Payer scorecard
Same hospital, same procedure — different price depending on who’s paying.
Each payer’s median negotiated rate as a percent of Medicare, across every hospital × procedure cell
where that payer publishes commercial rates. Spread is the typical same-procedure price ratio between this
payer’s cheapest and most expensive hospitals (10th–90th percentile, median across procedures):
a low median with a wide spread still overpays somewhere.
How to read “% of Medicare”:
Medicare’s payment is a hospital-specific benchmark built from CMS files — adjusted for local wages
and case complexity, and roughly pegged to the cost of care. A commercial rate at 300% means a private plan pays
about triple that benchmark for the same care at the same hospital. The gap is negotiation, not quality.
Full methodology →
Cells are hospital × procedure medians per payer group; related plan names are grouped
(e.g. Anthem, BCBS, and Anthem Pathway roll up to Anthem BCBS). Workers’ comp payers and Medicare Advantage
are classified separately and excluded, as are data-flagged cells. Payer groups with fewer than 100 usable cells
are not ranked. Plan-level scorecards and employer-weighted baskets are available through
[email protected].
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