Hospital Transparency

Data dictionary fields for hospital transparency data in Payerset.

Field Name	Description / Sample Values	Original Source
Payer	Payerset-standardized payer name (mapped across hospitals).	Payerset
Plan Name	Payerset-standardized plan/network name.	Payerset
Additional Payer Notes	Free-text notes hospitals sometimes include for a payer or plan. e.g., “Only applicable to self-pay patients seen in ER,” “BCBS rates exclude lab fees”	Hospital MRF
Billing Code Category	Broad clinical grouping of the billing code. “Imaging”, “Surgery–Outpatient”, “Lab & Pathology”	Payerset
Billing Code Type	Coding system. “CPT”, “HCPCS”, “MS-DRG”, “APC”, “NDC”	Hospital MRF
Billing Code	Billing code exactly as published. “99213”, “0274”, “J9206”, “30145”	Hospital MRF
Billing Code Description	Description from file (often truncated/abbreviated). “Office/outpatient visit est low-level”, “Knee arthroscopy w/ meniscus repair”	Hospital MRF
Drug Category	Therapeutic class if row represents a drug. “Antineoplastic Agents”, “Analgesics”	Hospital MRF
Drug Unit Type	Brand / generic / biosimilar flag. “Brand”, “Generic”, “Biosimilar”	Hospital MRF
Drug Unit	Unit of measure for drug price. “mg”, “mL”, “tablet”	Hospital MRF
Gross	Hospital’s standard (chargemaster) price.	Hospital MRF
Discounted Cash	Hospital’s cash price offered to self-pay patients.	Hospital MRF
Methodology	Hospital’s narrative on how standard charges were derived. “Cost-to-charge ratio”, “Rate-setting committee approved”	Hospital MRF
Maximum	Highest negotiated rate among all payers/plans for this code.	Hospital MRF
Minimum	Lowest negotiated rate among all payers/plans for this code.	Hospital MRF
Setting	Care setting or place of service (hospital-reported). “Inpatient”, “Outpatient”, “Emergency Dept”, “Ambulatory Surgery”	Hospital MRF
Standard Charge Algorithm	Text describing how STANDARD_CHARGE_PERCENTAGE or STANDARD_CHARGE_DOLLAR was calculated. “Gross × 25%”, “Average of top 3 commercial contracts”	Hospital MRF
Standard Charge Amount Dollar	A flat-dollar “standard charge” (CMS-defined).	Hospital MRF
Standard Charge Percentage	Percent-based standard charge, if reported. “150% of Medicare OPPS”	Hospital MRF