Frequently Asked Questions

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 March 2026

About Healthcare Price Transparency

Understanding the data, the regulation, and why it matters.

What is healthcare price transparency data?

Healthcare price transparency data consists of the negotiated rates between health insurers and healthcare providers, now publicly available under federal regulation. These are the contractually agreed-upon prices — not chargemaster list prices — though actual payments may vary based on specific plan terms and billing circumstances. DeductibleData extracts, processes, and delivers this data in clean, structured formats ready for analysis, benchmarking, and decision-making.

What is the Transparency-in-Coverage Rule?

The Transparency-in-Coverage (TiC) Rule is a federal regulation jointly issued by the Departments of HHS, Treasury, and Labor (26 CFR Part 54, 29 CFR Part 2590, and 45 CFR Part 147) requiring health insurers to publicly disclose their negotiated rates with healthcare providers. Since July 2022, insurers must publish Machine Readable Files (MRFs) containing in-network rates and out-of-network allowed amounts. The rule also requires a prescription drug pricing file, but enforcement has been deferred and technical specifications have not been finalized. Some drug pricing data (via NDC codes) does appear within the in-network rate files. These files make it possible to compare healthcare costs across providers and insurers for the first time.

What are Machine Readable Files (MRFs)?

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.

What is Schema 2.0 and how does it affect the data?

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.

Is healthcare price transparency data HIPAA protected?

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.

What is the difference between in-network and out-of-network rates?

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.

How does price transparency data compare to claims data?

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.

Use Cases and Customers

Who uses this data and what they do with it.

Who uses healthcare price transparency data?

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
  • Researchers — study healthcare economics, pricing variation, and policy impact

What makes DeductibleData different from downloading MRFs myself?

Scale and engineering. A single payer's MRF data can span thousands of files and terabytes of nested JSON. Processing it requires cloud infrastructure, specialized parsing, cross-file joins, and normalization into a single queryable dataset. DeductibleData has already built this pipeline. You tell us what you need — which payers, which providers, which billing codes — and we deliver clean, structured data ready for analysis. No infrastructure required on your end.

Can DeductibleData serve as the data backend for my product or platform?

Yes. Several of our customers use DeductibleData as the data layer behind their own tools and products. If you're building a cost estimator, a plan comparison tool, or any application that needs payer negotiated rate data, we can provide ongoing data feeds scoped to your specifications — delivered as CSV or Parquet files on a schedule that matches your update cadence. This lets you focus on your product while we handle the data engineering. Contact us to discuss your integration needs.

Data Coverage and Delivery

What data is available, how it's delivered, and how fresh it is.

What payers do you have data for?

DeductibleData processes data from major national and regional health insurers including Blue Cross Blue Shield plans, UnitedHealthcare, Aetna, and others. Our payer coverage is continuously expanding as we process additional MRF sources. Data availability and freshness varies by payer since publication schedules differ. Contact us for current coverage details on specific payers.

Do you have Medicare or Medicaid rates?

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.

Do you have historical pricing data?

Yes. We retain data from previous MRF publications, allowing you to analyze rate trends over time. Since insurers have been publishing MRFs since July 2022, we can provide data going back to the earliest available publications for payers we've processed. Contact us with your specific time range requirements.

How current is the data?

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.

What format is the data delivered in?

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.

How large will my data deliverable be?

It depends on your filters. A targeted pull for specific NPIs and billing codes from a single payer is often under 1GB. A single payer with all providers and all codes can produce terabytes of data. If you're unsure about scope, start with specific filters on our custom data pull page or contact us to discuss your needs before ordering.

How long does delivery take?

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.

Can I filter by provider type or geographic area?

Yes, you can filter by provider type (hospitals, physician groups, individual practitioners) and geographic area, in addition to NPI and billing code filters. You can also provide specific facility names or NPI lists for targeted extractions. Contact us with your requirements for a custom quote.

Do you offer claims volume data alongside negotiated rates?

Yes, through our data partner ecosystem. DeductibleData specializes in TiC negotiated rate data — what insurers have agreed to pay. For volumetric data like procedure counts, utilization patterns, and patient volume, we partner with 835/837 claims data resellers who have deep specialties in specific therapeutic areas. This means when you need both pricing and volume — for example, negotiated rates for a set of DRGs plus how often those procedures are performed at specific facilities — we can blend TiC rate data with claims volume data matched to your exact clinical focus. Contact us to scope a blended pricing and volume request.

What happens if my data processing job fails?

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.

Pricing and Billing

How pricing works, what's included, and subscription options.

How is DeductibleData pricing calculated?

Pricing is based on three factors: data volume (in terabytes), filtering complexity (narrower filters reduce cost), and a per-payer platform fee. Selecting all providers and all codes costs more than targeted queries for specific NPIs or billing codes. The price updates in real-time as you configure your request on our custom data pull page, so you can see exactly how your selections affect cost. There are no hidden fees — everyone gets the same pricing regardless of company size.

What billing codes can I filter by?

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.

What is an NPI number and how do I use it to filter data?

An NPI (National Provider Identifier) is a unique 10-digit number assigned to every healthcare provider in the United States. Type 1 NPIs identify individual practitioners (doctors, nurses, therapists). Type 2 NPIs identify organizations (hospitals, clinics, group practices). You can search by name or NPI number on our custom data pull page to filter your extraction to specific providers.

Can I get a subscription for recurring data updates?

Yes. Subscriptions are available monthly, quarterly, or bi-annually for customers who need regular data refreshes as new MRF files are published. This is ideal for ongoing market monitoring, competitive analysis, or maintaining current pricing databases. Configure your data pull to see subscription pricing options.

Can DeductibleData host my data for team access?

Yes. For large datasets, we can provide hosted query access where your team can search and extract specific slices without downloading the entire file. This is ideal for organizations that need collaborative access or don't have the infrastructure to store terabytes locally. Contact us to set up hosted access.

How We Compare

Pricing, access, and how DeductibleData stacks up against other TiC data vendors.

How does DeductibleData pricing compare to other TiC data vendors?

VendorStarting PriceSelf-Serve CheckoutContract Required
DeductibleData$164/moYes, credit cardNo
Serif Health*$1,000/mo ($12K/yr)No, demo requiredYes
Turquoise Health**$20K-$50K+/yr (est.)No, demo requiredYes
Most othersNot disclosedNoYes

*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.

Why doesn't DeductibleData require a demo or sales call?

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.

What is the difference between pay-per-pull and an annual contract?

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.

How does DeductibleData differ from platforms like Turquoise Health or Serif Health?

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.

What is the difference between MRF pricing data and claims data?

  • 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.

Is DeductibleData's lower price because the data quality is lower?

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.

Still have questions?

Our team is ready to help you find the healthcare pricing data you need.

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