Medical devices in general fall into the category of durable medical equipment (DME). Typically national, regional or even local vendors serve as the distributors of DME to the delivery system, ie hospitals, clinics, ASCs, etc. It is these DME vendors that hold the relationship with the delivery system and bill any fees. Manufacturers do hold direct relationships as well, but typically a vendor is in the middle and facilitate billing a well as collection from health insurance payers. Happy to discuss more if you like given my health insurance background.