Healthcare payment decisions are made every day on unverified assumptions.
Medlyze provides the data: the latest commercial, Medicare and Medicaid rate for any code and provider.
Send the codes, payers and states you care about. We return the latest rates in our data within 24 hours.
Test your payment assumption ↓What rate are you assuming? See the actual rates.
Real New York commercial rates, each traced to its file. A small slice: three codes, one state. The data behind it covers 200+ payers and 5,600+ hospitals.
Dot = median · thin line = lowest to highest rate · shaded bar = middle half of a payer’s providers · amber band = your rate ±10%
Start from the decision in front of you.
Launching a product
Set launch price points and a payer plan. What commercial payers and hospitals have published for the codes your product bills under, by payer and state.
DRG 194, New York: 4 payers’ medians run $20,542 to $29,170.
Device manufacturers →Negotiating a contract
Walk into a renewal with the market in hand. Your contracted rates beside what other payers and hospitals have published, with renewal dates and notice deadlines.
Inside Cigna, one provider lists 4 rates for DRG 194, $21,332 to $33,226.
Providers →Evaluating an offer
Check a payer’s proposal. Each proposed rate is seen against the market, code by code.
Same code, same state: Emblem Health’s median is $29,170 and Aetna’s is $20,542.
Compare contracts →Planning expansion
Decide which payers and states to pursue. Commercial rates for your test codes, and the payers where your contracts leave the most uncovered.
8 New York hospitals publish DRG 194 commercial rates; medians run $6,554 to $35,188.
Diagnostics and labs →Other buyers: employers, brokers, legal, revenue cycle, data partners.
| Code | Your contract | Payer median | Hospital median |
|---|---|---|---|
| DRG 194 | $21,500 | $24,254 | $13,757 |
| Your contract is | 11% below | 56% above |
Know where to focus negotiation effort before the conversation starts.
Securely load your payer contracts. We read the fee schedules, terms and renewal dates; you confirm each field. Then compare any two, and set them against the rates payers and hospitals have published.
“Before working with Medlyze, we were struggling through payer negotiations with no visibility in market rates and little leverage to improve our low reimbursement rates. Medlyze provided the exact support we needed by exposing competitor rates and delivering a clear contract negotiation strategy, finally giving us the data to align our approach. Now, we are positioned to increase our rates with our current payer and have a replicable strategy for future contracts with companies like Cigna.”
- Your contracted share of covered lives, by state, product and carrier
- Commercial, Medicare, Medicare Advantage, Medicaid and Managed Medicaid in one view
- A ranked list of the payers worth contracting with next
Know how much of your market your contracts actually reach.
We match your contract list to the payers behind it and measure the covered lives you can serve, so contracting effort goes to the opportunities worth the most.
- Every claim line checked against what your contract says it should pay
- Underpayments recovered, with appeals prepared for your team
- The root cause of each underpayment, so it stops recurring
Find underpaid claims, and the reason behind each one.
Medlyze audits claim lines against your contracts, recovers what was underpaid and gives your revenue cycle team a playbook to fix the process.
- Who insures each employer plan, and what it costs per person against peers
- What the broker is paid on each contract
- What the carrier pays the hospitals near the employer’s people
Know the plan, the carrier and what its network pays, before the renewal.
Find prospects, open the meeting with the employer’s own numbers and compare carriers on what they pay the same hospitals.
- Where a client’s negotiated rates rank against comparable plans
- Hospital-by-hospital comparison for the procedures that drive spend
- A prioritized list of what to investigate, ready for the CFO meeting
Show a client how its negotiated rates compare with the market.
CFO-ready benchmarking reports for the clients you have won: the rates behind their plan, set against the market, procedure by procedure.
- A market price for each service billed in a claim, by code and geography
- Commercial, Medicare and Medicaid reference points side by side
- Documentation that holds up in negotiation
Answer a disputed medical bill with a market price.
Benchmarks for the services in a bill, so a negotiation starts from what the market pays rather than what was charged.
Where do the commercial and hospital rates come from?
From the files payers and hospitals are required to publish: 200+ payers’ negotiated-rate files and the price transparency files of 5,600+ hospitals. We collect, match and check them, then add Medicare and Medicaid for reference.
Is the demo real data?
Yes. The rates in the demo are real: New York payers’ August 2026 negotiated-rate files and New York hospitals’ price transparency files, for three inpatient codes. Your request covers the payers, hospitals and codes you name, with Medicare and Medicaid.
We already have benchmarks.
A benchmark compares. Medlyze shows the rate and where it came from. Send three codes and the benchmark you use, and we reconcile them.
We already have consultants.
Bring them. They can work from the same data, so what they cite and what you cite match.
These files are public.
They are, and they are enormous and inconsistent. The work is collecting payer and hospital files, matching them to your codes and providers, and checking them, so you get an answer instead of a pile of files.
Is my data safe?
You send codes and payers to start. Contracts are loaded securely, with you.
Start with the decision in front of you.
Send the codes, payers and states involved. We return the latest rates in our data.