Frequently Asked Questions

Healthcare price transparency data is used by a range of professionals and organizations:

• Healthcare consultants — benchmark market rates and advise on payer contract negotiations
• Hospital systems — compare negotiated rates against peers and identify reimbursement gaps
• Health tech companies — build cost estimation, plan comparison, and price shopping tools
• Employers and benefits advisors — evaluate health plan options and healthcare spending
• Litigators — use negotiated rate data as expert evidence in billing disputes and underpayment cases
• Researchers — study healthcare economics, pricing variation, and policy impact

Data is delivered in one of two formats depending on size:

• CSV — for most requests. Compatible with Excel, Google Sheets, Python, R, SQL databases, and virtually any analysis tool. Each file includes standardized columns for provider information, billing codes, negotiated rates, and payer details.
• Parquet — for large-scale extractions that exceed Excel's ~1 million row limit. Delivered via cloud storage, optimized for Python, R, and cloud data warehouses.

We provide documentation explaining every field in your deliverable.

Our data includes 16 billing code types. You can filter by any of the following:

• CPT (Current Procedural Terminology) — medical procedures
• HCPCS (Healthcare Common Procedure Coding System) — services, equipment, and drugs
• MS-DRG (Diagnosis Related Group) — Medicare inpatient hospital services
• NDC (National Drug Code) — prescription drugs and pharmacy-dispensed products
• Revenue codes — facility and department charges
• CDT — dental procedures
• APC (Ambulatory Payment Classification) — outpatient hospital services
• AP-DRG / APR-DRG — alternative DRG classification systems
• ICD — diagnosis codes
• And additional types including EAPG, HIPPS, and others

Search for codes on our custom data pull page.

*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.

Three key differences:

• Price — DeductibleData starts at $164/month. That's roughly 6x cheaper than Serif Health ($12K/year) and an estimated 10-25x cheaper than Turquoise Health.
• Access — We're the only vendor with self-serve credit card checkout. No demo, no sales call, no contract.
• Focus — We deliver clean, filtered negotiated rate data scoped to your exact specifications, rather than bundling it into a broad compliance or analytics platform.

If you need specific MRF rate data without the overhead of an enterprise platform, we're built for that.

• MRF data — contracted negotiated rates published under the Transparency-in-Coverage Rule. What insurers have agreed to pay providers. This is what DeductibleData provides.
• Claims data (835/837 transactions) — what was actually billed and paid per patient encounter, including procedure volume and utilization patterns. Proprietary, not publicly available.

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.

You can query up to 5 billion rows of negotiated rate data using plain English. Common use cases:

• Compare negotiated rates across payers for the same billing code
• Find the highest and lowest paying insurers for a specific procedure
• Benchmark rates at a target hospital against regional or national peers
• Identify billing codes where rates are statistical outliers
• Summarize rate distributions by provider type or geography
• Forensic analysis of rate patterns for litigation support

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:

• DT — Death
• DB — Disbandment (organization dissolved)
• FR — Fraud
• OT — Other (retirement, no longer practicing, etc.)

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:

• OIG LEIE (List of Excluded Individuals/Entities, HHS) — individuals and entities excluded from participating in Medicare, Medicaid, and federal healthcare programs due to fraud, patient abuse, or program-related crimes. Updated monthly.
• SAM.gov exclusions (GSA) — government-wide debarments including procurement fraud, tax delinquency, and national security violations. Broader than healthcare-specific exclusions. Note: SAM.gov does not use NPI records, so provider matching relies on name and EIN.

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:

• Active in current NPPES registry (not deactivated)
• Not flagged in CMS monthly deactivation file
• Not listed on OIG LEIE or SAM.gov exclusion databases

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.

DeductibleData cross-references its NPI index against three public federal databases monthly:

• NPPES active NPI file (CMS) — provider deactivation status
• OIG LEIE (HHS) — exclusion from federal healthcare programs
• SAM.gov (GSA) — government-wide federal debarment

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:

• Published negotiated rates are contracted amounts, not guaranteed payment amounts — actual payments may vary based on plan terms and billing circumstances
• Rates in MRF files are payer-reported and have not been independently audited
• The legal weight of TiC data in any specific case depends on jurisdiction, claim type, and how the data is introduced as evidence

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.