Reimbursement decisions are made every day on unverified assumptions.
Medlyze provides the rate of record: the latest commercial, Medicare and Medicaid rate for any code and provider, each with its source.
Send the codes, payers and states you care about. We return the latest rates on record, each with its source, within 24 hours.
“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.”
“This is Gold!”
Use it to set a price, prepare for a negotiation, choose a payer or state, check a payer’s proposal, or explain a number internally.
What changes when the decision is made on the rate of record.
Here is the difference between assuming the answer and holding it.
Pick a code. See what payers and hospitals have published for it.
Real New York rates, commercial payers and hospitals side by side, for three inpatient codes. The same view for your codes, with Medicare and Medicaid, within 24 hours.
Dot = median · thin line = lowest to highest rate · shaded bar = middle half of a payer’s providers
Start from the decision in front of you.
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.
Device manufacturers →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.
Providers →Decide which payers and states to pursue
Commercial rates for your test codes, and the payers where your contracts leave the most uncovered.
Diagnostics and labs →Put rates inside your product
Payer, hospital, Medicare and Medicaid rate files, with source and effective date on every row.
Data partners →Other buyers: employers, brokers, legal, home health, revenue cycle.
| Code | Your contract | Payer median | Hospital median |
|---|---|---|---|
| DRG 194 | $21,500 | $24,254 | $13,757 |
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.
What we cover
Know before you commit whether your payers, states and codes are covered.
One view of all four sources. Hospitals and payers show the tracked universe by file-quality grade. Medicare is every fee schedule in every locality; Medicaid is every non-MCO state. Every rate keeps its source and the date the source says it took effect; each delivery is built to your scope and stamped with the pull date.
Look up a hospital’s ratingLook up a payer’s ratingSearch providers
One format for every source.
A payer’s negotiated rate, a hospital’s negotiated rate, a Medicare rate and a Medicaid rate become the same record: the rate, its source and when the source says it took effect.
- 1The rate.With its type and modifier, so rental, purchase and used are never mixed.
- 2The source.The public file it came from: a hospital, a payer, Medicare or a state.
- 3The effective date.When the source says the rate took effect. The record holds the latest published rate.
- 4The check date.When Medlyze last confirmed it against the source. Hospital and payer records add a file-quality grade from A to F.
- Code
- DRG 194 · Simple pneumonia and pleurisy with CC
- Payer
- United Healthcare
- 1Rate
- $20,771.00
- Type · modifier
- Case rate, median of 113 providers · none
- 2Source
- United Healthcare negotiated-rate file (Transparency in Coverage), 2026-08
- 3Effective
- 8/1/2026
- 4Checked
- 9/16/2026
- Code
- DRG 194 · Simple pneumonia and pleurisy with CC
- Hospital
- Montefiore Medical Center
- 1Rate
- $6,554.17
- Type · modifier
- Case rate, median of 8 commercial payers · none
- 2Source
- Montefiore Medical Center price transparency file (standard charges)
- 3Effective
- 4/1/2026
- 4Checked
- 9/16/2026
Real published rates for MS-DRG 194, New York. Medicare and Medicaid records have the same shape.
Built to your scope, from the latest published files.
Tell us the codes, payers and states. We produce the record for them, with each rate’s source and date.
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, each with its source.
We already have benchmarks.
A benchmark compares. The rate of record 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 record, 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 on record, each with its source.