Methodology, data sources and editorial standards

01How the numbers are built

Medicare baselines. Every CPT reference uses the CMS Physician Fee Schedule 2026 national, non-facility payment amount: 99205 ≈ $236.81, 99215 ≈ $183.50, 99417 ≈ $32.50 per unit, 11980 ≈ $105. Local Medicare rates vary by geographic practice cost index (GPCI); we use the national figure as a stable anchor.

Commercial allowables. Out-of-network PPO plans pay on an “allowed amount” set by the plan — often derived from FAIR Health percentiles or a multiple of Medicare. We express this as a market-tier multiple of Medicare: Tier 1 (NYC, SF Bay Area, Los Angeles/Orange County, Boston, Washington DC) 220–280%; Tier 2 (Chicago, Atlanta, Austin, Dallas–Fort Worth, Houston, Miami, Phoenix, Denver, Seattle) 170–215%; Tier 3 (regional and suburban markets, including Nashville in our model) 135–165%. Calculators use the midpoint (250%, 192.5%, 150%). These are estimates; your plan’s schedule may be lower, especially if it pays on a Medicare-based schedule.

Prices. Clinic fees, membership prices, pellet insertion fees, telehealth subscription prices and lab wholesale/retail prices are ranges compiled from published 2026 price lists, practitioner pricing and patient-reported quotes. They are labelled as ranges or estimates, never as a quote from a named clinic.

Practice economics. The physician P&L model uses MGMA-style ranges for wRVU volume and compensation per wRVU, published malpractice ranges for OB/GYN versus GYN-only coverage, and a lean staffing model (one RN/MA, one care coordinator) for the micro-practice.

02How the four calculators work

• Superbill net-cost calculator: allowable = lesser of the clinic’s charge and the tier-adjusted allowable; reimbursement = (allowable − remaining OON deductible) × coinsurance; HSA/FSA saving = marginal tax rate × net spend. For membership models the claim is capped at what you actually paid.
• BHRT comparator: 1- and 3-year totals for four delivery routes from your price inputs plus fixed visit and lab assumptions shown on the page.
• Lab panel builder: maps each clinical presentation to a biomarker set with CPT and ICD-10 codes, then prices it three ways (clinic retail, wholesale pass-through, hybrid insurance + wholesale).
• Practice P&L simulator: insurance net = wRVUs × compensation per wRVU; DSC net = membership + dispensary margin + ancillary − fixed and variable overhead; break-even = fixed overhead ÷ contribution per member.

All calculations run in your browser. Inputs are stored only in the page URL so you can share them; nothing is sent to us unless you submit the matching form.

03Editorial independence

No clinic, telehealth platform, laboratory, compounding pharmacy, pellet company or software vendor pays to be included, ranked or described on this site. We do not accept free products in exchange for coverage. If IntegrativeGyn.com ever earns referral fees from a clinic network or vendor, the affected pages will say so at the top, and rankings will not change because of it.

Named companies are described by their publicly available model and published pricing. Our “audits” examine what a contract is likely to cost a patient or physician and which questions to ask — they are not allegations about any company’s conduct. Companies may write to us through the contact page to correct a fact; corrections are made promptly and dated.

04Clinical advisory standards

Clinical content follows the positions of The Menopause Society, the American College of Obstetricians and Gynecologists, the Endocrine Society and the American Society for Reproductive Medicine where they exist. Where integrative practice goes beyond those positions (for example “optimal” functional reference ranges, compounded hormones or pellets), pages say so and state the strength of evidence. FDA-approved options are always named alongside compounded alternatives.

05Privacy

We collect personal information only when you submit the matching or inquiry form: the fields you fill in, the page you sent it from, an optional calculator snapshot you chose to attach, and technical data (IP address, country, browser) used to stop spam. We use it to answer your request and, for patients, to introduce you to a clinic only after you approve it. We do not sell or rent your information, do not use advertising trackers, and load no third-party fonts or scripts.

IntegrativeGyn.com is not a healthcare provider, so HIPAA does not apply to what you send us; please do not include detailed medical records in the notes field. To see, correct or delete what you sent, write to us via the contact page with your reference number.

Calculator inputs live only in your browser and the page URL. A theme preference may be saved in your browser’s local storage.

06Limitations and corrections

• Plans differ. Some PPOs pay out-of-network claims on a Medicare-based schedule far below our tiers; HMOs and EPOs usually pay nothing out of network.
• Prices change. Platforms revise memberships and labs revise kit prices; always confirm before paying.
• Law differs by state. Corporate Practice of Medicine rules, telehealth prescribing and controlled-substance rules change; physicians should confirm with a healthcare attorney.
• Tax treatment is fact-specific. Confirm HSA/FSA eligibility with your plan administrator or a tax professional.

Found an error? Tell us through the contact page. Material corrections are noted on the affected page with the date. This page was last reviewed on 7 November 2026.