Price Transparency Data & Tools:
Explore real negotiated healthcare rates.
Price transparency data is the set of negotiated rates, cash prices, and gross charges that hospitals and health insurers are federally required to publish. Below, explore that data for any state and specialty in seconds — and learn where it comes from, what it covers, and how providers turn it into leverage.
Price Transparency Data Explorer
Pick a specialty or procedure code. See, in one screen, how much published rate data exists nationally — and what payers are actually paying for the codes that move the needle.
| CPT | Description | Avg (National) | Medicare | % of Mcr | |
|---|---|---|---|---|---|
| 99214 | Office visit established, moderate complexity | $129.76 | $128.16 | 101% | |
What is price transparency data, and where does it come from?
Price transparency data is the set of negotiated rates, cash prices, and gross charges that hospitals and health insurers are federally required to publish in machine-readable files (MRFs). It exists because two CMS rules made the rates that payers once treated as trade secrets a matter of public record.
Hospitals must publish standard charges in a machine-readable file, plus a consumer display of at least 300 shoppable services. The rule covers gross charges, payer-specific negotiated rates, the discounted cash price, and minimum/maximum negotiated rates by payer.
- Payer-specific negotiated rates by service
- Discounted cash price for self-pay
- De-identified min & max negotiated rates
Insurers and group health plans must publish in-network negotiated rates and out-of-network allowed amounts for every covered item and service, by provider. Files are updated monthly and apply to most commercial and self-funded plans.
- In-network rates by NPI & CPT/HCPCS
- Out-of-network allowed amounts
- Prescription drug rates (where applicable)
Four ways finance and contracting teams use price transparency data.
The data isn't interesting in the abstract. It matters because it changes the answer to six specific operational questions — each of them tied to a real line on a P&L.
Fee schedule lookup
Pull a complete payer fee schedule for every code in your contract without logging into a payer portal — usable in your RCM or BI tool the same day.
View fee schedulesRate benchmarking
Compare your rates against what the same payer is paying competitors for the same CPT/HCPCS codes in your market. The basis of every credible negotiation.
Benchmark a contractUnderpayment detection
Flag claims paid below the contracted rate. Reconcile remittance against the rates the payer is publicly committing to — and recover the delta.
Identify underpaymentsPayer contract negotiation
Walk into renewal with evidence, not estimates. A line-item case for a rate increase tied to verifiable market data instead of historical inflation arguments.
Negotiation playbookCommon questions about price transparency data and tools.
Raw price transparency data is public.
PayerPrice makes it usable.
Run a free sample report against the rates in your market — see your contracts compared to every commercial payer's published file in under five minutes, no credit card.