Healthcare Rate Graph · Pricing Variance Intelligence
PactGrid is an AI pricing analyst for independent specialty practices. Tell us your payer, market, and target CPTs — it returns a cited Review Packet showing where your rates rank against local peers, in minutes. No claims feed, no PHI.
For independent specialty groups, $5M+ revenue, with a payer renewal in the next 6–12 months. Radiology live today.
Healthcare Rate Graph
Cigna · Denver · Radiology · CPT 70553
reference scenario · illustrative
The gap
Payers have actuarial teams, years of claims data, benchmark models, and pricing analysts. An independent specialty group has a contract PDF and a billing cycle. That asymmetry is structural — and it compounds at every renewal.
$400/hr over 3–6 months. You get a report; the next renewal, you start over.
No independent benchmark, no basis to push back. The payer's number becomes your number.
The rate stays where it is. For a mid-size group, an unchallenged gap can run to six figures a year — and it compounds silently.
Why now
Healthcare pricing just became observable at market scale, and the pieces to act on it finally exist at the same time.
ACA price-transparency rules mean every payer now publishes negotiated rates — for every code, in every market.
NPPES and taxonomy data anchor provider identity and specialty at scale.
AI structures the output — peer-cohort ranking, evidence language, source citation — into something a CFO can use in a meeting, not just read.
The problem
The market has data transparency. It lacks decision transparency. Turning raw disclosure files into something you can carry into a negotiation is the hard part — and PactGrid's job is to convert them into bounded, explainable review candidates.
MRF files run 50–300GB per payer. No team parses them in real time.
The same provider appears under 6+ NPIs across payers, facilities, and geographies.
Raw rates vary by market, plan type, and facility — apples to filing cabinets.
Overstating raw differences creates legal exposure. Most teams don't know the line.
How it works
Behind every question is a Review Desk — an AI analyst that assembles what a health-system pricing team would: your payer, your market, your peer cohort, and the evidence. It reasons over the rate graph and returns a cited Review Packet — the same loop a big system runs, as software, in minutes. The hard part is everything underneath it.
The same physician resolves across 6+ NPIs — months of iteration, not weeks of scraping.
Fair comparison groups by specialty, geography, facility type, and volume.
MRF-safe language that survives payer scrutiny, with legal and clinical judgment baked in.
Rate position
Provider rates diverge from the cohort average.
reference scenario · illustrative
Why it gets better
PactGrid doesn't reset between questions. Each review feeds a context base that learns how rates behave for your payers, your market, your codes — so your next renewal starts with institutional memory, not a blank benchmark report. The analyst that reviews your hundredth scenario carries every prior one. The data is public; the accumulated judgment isn't.
Every review, decision, and correction becomes signal the next analysis can use.
Patterns by payer, market, and code are distilled into a reusable context base.
Each scenario gets faster, more precise, and lower-cost than the one before it.
What you get
Underneath, PactGrid normalizes payer machine-readable files through a governed lakehouse into the Healthcare Rate Graph. What you receive is simpler — one cited Review Packet, built from public MRF data.
Your payer, market, specialty, and the target CPTs you're benchmarking — the review is bounded to the rates that matter for your renewal.
Starts from public data only — no claims feed, no PHI, no integration.
Where your published rate sits: percentile rank and variance against the peer-cohort average.
One number that tells you how far your rate is from the market.
How the comparison group is built — by specialty, geography, facility type, and volume — and who's in it.
A defensible comparison, not an apples-to-filing-cabinets average.
Every figure links back to the published machine-readable file it came from, with data freshness noted.
Evidence that survives payer scrutiny — bounded to a review candidate, never a confirmed conclusion.
Payer-safe wording your team can use to open the renewal conversation, grounded in the evidence above.
Words you can say to the payer, traceable to the source on every claim.
Proof
Cigna · Denver · Radiology · CPT 70553 (Brain MRI): a published rate of $236 sits at the 18th percentile of a 17-provider peer cohort whose average is $357. That is a review candidate — not a confirmed payment conclusion. The CFO opens the next renewal call with evidence: “We've benchmarked 70553 against a 17-provider Denver radiology peer cohort; we're at the 18th percentile, and we're requesting alignment with the cohort average.” Reference scenario, based on published MRF data.
Where the published rate ranks within the peer cohort.
Variance against the $357 cohort average — a review signal.
In the comparison cohort, resolved from published data.
Other groups also flagged as review candidates.
Benchmark cohort
Percentile and rate identify providers needing review.
reference scenario · illustrative
Proof and trust
Every figure is cited to published MRF data, bounded to a review candidate, and recorded as a human decision. The workflow constrains every output to sourced figures and human-reviewed claims — which is exactly what lets a CFO act on it. The data is public; the governed intelligence that reads it safely is not.
Every figure links back to the machine-readable file it came from.
Rate position and review candidates — never a confirmed payment conclusion.
A governed review workflow stands between a signal and any action.
Cohort average · recent quarters
$357
reference scenario · illustrative
Who it's for
Built for CFOs, physician owners, and managed-care leads at independent specialty groups of $5M+ in revenue with a payer contract renewal in the next 6–12 months. Radiology is live today; orthopedics, cardiology, GI, and PT/rehab are next.
The beachhead — live today on the reference scenario.
Orthopedics, cardiology, GI, and PT/rehab.
The moment a rate review changes the conversation.
Design partner program
If yes — request a rate review, and we'll show you exactly where your contracts stand before you sit down with your payer. We're onboarding 3–5 design partners now, working directly with your team before general release. The rate review is how you start.
Request a rate reviewLive data proven: 17 providers benchmarked · Cigna / Denver / Radiology.