Insights

Proprietary research on healthcare pricing
for the C-Suite.

Grounded in data from Machine-Readable Files that no one else is publishing. Every insight is backed by real negotiated rates.

Employer Playbook

$948 to $2,700payer median range for the same nerve block

Your TPA's Discount Is Not What You Think: A Houston Nerve Block Case Study

A "55% discount" on surgical nerve blocks in Houston can still leave employers paying 20x Medicare. Our analysis of 2,068 rates across 6 facilities exposes why discount percentages are the wrong metric — and what to measure instead.

01Houston nerve block median rates range from $948 (Centene) to $2,700 (Humana) — a 2.8x payer spread for the identical procedure at overlapping facilities
02Commercial nerve block rates average 20x Medicare reimbursement, with some payer-facility combinations exceeding 40x
03A self-insured employer with 100 orthopedic surgeries per year faces $50,000-$150,000 in addressable nerve block savings alone

Shashi Mudunuri

April 3, 202610 min read

15xpayer price spread for the same IV push

Hidden Cost

The 15x Markup Hiding in Your IV Infusion Claims

A routine IV push costs $21 through one Houston payer and $322 through another. Our analysis of 1,660 negotiated rates reveals how facility-based infusion pricing creates one of the largest hidden cost drivers in self-insured plans.

April 3, 20269 min read

23x Medicaremedian ratio to Medicare benchmark

Market Intelligence

What Houston Hospitals Actually Charge for Blood Transfusions: A Market Analysis

Our analysis of 2,118 negotiated rates across 6 Houston facilities reveals a 36x price spread for the same blood transfusion procedure — and your payer may be paying 23x the Medicare benchmark.

April 3, 20268 min read

3.8x Medicareaverage negotiated rate vs. Medicare across 50,000+ employer claims analyzed

Market Intelligence

What Machine-Readable Files Reveal: The Average Employer Pays 3.8x Medicare for Procedures Their Plan Already Covers

For the first time, price transparency data makes it possible to see exactly what every employer is overpaying. Our analysis of 50,000+ employer claims shows the average negotiated rate is 3.8x Medicare — nearly double the fair-price benchmark.

April 3, 20268 min read

$2,400per employee annual savings for employers using direct primary care

Employer Playbook

Direct Primary Care Is Saving Self-Insured Employers $2,400 Per Employee Per Year. Here's the Playbook.

Employers who pair direct primary care with high-deductible plans save $2,400 per employee per year. Here's how DPC works, why the economics make sense, and how to implement it.

March 27, 202610 min read

22%average total plan cost reduction with reference-based pricing vs. traditional PPO

Employer Playbook

Reference-Based Pricing for Self-Insured Employers: A Data-Driven Implementation Framework

Employers using reference-based pricing save an average of 22% on total plan costs. Here's a structured framework for evaluating and implementing RBP without the common pitfalls.

March 20, 202611 min read

2.8xhospital outpatient cost premium vs. ambulatory surgery centers for the same procedure

Market Intelligence

Hospital Outpatient vs. Surgery Center: How Facility Choice Adds $4,200 to the Average Procedure Cost

For 73 common surgical procedures, hospital outpatient settings cost 2.8x more than ambulatory surgery centers. Here's the data and how employers can act on it.

March 13, 20268 min read

5.3xprice variation for the same MRI within the same metro market

Market Intelligence

The MRI Price Trap: Why the Same Scan Costs $400 at One Facility and $2,100 at Another in the Same City

Price transparency data reveals a 5.3x price spread for identical MRI scans within single metro markets. Here's what drives the variation and what employers can do about it.

March 6, 20267 min read

$14,200average annual GLP-1 drug cost per covered patient

Hidden Cost

GLP-1 Drugs Will Cost Your Plan $14,200 Per Patient This Year. Here's What to Do About It.

GLP-1 medications like Ozempic and Wegovy are reshaping employer pharmacy costs. A structured approach to utilization management can reduce inappropriate use by 38% without limiting effective care.

February 27, 20269 min read

41%of self-insured employers overpay for stop-loss due to misaligned attachment points

Employer Playbook

Stop-Loss Insurance: Why 41% of Self-Insured Employers Are Overpaying for the Wrong Coverage

Most self-insured employers set stop-loss attachment points based on broker estimates, not claims data. A data-driven approach can recover $90K–$450K annually for mid-market plans.

February 20, 202610 min read

34%of in-network claims priced above 200% of Medicare — the fair price benchmark

Hidden Cost

In-Network Doesn't Mean Affordable: How 34% of Employer Claims Are Overpriced by Design

Being in-network doesn't mean a provider charges a fair price. New data shows 34% of in-network claims are priced above 200% of Medicare — the generally accepted benchmark for reasonable rates.

February 13, 20268 min read

$1,800per employee per year in downstream costs from unaddressed mental health

Hidden Cost

The Mental Health Coverage Gap Is Costing Self-Insured Employers $1,800 Per Employee Per Year

Unaddressed mental health needs generate $1,800 per employee per year in downstream medical costs. Here's what the data shows and what employers can do about it.

February 6, 20269 min read

12xhospital vs. independent lab price gap for routine tests

Market Intelligence

Routine Lab Work Costs 12x More at Hospitals Than Independent Labs: What Self-Insured Employers Need to Know

New price transparency data reveals a 12x gap between hospital and independent lab prices for identical tests. Here's what it means for your health plan.

January 30, 20267 min read

Proprietary research on healthcare pricingfor the C-Suite.

Your TPA's Discount Is Not What You Think: A Houston Nerve Block Case Study

The 15x Markup Hiding in Your IV Infusion Claims

What Houston Hospitals Actually Charge for Blood Transfusions: A Market Analysis

What Machine-Readable Files Reveal: The Average Employer Pays 3.8x Medicare for Procedures Their Plan Already Covers

Direct Primary Care Is Saving Self-Insured Employers $2,400 Per Employee Per Year. Here's the Playbook.

Reference-Based Pricing for Self-Insured Employers: A Data-Driven Implementation Framework

Hospital Outpatient vs. Surgery Center: How Facility Choice Adds $4,200 to the Average Procedure Cost

The MRI Price Trap: Why the Same Scan Costs $400 at One Facility and $2,100 at Another in the Same City

GLP-1 Drugs Will Cost Your Plan $14,200 Per Patient This Year. Here's What to Do About It.

Stop-Loss Insurance: Why 41% of Self-Insured Employers Are Overpaying for the Wrong Coverage

In-Network Doesn't Mean Affordable: How 34% of Employer Claims Are Overpriced by Design

The Mental Health Coverage Gap Is Costing Self-Insured Employers $1,800 Per Employee Per Year

Routine Lab Work Costs 12x More at Hospitals Than Independent Labs: What Self-Insured Employers Need to Know

Proprietary research on healthcare pricing
for the C-Suite.