Price Transparency Data for Medical Device Sales and Market Access

Medical device companies now have access to a new kind of market intelligence: negotiated rates between hospitals and payers, published under federal price transparency rules. These datasets provide a ground-level view of what insurers actually pay for specific procedures, offering valuable insights for both startups and commercial-stage companies.

Whether you're building your first health economics model or selling into a new IDN, price transparency data can help quantify opportunity and support your value proposition with real-world numbers.

Supporting Forecasts and Market Access Plans for Pre-Commercial Devices

For early-stage medical device companies, one of the biggest hurdles is building credible forecasts and market access strategies before a single unit is sold. Without claims data or a reimbursement history, it can be difficult to answer investor questions about pricing assumptions, or to prepare compelling submissions for payers, providers, and HTAs.

That’s where price transparency data can play a powerful role. Even if your device hasn’t yet received FDA clearance, you can analyze real-world negotiated rates for adjacent CPT or HCPCS codes to estimate what insurers are currently paying for similar procedures.

For example:

• A company developing a new robotic surgery system can analyze negotiated rates for procedures involving existing robotic platforms or similar surgical DRGs.
• A startup creating an implantable neurostimulation device might examine reimbursement rates for CPT codes covering comparable neuromodulation or pain management procedures.
• A diagnostic startup can reference imaging codes tied to similar workflows or body systems to understand payer behavior by geography.

This approach allows teams to:

• Ground revenue forecasts in actual market behavior rather than theoretical averages or outdated CMS fee schedules.
• Identify variation in negotiated rates across hospitals, regions, and payers, helping prioritize high-reimbursement markets for launch.
• Model conservative and aggressive pricing scenarios using payer-specific data to prepare for negotiations or investor scrutiny.

It also strengthens HEOR planning. By referencing real negotiated rates, startups can build more realistic cost-effectiveness models and budget impact analyses. These data points add credibility when preparing for coverage discussions or when submitting evidence to payer medical policy committees.

Additionally, transparency data can support early conversations with potential provider partners. If your device is likely to be billed under an existing procedure code, you can show what health systems in different regions are actually getting reimbursed, helping frame discussions around clinical workflow integration and financial return.

In short, price transparency data gives pre-commercial device companies a window into how the market values the types of care their technology enables. That visibility can inform everything from pitch decks to pricing strategy to payer engagement plans.

Benchmarking for Commercial Products

For companies with existing FDA-approved products, price transparency data offers a way to benchmark current reimbursement levels and arm sales teams with proof points.

When entering a new hospital system, it is no longer necessary to rely on anecdotal reimbursement intel or internal assumptions. Instead, commercial teams can look up the actual negotiated rate for the relevant CPT or HCPCS code at peer institutions. This is especially valuable in pricing discussions or when demonstrating the financial return of using your device.

Transparency data can also help uncover underperforming regions or hospitals where negotiated rates lag the national average. These pockets may represent opportunities for targeted sales efforts, payer engagement, or clinical education.

Strategic Applications

Medical device companies can apply this data across multiple teams:

• Sales and Market Access: Equip reps with localized reimbursement benchmarks to address objections or build ROI models
• HEOR and Value Evidence: Use payer-specific rates to improve cost-effectiveness modeling and inform coverage strategy
• Business Development: Identify high-reimbursement institutions for early adoption or pilot programs
• Competitive Intelligence: Monitor how procedure-level reimbursement trends may correlate with technology adoption

3 Codes to Start With When Benchmarking

When using transparency data to forecast reimbursement for a pre-commercial device, start by identifying the most applicable procedure codes. These three categories are common jumping-off points:

1. Adjacent CPT codes
Look for procedures that represent the same clinical workflow or anatomical focus. If you’re launching a next-gen cardiac mapping system, for example, CPT 93613 (intracardiac electrophysiologic 3D mapping) might serve as a proxy.

2. HCPCS Level II codes
For devices billed separately from procedures (e.g., durable equipment, implants, biologics), HCPCS codes like C-codes or Q-codes can provide insight into product-specific reimbursement levels.

3. DRG-linked outpatient or inpatient procedures
If your technology impacts DRG-assigned cases, map its impact to common surgical or procedural DRGs and review hospital-negotiated charges for those bundled episodes.

Once you’ve selected your target codes, tools like CMS.gov and the hospital’s posted machine-readable files (MRFs) can help you identify payer-specific reimbursement levels across geographies.

How to Access the Data

Price transparency data is publicly available, but turning it into something usable takes more than a simple download.

Hospitals are required to publish machine-readable files (MRFs) that list their negotiated rates with insurers for thousands of procedures. These files are often in CSV or JSON format and can contain millions of rows. Payers, under the Transparency in Coverage rule, publish even larger files that include in-network rates for nearly every provider and procedure in the country.

For most teams, working with this data in Excel or Google Sheets just isn't realistic. Standard spreadsheet tools crash under the volume or fail to properly handle nested data structures.

Gigasheet is built for this scale.
Our platform allows you to:

• Open and explore CSV files with up to 1 billion rows
• Instantly transform complex JSON files a spreadsheet-like format
• Filter, join, and analyze massive datasets with no coding required

We also maintain a Healthcare Price Transparency Data Catalog that includes pre-processed, indexed rate files for more than 5,500 hospitals. That means you can search for negotiated rates by CPT code, payer, or facility name without spending weeks wrangling raw files.

Whether you're modeling reimbursement, validating price assumptions, or supporting your HEOR strategy, Gigasheet provides the horsepower and flexibility to work directly with transparency data at scale.

Want to see how it works?
Set up a time with our team to explore how Gigasheet can support your market access, forecasting, or commercial strategy.

For years, reimbursement data was difficult to access, buried in contracts or claims databases. Now it's public. For medical device companies, this shift opens up new possibilities to improve forecasting, refine strategy, and make stronger, data-backed cases to hospitals and payers.

‍