Data & Resources
The free layer — benchmarks, tools, and research built from the same 36M+ rate corpus the product queries.
Everything below is free and built directly from insurer-published Transparency in Coverage Machine-Readable Files — the same data that powers Explorer’s paid query layer. No billing blog estimates, no modeled averages.
Benchmarks
Benchmarks
Negotiated Rate Benchmarks — 20 CPT codes
Payer-level and national medians for 20 procedures across 17 payers and 56 states — derived from 36M+ TiC filings.
CPT 27447 — Total Knee Arthroplasty
National median $4,544 · 17 payers · 56 states
CPT 99213 — Office Visit, Established Patient (low)
National median $84 · 16 payers · 56 states
CPT 70553 — MRI Brain with & without Contrast
National median $368 · 17 payers · 56 states
CPT 45378 — Diagnostic Colonoscopy
National median $828 · 17 payers · 56 states
Free Tools
Free Tools
Medicare ASP Lookup
J-code Average Sales Price payment limits, updated quarterly from CMS ASP drug pricing files.
NADAC Lookup
Drug acquisition costs from CMS's pharmacy invoice survey — 6,700+ drugs, searchable.
Medicare Allowed Amount Lookup
Average Medicare allowed amounts by CPT code, national and by state.
Contract Check
Enter your contracted rate — see where it sits against the national distribution in 30 seconds. Client-side only.
Hospital Price Transparency Fine Tracker
Every verified CMS civil monetary penalty — 27 hospitals, $6.15M and counting.
Employer Health Plan Lookup
Search 69,000+ Form 5500 filings — sponsor, carrier, and plan size for any large employer plan.
See It in Action
See It in Action
Research
Research
Machine-Readable Files: The Complete Guide (2026)
What the TiC rule requires, the three file types, where every major payer publishes their files, why files reach 1 TB, ghost rates, and a build-vs-buy cost framing.
How to Benchmark Your Reimbursement Rates (2026 Guide)
The practice administrator's playbook: top-20 CPTs, % of Medicare framing, and building the negotiation case.
Why Two Practices Get Paid Differently for the Same Code
Contract vintage, leverage, site of service, and payment methodology — the anatomy of a 13.8× spread.
MGMA Surveys vs TiC Data
Self-reported surveys vs measured payer filings — which benchmark to trust for which job.
What Healthcare Price Transparency Data Actually Costs
Vendor pricing compared in one table — including ours. Most quote-only; we publish.
The Plan Fiduciary's Data Checklist (2026)
What a prudent-process paper trail looks like after the J&J wave — rates, broker comp, PBM terms, cadence.
All research →
The full research index.
Reference
Reference
Healthcare Price Data Glossary
Negotiated rates, allowed amounts, ghost rates, billing class, % of Medicare — the vocabulary, defined precisely.
Data Coverage: Payers, States & Vintages
Exactly which payers, geographies, and data vintages are in the corpus — and where the gaps are.
Cite This Data
Citation formats and attribution requirements for journalists and researchers.
Data Updates
Dated record of every data refresh and publication.
Who It's For
Who It's For
Need the full data?
36M+ rates by payer, code, and state — queryable via dashboard or API.