Data Dictionary

Fields available in Rate Explorer

Comparison Analysis & Fee Schedule Generator

Field Name	Description / Sample Values	Original Source
Additional Information	Additional information relevant to rate	PAYER MRF
Billing Class	Institutional or Professional	PAYER MRF
Billing Code	Billing code as-is in MRF	PAYER MRF
Billing Code Modifier	Modifiers for different rates (22-99, P1)	PAYER MRF
Billing Code Name	Billing code name as-is in MRF	PAYER MRF
Billing Code Type	HCPCS, CPT, MS-DRG, etc	PAYER MRF
Billing Code Type Version	Version of the billing code (2023, 2024)	PAYER MRF
Expiration Date	Expiration date of the rate (12/31/2024)	PAYER MRF
Negotiated Rate	Negotiated Rate value	PAYER MRF
Negotiated Type	Fee schedule, negotiated, percentage, per diem	PAYER MRF
Negotiation Arrangement	Fee for service (ffs) or Bundle	PAYER MRF
NPI	Provider ID	PAYER MRF
Place of Service Codes	Location of service (11, 21, 22, etc)	PAYER MRF
TIN Type	EIN or NPI	PAYER MRF
TIN Value	Value of associated EIN or NPI	PAYER MRF
City	City Name from NPPES	NPPES
State	State Name from NPPES	NPPES
Organization Name	Organization Name from NPPES	NPPES
Organization Friendly Name	Org Name + DBA Name if present	ADDED BY PAYERSET
Taxonomy Grouping	High-level taxonomy grouping (Allopathic, Hospitals, Hospital Units, etc)	NUCC
Taxonomy Classification	More granular taxonomy classification (Clinic/Center, Abmulance, Nursing Care, etc)	NUCC
Taxonomy Specialization	Most granular taxonomy (Adult Mental Health, Oncology, Orthopedic Surgery, etc...)	NUCC
Payer	Payer column added for convenience	ADDED BY PAYERSET
Payerset Billing Code Name	Payerset standardized name of 21k+ billing codes	ADDED BY PAYERSET
Payerset Billing Code Category	Payerset categorization of 21k+ billing codes	ADDED BY PAYERSET
Payerset Billing Code Subcategory	Payerset subcategorization of 21k+ billing codes	ADDED BY PAYERSET
Payerset Billing Code Type	Payerset categorization of billing code types	ADDED BY PAYERSET
Plan ID	Payerset-created Plan ID that links back to original plan via PLAN_MAP table	ADDED BY PAYERSET
Plan Name	Friendly name of the plan, created by Payerset	ADDED BY PAYERSET
Plan Type	EPO, PPO, HMO, POS, or Other Type of the plan, created by Payerset	ADDED BY PAYERSET

Medicare Data

Inpatient Data

Field Name	Field Type	Friendly Name	Description / Sample Value
NPI	varchar	Provider NPI	Unique 10-digit National Provider Identifier. e.g. 1043270564 or No NPI Found
carrier_number	varchar	Carrier Number	Payer’s internal carrier code. e.g. 110107
Rndrng_Prvdr_Org_Name	varchar	Provider Organization Name	Name of the rendering provider’s organization. e.g. Atrium Health Navicent
Rndrng_Prvdr_City	varchar	Provider City	City where the provider is located. e.g. Macon
Rndrng_Prvdr_St	varchar	Provider Street Address	Street address of the provider. e.g. 777 Hemlock Street
Rndrng_Prvdr_State_FIPS	varchar	State FIPS Code	U.S. Census state FIPS code. e.g. 13
Rndrng_Prvdr_Zip5	varchar	Provider ZIP Code	5-digit postal ZIP code. e.g. 31201
Rndrng_Prvdr_State_Abbrvtn	varchar	State Abbreviation	USPS state abbreviation. e.g. GA
cbsa	varchar	CBSA Code	Core-Based Statistical Area code. e.g. 12060
drg_code	varchar	DRG Code	Diagnosis-Related Group code. e.g. 470
fee_schedule_dollar_amount	double	Fee Schedule Amount	CMS fee schedule amount in dollars. e.g. 125.00
Total_Discharges	varchar	Total Discharges	Total number of discharges reported. e.g. 250 (may be blank/null)
Avg_Submitted_Covered_Charges	double	Avg Covered Charges	Average submitted covered charges. e.g. 3250.50
Avg_Total_Payment_Amount	double	Avg Total Payment	Average total payment amount. e.g. 2900.75
Avg_Medicare_Payment_Amount	double	Avg Medicare Payment	Average amount paid by Medicare. e.g. 1800.25
Avg_Medicare_Payment_Percent	double	Medicare Payment %	Medicare payment as percentage of covered charges. e.g. 55.33
latitude	double	Latitude	Geographic latitude of the provider. e.g. 32.8095
longitude	double	Longitude	Geographic longitude of the provider. e.g. -83.6168

Outpatient Data

Field Name	Field Type	Friendly Name	Description / Sample Value
HCPCS Code	varchar	HCPCS Procedure Code	Healthcare Common Procedure Coding System code. e.g. 0275T
Modifier	varchar	HCPCS Modifier	Optional two-character modifier. e.g. "" (empty if none)
Short Description	varchar	Service Short Description	Brief description of the procedure. e.g. Perq lamot/lam lumbar
Mac Locality	varchar	MAC Locality Code	Medicare Administrative Contractor locality code. e.g. 111205
Locality County	varchar	County	County that corresponds with Mac Locality
Locality State	varchar	State	State that corresponds with Mac Locality
Non-Facility Price	varchar	Non-Facility Price	Allowed charge in a non-facility setting. e.g. "$0.00"
Facility Price	varchar	Facility Price	Allowed charge in a facility setting. e.g. "$0.00"
Non-Facility Limiting Charge	varchar	Non-Facility Limiting Charge	Payment limit for non-facility. e.g. "$0.00"
Facility Limiting Charge	varchar	Facility Limiting Charge	Payment limit for facility. e.g. "$0.00"
GPCI Work	double	Work GPCI Factor	Geographic practice cost index for work. e.g. 1.088
GPCI PE	double	Practice Exp. GPCI Factor	Geographic practice cost index for practice expense. e.g. 1.419
GPCI MP	double	Malpractice GPCI Factor	Geographic malpractice cost index. e.g. 0.445
Proc Stat	varchar	Procedure Status	Status indicator (e.g. R=revised). e.g. "R"
Work RVU	double	Work RVU	Relative value unit for physician work. e.g. 0.00
NA Flag for Trans Non-FAC PE RVU	varchar	Flag: Transitional Non-Facility PE RVU Missing	"NA" if no transitional practice-expense RVU available
Transitioned Non-FAC PE RVU	double	Transitional Non-Facility PE RVU	Transitional practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Fully IMP Non-FAC PE RVU	varchar	Flag: Fully Implemented Non-FAC PE RVU Missing	"NA" if no fully implemented practice-expense RVU available
Fully Implemented Non-FAC PE RVU	double	Fully Impl. Non-Facility PE RVU	Final practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Trans Facility PE RVU	varchar	Flag: Transitional Facility PE RVU Missing	"NA" if no transitional practice-expense RVU for facility available
Transitioned Facility PE RVU	double	Transitional Facility PE RVU	Transitional practice-expense RVU, facility. e.g. 0.00
NA Flag for Fully IMP FAC PE RVU	varchar	Flag: Fully Implemented Facility PE RVU Missing	"NA" if no fully implemented practice-expense RVU for facility available
Fully Implemented Facility PE RVU	double	Fully Impl. Facility PE RVU	Final practice-expense RVU, facility. e.g. 0.00
MP RVU	double	Malpractice RVU	Relative value unit for malpractice. e.g. 0.00
Transitioned Non-FAC Total	double	Transitional Non-Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(non-facility). e.g. 0.00
Transitioned Facility Total	double	Transitional Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(facility). e.g. 0.00
Fully Implemented Non-Fac Total	double	Fully Impl. Non-Facility Total RVU	Sum of RVUs (work+PE+MP) final, non-facility. e.g. 0.00
Fully Implemented Facility Total	double	Fully Impl. Facility Total RVU	Sum of RVUs (work+PE+MP) final, facility. e.g. 0.00
PCTC	varchar	Multiple-Procedure Indicator	Indicator for multiple-procedure payment reduction. e.g. "YYY"
Global	double	Global Surgical Indicator	Global surgery period indicator (0=no global). e.g. 0
Pre Op	double	Pre-Operative RVU	RVU for pre-operative period. e.g. 0.00
Intra Op	double	Intra-Operative RVU	RVU for intra-operative period. e.g. 0.00
Post Op	double	Post-Operative RVU	RVU for post-operative period. e.g. 0.00
Mult Surg	double	Multiple Surgery RVU	RVU adjustment for multiple surgeries. e.g. 0.00
Bilt Surg	double	Bilateral Surgery RVU	RVU adjustment for bilateral procedures. e.g. 0.00
Asst Surg	double	Assistant Surgeon RVU	RVU for assistant surgeon. e.g. 0.00
Co Surg	double	Co-Surgeon RVU	RVU for co-surgeon. e.g. 0.00
Team Surg	double	Team Surgery RVU	RVU for team surgery. e.g. 0.00
Phys Supv	double	Physician Supervision RVU	RVU for physician supervision. e.g. 0.00
Endobase	varchar	Endoscopic Base RVU Indicator	Indicator if code is endoscopic base. e.g. ""
Conv Fact	double	Conversion Factor	Dollar-to-RVU conversion factor. e.g. 32.3465
Not Used for Medicare	varchar	Excluded from Medicare	Flag if code is not payable by Medicare. e.g. ""
Diag Imaging Family Ind	int64	Diagnostic Imaging Family Indicator	Family group code. e.g. 99
Opps Non-Facility Payment Amount	varchar	OPPS Non-Facility Payment	Payment amount under OPPS non-facility. e.g. "NA"
Opps Facility Payment Amount	varchar	OPPS Facility Payment	Payment amount under OPPS facility. e.g. "NA"
Non-Fac PE Used For Opps PMT AMT	double	Non-Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS non-facility calculation. e.g. 0.0
Facility PE Used For Opps PMT AMT	double	Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS facility calculation. e.g. 0.0
Malpractice Used For Opps PMT AMT	double	Malpractice PE Weight for OPPS Payment	Malpractice index used in OPPS payment calculation. e.g. 0.0

Utilities

UnitedHealthcare CSTM-ALL

Field Name	Field Type	Friendly Name	Description / Sample Value
NPI	varchar	Provider NPI	National Provider Identifier. e.g. 1417993361
TIN_TYPE	varchar	Tax ID Type	Type of tax identifier (e.g., ein, ssn).
TIN_VALUE	varchar	Tax ID Value	Taxpayer Identification Number. e.g. 390286215
BILLING_CODE	varchar	Payer Billing Code	Code used by payer for billing. e.g. MISC, THR1
BILLING_CLASS	varchar	Billing Class	Class of billing (e.g., institutional, professional).
EXPIRATION_DATE	date	Agreement Expiration Date	Date the agreement expires. e.g. 1999-12-31 (from 12/31/99)
NEGOTIATED_RATE	double	Negotiated Rate	Agreed-upon rate. e.g. 75, 200, 28, 210, 90
NEGOTIATED_TYPE	varchar	Rate Type	Type of negotiated rate. e.g. percentage, per diem
SERVICE_CODES	varchar	Applicable Service Codes	Comma-separated list of service codes. (empty if none)
FACILITY_FLAG	varchar	Facility Flag	Indicator if facility setting. e.g. Y/N or blank
PLACE_OF_SERVICE	varchar	Place of Service	Payer’s place-of-service code/name. e.g. No Service Code
NEGOTIATION_ARRANGEMENT	varchar	Negotiation Arrangement	Arrangement type. e.g. ffs
ADDITIONAL_INFORMATION	varchar	Additional Information	Extra qualifiers. e.g. age[18-64]
BILLING_CODE_MODIFIER	varchar	Billing Code Modifier	Modifier for billing code. e.g. (empty)
BILLING_CODE_TYPE	varchar	Billing Code Type	Code system used. e.g. CSTM-ALL
BILLING_CODE_TYPE_VERSION	varchar	Billing Code Version	Version/year of the code system. e.g. 2025
BILLING_CODE_NAME	varchar	Billing Code Description	Human-readable description of billing code. e.g. OUTPATIENT MISCELLANEOUS (DEFAULT)
PAYER	varchar	Payer Name	Name of the insurance payer. e.g. UNITED_HEALTHCARE
NPPES_PRIMARY_TAXONOMY_CODE	varchar	Primary Taxonomy Code	NPPES taxonomy code. e.g. 101Y00000X
NPPES_STATE	varchar	Provider State	USPS state abbreviation. e.g. WI, AZ, CA
NPPES_CITY	varchar	Provider City	City of provider. e.g. FORT ATKINSON, PHOENIX
NPPES_COUNTY	varchar	Provider County	County of provider. e.g. JEFFERSON, MARICOPA
NPPES_ORGFRIENDLYNAME	varchar	Provider Organization Name	Official organization name. e.g. FORT HEALTHCARE INC - FORT ATKINSON MEMORIAL HEALTH SERVICES
NUCC_TAXONOMY_GROUPING	varchar	NUCC Taxonomy Grouping	Broad taxonomy grouping. e.g. Behavioral Health & Social Service Providers
NUCC_TAXONOMY_CLASSIFICATION	varchar	NUCC Taxonomy Classification	Taxonomy classification. e.g. Counselor
NUCC_TAXONOMY_SPECIALIZATION	varchar	NUCC Taxonomy Specialization	Taxonomy specialization. e.g. Addiction (Substance Use Disorder) or None
NUCC_TAXONOMY_DISPLAYNAME	varchar	NUCC Display Name	Display name for taxonomy. e.g. Counselor
PAYERSET_BILLING_CODE_NAME	varchar	Payerset Billing Code Name	Internal billing code name in Payerset. e.g. OUTPATIENT MISCELLANEOUS (DEFAULT)
PAYERSET_BILLING_CODE_TYPE	varchar	Payerset Billing Code Type	Internal billing code type in Payerset. e.g. CSTM-ALL