Payerset tracks the Transparency in Coverage machine-readable files of 183 commercial payers, and grades 130 of them on three dimensions: table-of-contents quality, file accessibility, and data quality.
The Price Transparency Project
Price Transparency by the Numbers
Key statistics on U.S. healthcare price transparency, drawn from Payerset’s data and published analyses. Each figure is a complete, sourced claim, free to cite with attribution to Payerset and a link to this page.
Updated August 31, 2026 · Scorecard figures computed from data as of May 31, 2026
The state of payer files
Figures in this section are computed directly from the Payer Compliance Scorecard dataset (as of May 31, 2026) and update with it.
Fewer than half of graded payers publish top-quality files: 61 of 130 (47%) earn an overall score of 5 out of 5, while roughly 1 in 9 score 2 out of 5 or below.
27% of tracked payers (49 of 183) carry an active data alert: table-of-contents redirects, missing files, or coverage gaps that affect how their rates can be used.
9% of graded payers publish a table of contents scoring 2 stars or fewer, the file that determines whether their negotiated rates can be located at all.
Payer Transparency in Coverage files now cover roughly 1.7 million care-delivery NPIs: every provider with a commercial contract, far beyond the ~6,100 registered hospitals covered by hospital files alone.
Payerset observes file-size reductions of up to 90% for payer files properly restructured under TiC Schema 2.0, a figure cited in Payerset’s formal commentary to CMS on the proposed Schema 3.0 rule.
Source: Payerset commentary to CMS, proposed rule CMS-9882-P (Feb 2026)
What the rate data shows
In a published Payerset analysis, 94% of a hospital’s inpatient DRG rates for a commercial plan divided back to a single negotiated base rate, meaning most of an inpatient rate grid can be reconstructed from one number.
Source: Gaining Leverage by Uncovering Contract Structures (Payerset, Aug 2026)
For the same total knee replacement in the same market, health-system-owned surgery centers were paid roughly 73% more than independent ASCs, and across all three orthopedic procedures Payerset tested, facility rates rose with the market power of the owner.
A single-code comparison can flip the conclusion entirely: in a Payerset comparison of two competing hospitals, the one that looked $69 more expensive on the ED visit code alone was about $250 cheaper on the full chest-pain visit bundle.
From the field
Documented outcomes from teams using price transparency data in live negotiations. Organizations anonymized.
A payer opened a renewal claiming 15% overpayment and pushing for a rate decrease; service-line analysis of transparency data showed the actual gap was closer to 2%, and the hospital negotiated a budget-neutral outcome instead.
Source: Case study presented at the HFMA Provider and Payer Symposium (Feb 2026), via the 2026 Field Guide
A health system used service-line benchmarking to show one of its growth service lines was reimbursed 35% below market, and turned the payer’s own transparency data into a rate increase it could not have evidenced before.
Source: Case study presented at the HFMA Provider and Payer Symposium (Feb 2026), via the 2026 Field Guide
Health systems have used Transparency in Coverage data in physician-retention campaigns to demonstrate that their rates run 10–15% higher than the top three competitors in key service areas.
The wider landscape
External benchmarks we reference often, with links to the primary sources.
Employers and private insurers pay hospitals an average of 254% of what Medicare would pay for the same services, the industry’s most-cited commercial-to-Medicare benchmark.
Source: RAND Corporation, Prices Paid to Hospitals by Private Health Plans, Round 5.1 (2024)
Only 27% of U.S. hospitals were fully compliant with price transparency requirements in CMS’s early-2021 assessment; in 2026, nearly every hospital posts a machine-readable file with a named executive attesting the data is true, accurate, and complete.
Source: CMS assessment via Health Affairs Forefront (2023); attestation per CMS CY 2026 OPPS/ASC Final Rule
Under the proposed TiC Schema 3.0 rule, a carrier that today publishes 50 separate rate files with identical content for 50 plans on the same network would publish one rate file per provider network instead.
Citing these figures
Statistics on this page are free to reference with attribution: “Payerset, Price Transparency by the Numbers” and a link to this page. Payerset-derived figures come from our normalized Transparency in Coverage and Hospital Price Transparency datasets; scorecard figures recompute automatically when the underlying data updates. For questions about methodology or access to the underlying data, contact the team.
The data behind the numbers
Every figure above comes from the same normalized rate data Payerset customers use for benchmarking and contract negotiations.