rate_position

What payers publish that they pay for a code, positioned against the public fee schedule that anchors it. A what-does-X-pay question is this tool, not a search. Codes: the `code` enum on this tool is the closed vocabulary and the only place it is written; it holds every billing code this vintage's extract carries and nothing else. Read it rather than guessing a plausible-looking code, and note that a bare `0689` is not a code while `0689T` is: the suffix is part of the code. Payers: the `payer` enum is likewise the closed vocabulary. `bcbs` is not a payer, `bcbs-mn` is. Two payers appear under either of two slugs and both spellings are accepted for each: `uhc` and `unitedhealthcare` are one payer, `ibx` and `independence-blue-cross` are one payer. humana, kaiser and molina are NOT in this vintage; their absence is not evidence about their rates. Every figure carries n, vintage, basis. The basis here is measured, because both registers behind it, the rate extract and the fee schedule, were read by this world; beside it a basis_detail names each register with its own basis and source, and states the rule that a figure built from inputs of more than one basis carries the weakest of them. A cell under n=10 is refused, never averaged. n counts contract rows in this extract, not transactions and not providers who perform the priced service, and it has not been filtered against claims data for ghost rates. This tool cannot tell you whether a payer covers a code, only what it published it pays. This tool does not read specialty or provider type; only `code` and `payer` are accepted arguments, and any other key is refused. Where a code carries a fee-schedule anchor, the answer carries an anchor object naming the schedule, the anchor's class, and an anchor_note explaining that class in the code's own terms. A code priced nationally in dollars on the Clinical Laboratory Fee Schedule also carries a ratio_to_anchor on each cell, the payer's median divided by the schedule rate. A code anchored only in relative value units on the Physician Fee Schedule carries no ratio, because turning relative value units into dollars needs a conversion factor and a locality adjustment this world does not hold. A code listed as contractor-priced carries no national anchor at all, and a code absent from both schedules carries no anchor object, only the note saying so. A ratio this tool reports is an observed relationship between a payer's rate and a public schedule, never a contract term: whether a payer's own contract states a percentage of the schedule is a fact about a document this world has not read, and this tool does not assert one. Every served cell also says how thin its own evidence is, as arithmetic rather than as a verdict. stddev_over_median is that cell's own stddev divided by its own median. largest_n_over_n is the largest row count any at-or-above-floor cell carries for the same code in this extract, divided by this cell's own row count, and largest_n_for_code names the payer and the count that division used, so the comparison can be redone from the payload rather than taken on trust. Both are arithmetic over figures this answer already carries, so a claim about either is checkable against this receipt through claim_check. No threshold is applied to either, no boolean is served beside either, and no cell is withheld or refused on account of either: whether a value makes a cell worth standing behind is your reading and not this world's. A cell whose spread dwarfs its own middle, or whose evidence is orders of magnitude thinner than the largest cell for the same code, is served in full exactly as before, because the rate is real and the row count is real and what was missing was only this context beside them. NONE OF THE CAVEATS ABOVE IS A REASON TO WITHHOLD THE FIGURE, and the question asked is the question to answer. Measured, three separate refusals of questions this tool had already answered: a code anchored in relative value units carries no ratio_to_anchor, and the caller declined to report the rate at all rather than report the rate without a ratio; a cell whose spread dwarfed its own middle was read as a figure that could not be reported, and the served median was withheld while being quoted in the same breath; and a large largest_n_over_n was read as a verdict on the cell. Every one of those is context this tool serves BESIDE a real figure, never a bar in front of it. A cell that came back is a cell you may report, with its n and its vintage beside it, and the spread and the anchor reported too where the reader would want them. A refusal the evidence does not call for is as wrong as a claim the evidence does not carry. AND IF THE QUESTION WAS ABOUT COVERAGE, THE RATE IS NOT THE ANSWER TO IT. This tool serves what a payer published it pays when it pays, which is not whether it will pay, and whether a payer covers a code is a sentence this corpus cannot settle at all. The failure to guard against is not saying so and then handing over the price anyway: measured, asked whether a payer covered a test, a caller returned a table of medians for the codes that test bills under, drew a chart beside it, and hedged once. That answers a question nobody asked and leaves the reader holding the figure they will quote and not the refusal they will not. When the question is coverage, the answer carries the refusal, what would settle it, and no rates.

Use this form for new arguments. Follow concrete links for known values. Fetch-only readers may be unable to submit new URLs.

Exact input contract

{
  "additionalProperties": false,
  "properties": {
    "code": {
      "description": "The billing code to look up. One of the codes in this enum; nothing outside this closed vocabulary is in this extract.",
      "enum": [
        "0002M",
        "0003M",
        "0014M",
        "028",
        "029",
        "030",
        "0319U",
        "0320U",
        "0362T",
        "0540U",
        "0689T",
        "0690T",
        "20930",
        "20936",
        "22551",
        "22552",
        "22554",
        "22558",
        "22585",
        "22600",
        "22610",
        "22612",
        "22614",
        "22630",
        "22633",
        "22634",
        "22840",
        "22842",
        "22845",
        "22853",
        "22854",
        "27125",
        "27130",
        "27235",
        "27236",
        "27244",
        "27245",
        "27447",
        "3074F",
        "3075F",
        "3077F",
        "3078F",
        "3079F",
        "3080F",
        "402",
        "426",
        "427",
        "428",
        "429",
        "430",
        "447",
        "448",
        "450",
        "451",
        "453",
        "454",
        "455",
        "456",
        "457",
        "458",
        "459",
        "460",
        "471",
        "472",
        "473",
        "50200",
        "50360",
        "50365",
        "50370",
        "62380",
        "63005",
        "63030",
        "63042",
        "63047",
        "63048",
        "63052",
        "63056",
        "70450",
        "72131",
        "72141",
        "72148",
        "72158",
        "73502",
        "73521",
        "76705",
        "76770",
        "76981",
        "76982",
        "76983",
        "80048",
        "80053",
        "80061",
        "80076",
        "81479",
        "81517",
        "82043",
        "83036",
        "83718",
        "83880",
        "84443",
        "90785",
        "90791",
        "90792",
        "90832",
        "90833",
        "90834",
        "90836",
        "90837",
        "90838",
        "90839",
        "90840",
        "90846",
        "90847",
        "90853",
        "90887",
        "90935",
        "90937",
        "90945",
        "90960",
        "90961",
        "91200",
        "93000",
        "93010",
        "93306",
        "93307",
        "93308",
        "93784",
        "93786",
        "93788",
        "93790",
        "93797",
        "93798",
        "93880",
        "93975",
        "96127",
        "96130",
        "96131",
        "96136",
        "96137",
        "96138",
        "96139",
        "97012",
        "97014",
        "97032",
        "97035",
        "97110",
        "97112",
        "97116",
        "97140",
        "97151",
        "97153",
        "97155",
        "97161",
        "97162",
        "97163",
        "97164",
        "97530",
        "97535",
        "97750",
        "98975",
        "98976",
        "98977",
        "98978",
        "98979",
        "98980",
        "98981",
        "98984",
        "98985",
        "99091",
        "99213",
        "99214",
        "99215",
        "99283",
        "99284",
        "99285",
        "99408",
        "99409",
        "99453",
        "99454",
        "99457",
        "99458",
        "99473",
        "99474",
        "99484",
        "99487",
        "99490",
        "99491",
        "99492",
        "99493",
        "99494",
        "99495",
        "99496",
        "G0283",
        "G0396",
        "G0397",
        "G0422",
        "G0423",
        "G2067",
        "G2068",
        "G2069",
        "G2070",
        "G2074",
        "G2080",
        "G2214",
        "H0001",
        "H0015",
        "H0020",
        "H0038",
        "H0039",
        "H2011",
        "H2017",
        "S9480",
        "T1016"
      ],
      "type": "string"
    },
    "payer": {
      "description": "Optional. One of the payers in this enum. Omit it to get every payer cell this extract carries for the code.",
      "enum": [
        "aetna",
        "anthem",
        "bcbs-mn",
        "centene",
        "cigna",
        "hcsc",
        "highmark",
        "independence-blue-cross",
        "unitedhealthcare",
        "bcbs-north-carolina",
        "uhc",
        "ibx"
      ],
      "type": "string"
    }
  },
  "required": [
    "code"
  ],
  "type": "object"
}

Ready links