Listed rate vs what you're paid: how to read insurer rate data

Why a listed rate is not a paycheck, what changes it, and how to use it in a negotiation.

What a listed rate is

Since 2022, insurers must publish the rates they have agreed with every billing group (the Transparency in Coverage rule). A listed rate is the contract amount for one service, for one billing group, before the patient's copay or deductible and before any denial.

Why it differs from what you take home

• Patient share. The insurer pays the listed rate minus the copay, coinsurance or deductible, which the patient owes.
• Denials and adjustments. Claims can be denied, down-coded or reduced by modifiers (for example, some telehealth rules).
• Who the group pays. If you work through a platform or an employer, the listed rate goes to their billing group. Your pay is whatever your agreement with them says.
• Ghost rates. Files can list rates for services a group never bills. NP Link uses one value per group and medians to limit this.

How to use it

A listed rate is the best public answer to "what does this insurer pay a group like mine for this visit". If yours is below the typical rate for your state, that is evidence for a raise request. Find your state, then check your rate.

All guides · NP Reimbursement 2026 · About the data