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Overview

The Rates table contains negotiated rate information extracted from payer transparency in coverage files.

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Table Columns

Each column in the Rates table is described below with examples of the data it contains.

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Column Descriptions

Detailed descriptions and examples for each column will be provided below.

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schedule_id

Type: string Unique identifier for each fee schedule in the system. This links the rate to a specific payer’s fee schedule file and corresponds to the schedule_id in the providers table. Example Values:

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schedule_line_id

Type: string Unique identifier for each individual rate line within a schedule. This identifies a specific negotiated rate entry and allows for precise referencing of individual rate records. Example Values:

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billing_code

Type: string The procedure or service code for which the rate is negotiated. This is typically a CPT (Current Procedural Terminology) code, HCPCS code, or other standardized medical billing code. Example Values:

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billing_code_type

Type: string The classification system or type of the billing code. Each value represents a specific medical coding standard used in healthcare billing. Possible Values:
  • CPT - Current Procedural Terminology
  • HCPCS - Healthcare Common Procedure Coding System
  • ICD - International Classification of Diseases
  • MS-DRG - Medicare Severity Diagnosis Related Group
  • APR-DRG - All Patient Refined Diagnosis Related Group
  • APC - Ambulatory Payment Classification
  • CDT - Current Dental Terminology
  • NDC - National Drug Code
  • HIPPS - Health Insurance Prospective Payment System
  • RC - Revenue Code
  • LOCAL - Local or payer-specific code
  • CSTM-ALL - Custom or all-inclusive code
Example Values:

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billing_code_modifier

Type: array An array of modifier codes that provide additional information about how a service or procedure was performed. Modifiers can affect reimbursement rates and indicate special circumstances such as bilateral procedures, multiple surgeons, assistants, or equipment rentals. Multiple modifiers can be applied to a single billing code. Example Values:

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billing_class

Type: string Indicates whether the rate applies to professional or institutional services. This field has only two possible values, each representing a distinct billing category. Possible Values:
  • professional - Services billed by individual physicians or practitioners (typically uses CMS-1500 form)
  • institutional - Services billed by hospitals or facilities (typically uses UB-04 form)
Example Values:

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negotiated_type

Type: string Specifies the methodology used to determine the negotiated rate. This field has a limited set of values, each representing a distinct rate calculation method. Possible Values:
  • negotiated - A directly negotiated fixed rate
  • fee schedule - Rate based on a predetermined fee schedule
  • percentage - Rate calculated as a percentage of a reference amount (e.g., percentage of Medicare)
  • per diem - Daily rate for services
  • derived - Rate derived or calculated from other rates
Example Values:

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negotiation_arrangement

Type: string Defines the payment arrangement structure between the payer and provider. This field has only three possible values, each representing a fundamental payment model. Possible Values:
  • ffs - Fee-for-service, payment for each individual service rendered
  • capitation - Fixed payment per patient or member, regardless of services provided
  • bundle - Bundled payment covering a group of related services
Example Values:

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setting

Type: string Indicates the care setting where the service is provided. This field has three possible values representing different service delivery contexts. Possible Values:
  • outpatient - Services provided without an overnight hospital stay
  • inpatient - Services provided with an overnight hospital stay or admission
  • both - Rate applies to both inpatient and outpatient settings
Example Values:

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service_code

Type: array An array of service codes that may provide additional classification or categorization for the billing code. These codes can supplement the primary billing code with extra context about the service being provided. Example Values:

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additional_information

Type: string Optional field for any supplementary information about the negotiated rate. This field is typically null but may contain notes, clarifications, or special conditions related to the rate when provided by the payer.

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severity_of_illness

Type: string Field intended to capture severity of illness indicators or risk adjustment factors. This field is currently null across all records but may be populated in future data sets to reflect patient acuity or complexity levels.

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expiration_date

Type: string The date when the negotiated rate expires or is no longer valid. A value of 9999-12-31 indicates that the rate has no expiration date and remains valid indefinitely or until updated. Example Values:

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name

Type: string The name or description of the procedure, service, or billing code. This provides a human-readable label for the billing code to help identify what service the rate applies to. Example Values:

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description

Type: string A more detailed description of the procedure or service. This typically provides additional context or a fuller explanation compared to the name field, though it may sometimes contain the same information. Example Values:

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bundled_code_with_type_list

Type: array An array of billing codes that are bundled together with the primary billing code. Each entry is formatted as code|type where the code is the billing code value and the type indicates the code system (e.g., RC for Revenue Code). This identifies all component services included in a bundled rate. Example Values:

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negotiated_rate

Type: float The actual dollar amount of the negotiated rate for the service or procedure. This represents the reimbursement amount agreed upon between the payer and provider. A value of 0.0 may indicate rates that are not disclosed or are calculated using alternative methods. Example Values:

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source_file_ids

Type: array An array of identifiers referencing the original transparency in coverage files from which this rate data was extracted. This enables traceability back to the source payer files. Example Values:

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date_key

Type: string
Partition: 0 The date representing when the data was processed or loaded into the system. This field is used as a partition key for data organization and querying efficiency. Currently represents a single snapshot date for the available data set. Example Values:

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network_slug

Type: string
Partition: 1 A standardized identifier for the insurance network. This slug is used for consistent referencing and filtering of network data across the system. The slug typically includes the payer identifier and network name. This field corresponds to the network_slug in the providers table and links rates to specific networks. Example Values: