Loading...
Loading...
Loading...
Healthcare price transparency data is publicly available under federal law — but it takes serious engineering to make it usable. Here's how DeductibleData turns terabytes of raw insurer data into the specific datasets you need.
Last updated May 7, 2026
Understanding the data, the regulation, and why it matters.
Machine Readable Files are the standardized data files that health insurers publish to comply with the TiC Rule. They contain negotiated rates in JSON format. Individual files can exceed 100GB, with a single payer's complete dataset reaching terabytes. The nested JSON structure, thousands of files per payer, and sheer scale make them impractical to process without specialized cloud infrastructure and engineering. DeductibleData handles this complexity and delivers only the data you need.
Schema 2.0 is the updated data format for Machine Readable Files, enforced since February 2, 2026. Key changes include requiring a business_name alongside every EIN, consolidating billing code types, adding APR-DRG severity levels, and moving provider groups to inline-only format. These changes improve data quality and consistency, meaning DeductibleData's extractions from Schema 2.0 files contain richer, more reliable information than earlier formats.
No. MRF data contains zero patient information. The TiC Rule specifically requires disclosure of negotiated rates, which are contractual prices between insurers and providers. The data includes provider business identifiers (NPI, TIN) that are already public information. There is no Protected Health Information (PHI) in any of our deliverables.
In-network rates are the negotiated prices that insurers have agreed to pay contracted providers — typically lower than list prices. Out-of-network allowed amounts reflect historical payments insurers have made for services from non-contracted providers during a rolling 90-day period, often based on Medicare rates, usual and customary charges, or plan-specific methodologies. DeductibleData primarily provides in-network negotiated rate data from MRF files.
Price transparency data shows the negotiated rates between insurers and providers — what an insurer has agreed to pay for a service. Claims data shows what was actually billed and paid for specific patient encounters. TiC data is publicly available and covers every contracted rate, while claims data is proprietary and limited to actual utilization. They complement each other: TiC data is broader (every rate, every provider), while claims data captures real-world utilization patterns and patient volume.
Who uses this data and what they do with it.
Healthcare price transparency data is used by a range of professionals and organizations:
Yes — this is one of the most common reasons healthcare providers purchase TiC data. Payer representatives often tell providers that the rates they're offering are "market standard" or "competitive."
Negotiated rate data gives you the factual record of what the same payer is actually paying other providers in your area for the same billing codes. Showing an insurer their own published rates for comparable providers — which they are federally required to disclose — is one of the most direct tools available for contract negotiation.
Many of our customers purchase this data specifically to enter payer negotiations with documented benchmarks rather than taking a payer's word for what market rates look like.
Yes. Behavioral health providers have some of the largest gaps between what payers claim are "market rates" and what they actually pay comparable providers. Mental health parity law requires commercial insurers to cover behavioral health services at rates comparable to medical and surgical services — and negotiated rate data is one of the few ways to independently verify compliance.
CPT codes for therapy services (90832, 90834, 90837, 90847), psychiatric evaluation (90791), and medication management (99213–99215) are all well-represented in commercial payer MRF data. You can search for these codes by number or description on our custom data pull page.
What data is available, how it's delivered, and how fresh it is.
DeductibleData focuses on commercial payer negotiated rates published under the Transparency-in-Coverage Rule. Medicare and Medicaid rates are set by CMS and published through separate channels (Medicare Physician Fee Schedule, OPPS, IPPS). Our data captures what commercial insurers like UnitedHealthcare, BCBS, and Aetna pay providers — which is often significantly different from government rates and is the data most consultants and hospital systems need for contract benchmarking.
Insurers are required to publish MRF data monthly under federal regulation. We continuously monitor and index new publications, typically processing them within days of release. When you request a data pull, we extract from the most recent available files. The data reflects currently negotiated rates, though actual prices paid may vary based on specific plan terms.
Data is delivered in one of two formats depending on size:
We provide documentation explaining every field in your deliverable.
Delivery takes hours to 7 business days depending on data volume, with targeted requests completing fastest. Small, targeted requests (under 10GB) typically complete within hours. Medium requests take 1-3 business days. Very large extractions covering all providers and all codes for a major payer can take 3-7 business days due to the scale of processing. You'll receive email notifications with progress updates throughout.
We monitor every job and are notified immediately if an issue occurs. In most cases, we can resume processing from where it left off. You won't be charged for incomplete deliveries, and we'll keep you informed via email until your data is ready for download.
Once your job is complete, you'll receive an email notification. Log in to your account dashboard, find the completed job, and click Download. The file is delivered as a CSV (or Parquet for large extractions) that you can open in Excel, Google Sheets, Python, R, or any data tool. Download the file to your local storage promptly — download links expire after a limited window.
How pricing works, what's included, and subscription options.
Our data includes 16 billing code types. You can filter by any of the following:
Search for codes on our custom data pull page.
Start with the CPT or HCPCS codes your practice or organization bills most frequently. Some common examples by specialty:
You can search for codes by description or number on our custom data pull page. If you're unsure which codes are most relevant, contact us and we'll help you identify the right starting set.
Start with the insurers that make up the largest share of your patient volume or contract portfolio. For most practices and consultants, that's a handful of commercial payers — Anthem, Aetna, UnitedHealthcare, and one or two BCBS plans depending on geography.
You can add multiple payers in a single data pull on our custom data pull page. If you work primarily with Medicaid managed care organizations, note that managed care plans publish under different names by state — contact us if you need help identifying the right plan names in our system.
Yes. Our pricing calculator on the custom data pull page shows you the exact cost before checkout, with no account required. Configure your payers, providers, and billing codes and the price updates in real time. There's no minimum commitment, no sales call, and no waiting for a quote. If the estimate is higher than expected, try narrowing your provider filters — using specific NPIs rather than a broad geographic or taxonomy filter significantly reduces cost.
Published MRF rates are the contractually negotiated prices payers are legally required to disclose and, in principle, honor. If you're receiving payments below the published negotiated rate for a billing code, that's a potential underpayment case.
TiC data is increasingly used in payment audits and litigation to document systematic underpayment relative to contracted rates. The data alone doesn't prove underpayment — actual payment amounts come from your practice management system or EOBs, not the MRF — but the combination of your payment history and published negotiated rates creates a factual basis for a formal dispute or legal proceeding.
Contact us if you need data scoped for a payment audit or litigation support.
Pricing, access, and how DeductibleData stacks up against other TiC data vendors.
| Vendor | Starting Price | Self-Serve Checkout | Contract Required |
|---|---|---|---|
| DeductibleData | $164/mo | Yes, credit card | No |
| Serif Health* | $1,000/mo ($12K/yr) | No, demo required | Yes |
| Turquoise Health** | $20K-$50K+/yr (est.) | No, demo required | Yes |
| Most others | Not disclosed | No | Yes |
*Serif Health pricing published on their blog. **Turquoise Health estimate based on enterprise sales model and $55M in venture funding (public record).
See your exact price on our real-time pricing calculator.
Our product is self-explanatory and our pricing is transparent. You configure exactly what you need — payers, providers, billing codes — on our custom data pull page, see the price in real time, and check out with a credit card.
No scoping call, no contract negotiation, no waiting for a quote. Most vendors in this space require demos because their pricing is opaque and varies by customer. We believe if you can't show your price, you're not confident in it.
Pay-per-pull means you pay only when you need data, with no minimum commitment and no lock-in. Annual contracts, which most vendors in this space require, lock you into a fixed payment regardless of how much data you actually use. DeductibleData offers both one-time purchases and optional subscriptions (monthly, quarterly, or bi-annual), but subscriptions are opt-in — you're never required to commit upfront.
Three key differences:
If you need specific MRF rate data without the overhead of an enterprise platform, we're built for that.
The two are complementary: MRF data tells you the price, claims data tells you the volume. DeductibleData partners with claims data specialists for customers who need both pricing and volume in a single deliverable. Contact us to scope a blended request.
No. Every vendor in this space pulls from the same source: the Machine Readable Files that health insurers are federally required to publish under the TiC Rule. The provider IDs, billing codes, negotiated rates, and payer metadata are identical regardless of who processes them. DeductibleData's lower price reflects our business model — automated pipeline, no enterprise sales team, no venture capital overhead — not a difference in data quality.
What the Explore feature is, how it works, and what you can do with it.
Explore is an AI-powered research interface built into every DeductibleData job. Once your data pull is complete, Explore lets you ask natural language questions directly against your extracted dataset — without writing SQL or downloading the file. It translates your questions into database queries, runs them against your data, and returns plain-English answers with supporting numbers.
You can query up to 5 billion rows of negotiated rate data using plain English. Common use cases:
Explore is available to all users — no additional subscription required. It is accessible directly from any completed job in your account dashboard. There is no paywall or demo requirement to use it.
Yes. Each job includes up to 20 Explore queries. This limit is enforced server-side and resets per job — not per account. Most analyses are completable within 20 focused questions. If you need to run an extended research session, you can initiate a new data pull job to reset your query count.
No. Explore accepts plain English questions. The underlying system generates and executes the necessary database queries on your behalf. You describe what you want to know; Explore figures out how to retrieve it.
Yes. Every completed job includes access to Explore, our AI-powered research interface. You can ask natural language questions directly against your dataset — 'What's the average negotiated rate for CPT 90837 across my payers?' or 'Which payer pays the most for family therapy?' — and get answers without downloading or opening the file. This is particularly useful for quick lookups, sharing findings verbally, or when you want to explore the data before deciding whether a full download is needed.
How DeductibleData builds its provider index and determines which NPIs are included or excluded.
DeductibleData builds its provider index from the NPPES (National Plan and Provider Enumeration System) registry, maintained by CMS. NPPES is the authoritative federal database of all healthcare providers assigned National Provider Identifiers. CMS publishes a full monthly replacement file and a separate monthly deactivation file. As of March 2026, CMS has migrated to Version 2 of the downloadable files; we use Version 2 as the current standard.
An NPI is treated as active if it exists in the current NPPES registry and does not appear in the CMS monthly deactivation file. The four official deactivation reason codes we screen against are:
NPIs flagged with any of these codes are excluded from our provider index.
Yes. Our NPI index is cross-referenced against two federal exclusion databases:
Providers appearing on either list are flagged in our dataset. A clean record on one list does not guarantee a clean record on the other — both are checked independently.
Our index includes all Type 1 (individual practitioners) and Type 2 (organizational) NPIs that meet all three criteria:
We do not restrict by provider taxonomy — the index covers physicians, hospitals, ambulatory surgery centers, group practices, therapy providers, and all other NPI-holding entities.
The NPI index is refreshed monthly, aligned with CMS's publication schedule for NPPES updates and the OIG LEIE. This means provider status — active, deactivated, or excluded — reflects the most current available federal data.
What compliance validations we perform on the data and how it can be used in legal and regulatory contexts.
DeductibleData cross-references its NPI index against three public federal databases monthly:
We do not independently verify the accuracy of the underlying negotiated rates. Those are published directly by payers under the Transparency-in-Coverage Rule and delivered as reported. Payer-reported rates are contractually negotiated prices and may not reflect actual payment amounts in every case.
TiC negotiated rate data has been used as evidence in healthcare billing disputes, underpayment cases, and payer contract litigation. The data is payer-reported under federal regulatory mandate — a primary source for establishing contracted rates.
Important caveats:
Use of this data in litigation or compliance proceedings should involve qualified legal counsel.
No — analyzing publicly mandated TiC data for benchmarking and contract negotiation is not an antitrust violation. The TiC Rule specifically requires payers to publish these rates; using them is the intended purpose of the regulation.
Antitrust risk in healthcare pricing data applies to payers coordinating rates using shared algorithms or intermediaries — not to analysts, consultants, or providers consuming publicly available rate data. The DOJ has specifically addressed algorithmic price coordination among insurers (see ongoing MultiPlan litigation), but that concern is about payer behavior, not data consumers.
If you have specific antitrust questions about your use case, consult qualified legal counsel.
Not currently. Every U.S. state maintains its own Medicaid exclusion list, separate from both the federal OIG LEIE and SAM.gov. A provider can be excluded from a state Medicaid program without appearing on either federal list. Our current compliance checks cover the two federal exclusion databases (OIG LEIE and SAM.gov) and the NPPES deactivation file. If your use case requires state-level Medicaid exclusion screening, we recommend supplementing our data with a specialized exclusion monitoring service.
Our team is ready to help you find the healthcare pricing data you need.