakdowns by provider and service.

📍

Provider Geo Search

Find in-network providers by specialty, radius, or NPI with enriched NPI Registry data including practice location and taxonomy.

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Cross-Payer CPT Benchmarks

Pre-computed p10, p25, p50, p75, and p90 rate percentiles per procedure code across all payers, networks, and billing classes — in one query.

🔗

Plan Network Mapping

Resolve plan IDs to their underlying reporting entity and network tier. Supports plan selection, benefits administration, and enrollment workflows.

⏱️

Sub-50ms Response Times

TimescaleDB hypertables partition 700M+ rows by date. Composite indexes on NPI, billing class, and network key deliver single-digit ms queries.

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Monthly Zero-Downtime Refresh

New MRF files from every carrier load into shadow entities. is_current flips atomically at completion. No read interruptions, no stale queries.

📋

Compliance-Ready Data

Built to the CMS Transparency in Coverage Rule (45 CFR § 180). Full load-audit trail per file, per network, per carrier — always traceable to the source MRF.

🛠️

SDK & Webhook Support

Python and TypeScript SDKs, OpenAPI 3.1 spec, and event webhooks for monthly refresh completion. Ready for production CI/CD pipelines.

API Reference

Clean, consistent, documented — REST API for negotiated rate data.

REST endpoints returning structured JSON across all payers. Authenticate with a bearer token. Filter by payer, network, NPI, or CPT code in a single call.

GET/v1/rates

Fetch negotiated rates for a CPT code, filtered by payer, NPI, or network

GET/v1/rates/all

Paginated export of all rates for a given payer, network, and date range

GET/v1/providers/search

Find in-network providers by specialty, zip code, or NPI — across any payer

GET/v1/benchmarks

Cross-payer market percentiles (p10–p90) per CPT code and billing class

GET/v1/plans/{plan_id}

Resolve a plan ID to its payer, network, reporting entity, and sponsor

GET/v1/oon/rates

Out-of-network allowed amounts by provider NPI, payer, and procedure code

GET/v1/payers

List all indexed payers and networks with coverage stats and last refresh date

// Example response

GET /v1/rates

{
  "data": [
    {
      "procedure_code": "99213",
      "network_key": "CIGNA|PATHWELL OAP",
      "billing_class": "professional",
      "negotiated_rate": 127.45,
      "negotiated_type": "negotiated",
      "npi": 1234567890,
      "tin": "12-3456789",
      "expiration_date": "2025-12-31"
    }
  ],
  "pagination": {
    "page": 1,
    "per_page": 50,
    "total": 4821
  }
}

Who Uses PayerBenchmark

Built for everyone who needs
to understand what payers pay.

From self-insured employers to revenue cycle teams, transparent rate data across every major carrier changes how healthcare decisions get made.

Employers & HR Teams

Benchmark Your Plan Before Renewal

Compare your negotiated rates against published network rates from Cigna, Aetna, UHC, and BCBS for your top 20 procedures. Walk into renewals with data.

Validate whether your TPA's rates are competitive
Compare rates across multiple carriers side by side
Identify high-cost service lines by CPT code

TPAs & Benefit Brokers

Arm Your Clients With Rate Intelligence

Embed PayerBenchmark rate data into your reporting dashboards. Show clients real rates from any carrier alongside their claims spend.

Automated monthly rate refresh across all clients
Excess-of-benchmark analysis for reference-based pricing
Network adequacy checks by specialty and geography

Healthcare Providers

Know Where You Stand Before Negotiating

Understand what Cigna, Aetna, UHC, and BCBS pay competing providers in your market. Bring cross-payer benchmarks to every contracting conversation.

See p50 and p90 rates across all major payers
Identify if your TIN is paid below market by any carrier
Prepare data-driven counter-offers for re-negotiation

Digital Health Startups

Power Your Price Transparency Product

Skip months of MRF parsing infrastructure. Embed real multi-payer rate data into your cost estimator, benefit design tool, or care navigation app.

Single API call replaces your entire MRF pipeline
Provider-level rates for accurate cost estimates
OON exposure calculations before patient referrals

Revenue Cycle Management

Catch Underpayments Before Write-Off

Compare remittances against published negotiated rates from Cigna, Aetna, UHC, and others for the same NPI and CPT. Flag systematic underpayments automatically.

Load remittance data alongside rate benchmarks
Detect payer-specific underpayment patterns
Build evidence for appeals with published rate proof

Health Economists & Researchers

Longitudinal Rate Analysis at Scale

Time-series negotiated rate data across 50+ networks and all major carriers — millions of provider-code combinations. Perfect for policy research and market studies.

Monthly snapshots preserved for trend analysis
Bulk export endpoints for custom analytics
Cross-network rate disparity studies

Data Coverage

All major payers.
2B+ negotiated rate rows indexed.

We track every MRF file published under the CMS Transparency in Coverage Rule — across Cigna, Aetna, UnitedHealth, BCBS, Humana, and more. Refreshed monthly.

Payer	Networks	Status
Cigna	13 networks incl. OAP, LocalPlus, SureFit, OON	Live
Aetna	PPO, HMO, Open Choice, CVS Health OON	Live
UnitedHealth	Choice Plus, Options PPO, Navigate, OON	Live
BCBS (multi-state)	BlueCard PPO, HMO, FEP, OON	Live
Humana	ChoiceCare, HumanaOne PPO, OON	Live
Molina Healthcare	Marketplace, Medicaid networks	Live
Centene / WellCare	Ambetter, WellCare PPO, Medicaid	Live
Kaiser Permanente	HMO networks by region	Live
Anthem / Elevance	PPO, HMO, EPO, FEHB OON	Upcoming
Oscar Health	EPO, PPO marketplace networks	Upcoming

📦

2B+

Total negotiated rate rows indexed across all payers

🏥

2M+

Unique provider NPIs across all payers and networks

🔬

12,000+

Distinct CPT/HCPCS codes tracked

📅

Monthly

MRF ingestion cycle, zero-downtime refresh

⚖️

Major payers indexed with full network coverage

FAQ

Common questions about the
negotiated rates API.

What is PayerBenchmark?

PayerBenchmark is a healthcare price transparency API that indexes CMS Machine-Readable Files (MRFs) from major US payers including Cigna, Aetna, UnitedHealth, BCBS, and Humana — giving developers instant access to negotiated rates, out-of-network amounts, and CPT code benchmarks across all networks.

Which payers and networks are covered?

We currently index Cigna (13 networks), Aetna, UnitedHealth, BCBS multi-state, Humana, Molina Healthcare, Centene/WellCare, and Kaiser Permanente. Anthem/Elevance and Oscar Health are coming soon. All 8+ live payers have full network coverage with 2B+ rate rows indexed.

How does PayerBenchmark get its negotiated rate data?

We ingest CMS Machine-Readable Files (MRFs) mandated under the Transparency in Coverage rule (45 CFR § 180). These files are publicly disclosed by all major health insurers. Our pipeline normalizes, deduplicates, and indexes the data monthly with zero-downtime refresh cycles.

Can I look up rates by CPT or HCPCS code?

Yes. PayerBenchmark supports lookups by CPT code, HCPCS code, NPI, TIN, network, and payer. Over 12,000 distinct billing codes are tracked across all indexed payers, with p50 and p90 benchmark percentiles computed from cross-payer data.

What is the API response time and uptime guarantee?

PayerBenchmark delivers a median API response time of under 50ms with a 99.9% uptime SLA. All endpoints are documented REST APIs with SDKs and webhook support available on Growth and Enterprise plans.

Is there a free tier?

Yes — the Starter plan is free and includes full access to all payers, all networks, and all API endpoints with no feature gating. You only hit rate limits as you scale. No credit card required to get started.

Pricing

Start free. Scale when you need to.

Every plan includes full access to all payers, all networks, and all API endpoints. No feature gating — just rate limits.

Starter

1,000 API calls / month · Free forever

All payers & networks
Negotiated rates & benchmarks
OON allowed amounts
Provider search
Community support

Get Started Free

Negotiated Rates forEvery Major Payer.

Everything you need toquery negotiated rates by payer, CPT code & NPI.