DataRise™ Commercial Reimbursement Data is available for custom orders.
Subscribers now have unprecedented access to virtually all commercial contract reimbursement rates by health plan, provider, and service. Available commercial reimbursement rates include hard-to-find services, such as:
- Ambulatory surgery center (ASC) reimbursement (see below or click here to see more)
- Air ambulance reimbursement
- Fertility benefit reimbursement (click here to see more)
- Hospital-based physician reimbursement (see anesthesiology below)
- Hospital inpatient & outpatient reimbursement (click here to see more)
- Lab service reimbursement
- Out-of-network reimbursement
- PCP & specialist reimbursement (see orthopaedic surgery below)
- Telemedicine reimbursement (new codes in 2025)
- Urgent care reimbursement (see below)
- AND MUCH MUCH MORE!
Georgia HFMA Presentation (6/19/25) w/40 Data Examples
#1 Intro & Agenda02:26
#2 What is the Transparency in Coverage Rule?02:54
#3 GA Commercial Reimbursement: Physician Services16:18
#4 GA Commercial Reimbursement: Surgery Centers03:01
#5 National ASC Chains Dominate Reimbursement05:21
#6 GA Commercial Reimbursement: Inpatient Hospital02:00
#7: Observations in Other States10:39
#8: Use Applications02:15
#9 New Treatment Pricing03:10
#10 Fertility Treatment Pricing01:57
#11 Specialty Pharmacy Drug Trends02:24
#12 Closing00:48
Queries are custom searches performed by an Acuvance professional upon request. Turnaround times will be quoted at order, but expect turnaround times of 24 to 72 hours for raw data for most query searches. Analysis is a separate service that can be provided by Coker’s consultants.
If there are more than 1 million results, your data will be accessible via a private online portal. The Unlimited Query Plan is subject to limitations on processing time (24 to 72 hours per health plan ordered).
Example #1: CO UHC Choice Plus (29880) ASC Rates
The graph and data table below detail commercial reimbursement rates under UnitedHealthcare’s Choice Plus health plan in Colorado for procedure code 29880 (knee arthroscopy with meniscus repair) in 100 ambulatory surgery centers (ASCs).
At a quick glance, it is obvious that HCA’s HealthOne ASCs have some of the best reimbursement rates in the Colorado market, followed by USPI, UCHealth, and Children’s Hospital. Reimbursement rates under UHC’s Choice Plus plan drop off substantially for smaller ASC operators after UCHealth.
Commercial ASC Reimbursement: Colorado UHC Choice Plus 29880
Example #2: CO UHC Choice Plus Anesthesiology Rates
Anesthesiology is probably the physician specialty with the wildest fluctuations within markets. The graph and data table below summarize commercial reimbursement rates under UnitedHealthcare’s Choice Plus health plan in Colorado for anesthesiology reimbursement for four common anesthesiology codes (00142, 00670, 00790, 01402).
As observed in other markets, professional anesthesiology reimbursement fluctuates wildly in Colorado from about 180% to 650% of Medicare (Colorado GPCI-adjusted).
Commercial Anesthesiology Reimbursement: CO UHC Choice Plus
Example #3: CO UHC Choice Plus Urgent Care Rates
Urgent care reimbursement has been difficult to identify historically. No more. The graph below summarizes commercial reimbursement rates under UnitedHealthcare’s Choice Plus health plan in Colorado for urgent care service code URC.
At a quick glance, it is obvious that HCA’s HealthOne has the highest urgent care reimbursement rates in Colorado ($630), followed by Boulder Community Health ($537), Children’s Hospital Colorado ($437), and CommonSpirit ($370). Compared to other urgent care operators, UCHealth’s urgent care rates are surprisingly low at $172 to $262.
Example #4: CO UHC PPO (29880) Surgeon Pro Fees
The graph below summarizes commercial reimbursement rates with orthopaedic surgeons under UnitedHealthcare’s PPO health plan in Colorado for procedure code 29880 (knee arthroscopy with meniscus repair).
At a quick glance, it is obvious that the Steadman Clinic in Vail has the highest professional rates in Colorado (571% of Medicare) for this procedure, followed by pediatric surgeons affiliated with Children’s Hospital of Colorado (385%) and UCHealth (336%). Reimbursement is substantially lower for orthopaedic surgeons in physician groups operated by CommonSpirit and Advent Health (214%), as well as Panorama Orthopedics (165%).
More Commercial Reimbursement Examples
Where does this data come from?
UnitedHealthcare, Cigna, Aetna, Elevance, and other commercial carriers released hundreds of thousands of massive data files (>100 GB per file) under the Transparency in Coverage rules. Unfortunately, these carriers released health plan data files in an obscure data format (json) that is difficult to parse. Most of these massive multi-gigabyte files cannot be opened in Microsoft Excel.
We do the hard programming work, so you don’t have to.
Do NOT pay more to FAIR Health or Optum for blinded data for one procedure code in one ZIP code.
Purchase prepaid Health Plan Query Credits.
Use these credits whenever you need them. These query credits never expire.
What is a Per Health Plan Query Credit? What does it get me?
Pricing is based on the number of unique health plans searched, not the number of service codes searched. If you request searches on three (3) health plans, pricing does not change whether you request searches for one (1) service code or 100 service codes on those three health plans. Searching three health plans costs three credits.
Each one of the four examples above is an example of one query on one health plan (UHC Choice Plus in Colorado).
Queries are custom searches performed by an Acuvance professional upon request. Turnaround times will be quoted at order, but expect turnaround times of 24 to 72 hours for most query searches.
If there are more than 1 million results, your data will be accessible via a private online portal. The Unlimited Query Plan is subject to limitations on processing time (24 to 72 hours per health plan ordered).