The evidence
The numbers payers already know
Commercial reimbursement is not a fee schedule handed down from above — it is a spread, and practices sit all over it. Here is what that spread looks like.
117% – 243%
Commercial pay as a share of Medicare, by state
The same procedure, the same payer network, wildly different money. Where your contract sits in that spread is a negotiated outcome — not a fixed rule.
148%
National average commercial-to-Medicare ratio
Roughly a quarter of markets sit below 128%. If your contracts are in the bottom quartile, the gap to the average is real revenue you are already producing.
68%
Of facilities saw payment ratios fall over a recent 4-year window
Evergreen contracts drift downward in real terms every year they go untouched. Doing nothing is an active decision to be paid less.
Everyone's revenue went up. Physician payment went down.
Cumulative change, 2001–2023. Premiums and payer earnings compounded; physician reimbursement moved backwards against inflation.
- Large insurer net income
- +1,554%
- Average family premium
- +282%
- General inflation
- +82%
- Physician payment
- -15.5%
Five levers decide what you are paid
Every one of them is negotiable, and every one of them is currently being set by the side with more data.
- 01
Provider credentials
Specialty mix and credentialing tier move your fee schedule.
- 02
Service type
Code-level weighting differs sharply between contracts.
- 03
Geographic location
Regional benchmarks vary by more than 100 points.
- 04
Network status
In-network leverage is a negotiating position, not a status.
- 05
Plan type
Commercial, exchange, and ASO lines are priced separately.
Model your own upside
Set your commercial volume, payer count, and how long your rates have gone untouched, then toggle the levers we would pull. The range updates live.
Estimated annual revenue lift
$177,444 – $561,906
5.9% – 18.7% of your commercial book, recurring every year the improved rates stay in force.
Over three years: $532k – $1.69M
Directional estimate based on typical commercial rate spreads. Your actual range comes from your own fee schedules.
Gated resource · PDF
Get the full rate negotiation brief
Benchmark ranges, the five renegotiation levers, exposure by contract signal, a worked upside model, and your next steps. Tell us where to send it and the download unlocks immediately.