Guides

Serif Health Commercial Payer Rates

Overview

Serif Health compiles negotiated in-network allowed amounts for the 293 most commonly billed medical codes across CPT, HCPCS, MS-DRG, and Revenue Code (RC) types for in-network providers in the United States. The data is sourced from payers' price transparency machine-readable files (MRFs) and parsed into cleaned and enriched datasets covering healthcare pricing, reimbursement variation, and site-of-care economics nationally.

Each dataset distinguishes professional from facility billing, captures site-of-care variation (e.g., hospital, ASC, office), and includes both inpatient and outpatient procedures. The data spans a range of negotiation types including fee schedules, percentage of billed charges, and per diem rates, as well as contracting arrangements such as fee-for-service, bundled payments, and capitation.

Four national commercial PPO networks are available as separate datasets: Aetna Open Access Managed Choice (PPO), Cigna National OAP (PPO), Blue Card (PPO), and UnitedHealthcare Choice Plus (PPO). These datasets enable research on healthcare price variation, market competition and consolidation, payer contracting strategies, site-of-care economics, and health policy evaluation.

Data Description

The grain is one row per unique combination of provider (EIN / NPI list), medical code, negotiated rate, place of service, and negotiation type. No single field is a unique key, and the datasets contain no fully duplicate rows.

Key fields include:

  • Provider identifiers (EIN, NPI list)
  • Medical code and code type
  • Negotiated rate
  • Place of service
  • Negotiation type
  • Professional-vs-facility indicator

Networks Covered:

Four national commercial PPO networks are available as separate datasets:

  • Aetna — Open Access Managed Choice (PPO): A national Aetna PPO network that underlies many of its commercial health plans.

  • Cigna — National OAP (PPO): A national Cigna PPO network that underlies many of its commercial health plans.

  • Blue Card (PPO): The nationwide Blue Cross Blue Shield BlueCard program, through which members receive in-network care from participating Blue plans across the U.S. while their home Blue plan coordinates claims and payment.

  • UnitedHealthcare — Choice Plus (PPO): A national UnitedHealthcare PPO network that underlies many of its commercial health plans.

Coverage

Geographic Coverage: United States, in-network providers.

Medical Codes: 293 most commonly billed medical codes across CPT, HCPCS, MS-DRG, and Revenue Codes.

Current Vintage: June 2026 (a monthly MRF snapshot).

Methodology

Rates are sourced directly from payers' machine-readable files (MRFs). Under the federal Transparency in Coverage rule, U.S. commercial health plans must publicly disclose their negotiated in-network allowed amounts as MRFs and update them monthly.

Serif Health ingests these files monthly, removes "zombie" rates (for example, a dental code priced under an orthopedic surgeon), runs a series of QA tests, and enriches the records using its proprietary database.

More information on data methodology and partner specific nuances is covered in the Serif Health Knowledge Base.

Additional Notes

Known Limitations:

  • Commercial in-network rates only.
  • Rate ambiguity: payers sometimes post multiple rates for a single code–provider combination with all other fields held constant. Serif Health publishes guidance on selecting the most representative rate.