FAIR Health benchmarks are derived from billed charges — not contracted rates. PayerBenchmark indexes actual CMS MRF negotiated rates from all 5 major payers, queryable via REST API in under 50ms.
| Feature | PayerBenchmark | FAIR Health |
|---|---|---|
| Data Source | ✔ Actual CMS MRF negotiated rates | ✗ Billed-charge estimates (not contracted rates) |
| REST API Access | ✔ Full REST API, OpenAPI 3.1 spec | ~ Limited API; primarily reports & downloads |
| Query Latency | ✔ <50ms p99 | ✗ Report-based; no real-time queries |
| Payer-Specific Rates | ✔ Cigna, Aetna, UHC, BCBS, Humana | ✗ Aggregated estimates, not payer-specific |
| Cross-Payer Benchmarks | ✔ p10–p90 percentiles via API | ~ Percentiles available but billed-charge based |
| OON Allowed Amounts | ✔ Real OON payment data from MRFs | ~ Billed-charge based OON estimates |
| Filter by NPI / CPT | ✔ NPI, CPT, payer, network, date range | ✗ Pre-built reports; no per-NPI filtering |
| Monthly Data Refresh | ✔ Zero-downtime monthly CMS refresh | ~ Periodic updates, not monthly MRF-aligned |
| Programmatic Integration | ✔ REST API + SDKs + bulk export | ✗ Primarily UI-based reports and CSV downloads |
| Pricing Transparency | ✔ Public usage-based tiers | ~ Subscription licensing, custom pricing |
FAIR Health benchmarks are derived from what providers billed — not what payers actually paid. Billed charges can be 3–10x higher than negotiated rates. This matters enormously for cost estimation, dispute resolution, and contract modeling.
Since July 2022, every major commercial payer publishes actual negotiated rates under the CMS Transparency in Coverage rule. PayerBenchmark indexes all of them — 2B+ real contracted rate rows, not estimates derived from billed charges.
FAIR Health publishes pre-built reports and CSV downloads. PayerBenchmark exposes a real-time REST API — query any CPT code, any NPI, any payer, any network, and get results in under 50ms. No waiting for a report to generate.
FAIR Health aggregates across payers. PayerBenchmark breaks rates out by payer and network — so you can see exactly what Cigna pays vs. Aetna vs. UHC for the same CPT code at the same provider. Critical for contract negotiation.
The /v1/benchmarks endpoint computes p10–p90 percentiles from actual payer-contracted rates across all 5 major payers — not from billed charges. This is a fundamentally more accurate benchmark for cost transparency and dispute resolution.
REST API with OpenAPI 3.1 spec, Python/TypeScript/.NET SDKs, cursor-based bulk export, and usage-based pricing. FAIR Health was designed for analysts consuming pre-built reports — PayerBenchmark was designed for engineering teams building on top of the data.
Document which benchmarks you're pulling from FAIR Health today — OON estimates, in-network percentiles, geographic breakdowns. These map directly to PayerBenchmark's API endpoints.
In-network rate benchmarks → /v1/benchmarks. OON allowed amounts → /v1/oon/rates. Payer-specific rates → /v1/rates?payer=<payer>. Geographic filters are supported via state and CBSA parameters.
Pull benchmarks for your top 20–50 CPT codes from both sources. You'll typically find PayerBenchmark's negotiated-rate percentiles are 40–70% lower than FAIR Health's billed-charge estimates — which is the actual market reality.
Replace manual FAIR Health report downloads with API calls. Set up a monthly refresh job aligned with CMS MRF publication cycles. Your benchmarks will now stay current automatically.
Stop benchmarking against billed-charge estimates. PayerBenchmark gives you actual contracted rates — the numbers payers and providers actually agreed to — via a sub-50ms REST API.