Find Negotiated Rates in an Insurer Price File
Find Negotiated Rates in an Insurer Price File - a deterministic tool in Sophie Well's Revenue Cycle & Utilization group.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Inputs and output
- What you enter
- What you get
- Example: the negotiated rates for the codes you name, each professional rate beside the Medicare amount for your locality.
How this is calculated
Citation
Transparency in Coverage in-network rates file (45 CFR 147.212(b)(1)(i)); Medicare amounts from the CMS physician fee schedule RVUs, GPCIs and conversion factor (42 CFR 414.20-414.22), facility or nonfacility by place of service (Pub. 100-04, ch. 12, sec. 20.4.2). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.