Negotiated Rate

A negotiated rate is the price a health plan and a provider have agreed to in a written contract. It sits between the hospital's chargemaster (the sticker price) and the cash price (what someone pays with no insurance at all). Every in-network claim runs through this number.

Here's what surprises people: negotiated rates for the exact same procedure can vary two, three, sometimes ten times across facilities inside the same city. A knee MRI in Austin might be contracted at $380 at one imaging center and $2,100 at a hospital-owned facility five miles away — same CPT code, same scan, same carrier. Since the Transparency in Coverage rule took effect, carriers must publish these rates in monthly Machine-Readable Files (MRFs), which is how tools like TruePrice can now show you what your plan actually pays before you walk in. Self-funded employers feel this variance most because every dollar of the negotiated rate comes out of their claims budget, not a premium pool.

The takeaway: before any non-emergency service, ask what your negotiated rate is for the specific CPT code at the specific facility. Two facilities in the same network can carry wildly different negotiated rates for identical care.