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Version: 2.2

v2_1_3

Core Rates Month: 2025_07 Generated: 2025-09-28 08:44:13

Overview​

This analysis examines coverage gaps in CLD data by identifying rows where canonical_rate IS NULL and investigating raw data sources to check if the gaps are legitimate.

1. Coverage Gap Statistics​

Overall Coverage Statistics​

  • Total Records: 2,076,191,059.0
  • Records with canonical_rate: 624,800,317.0
  • Records without canonical_rate: 1,451,390,742.0
  • NULL Rate Percentage: 70.0%
Click to see SQL

            SELECT
                COUNT(*) as total_records,
                COUNT(canonical_rate) as records_with_rate,
                COUNT(*) - COUNT(canonical_rate) as records_without_rate,
                ROUND(1.000*(COUNT(*) - COUNT(canonical_rate)) / COUNT(*), 2) as null_rate_percentage
            FROM tq_dev.internal_dev_csong_cld_v2_1_3.prod_combined_all

Coverage Statistics by Provider Type​

provider_typetotal_recordsrecords_with_raterecords_without_ratecoverage_percentagenull_rate_percentage
Imaging Center46,327,8904,540,19441,787,69610.0%90.0%
Rehabilitation Hospital61,289,4517,810,13753,479,31413.0%87.0%
Childrens Hospital38,031,9127,541,19630,490,71620.0%80.0%
Laboratory16,082,1193,360,38212,721,73721.0%79.0%
ASC254,840,46762,623,699192,216,76825.0%75.0%
Physician Group1,020,781,784274,550,279746,231,50527.0%73.0%
Critical Access Hospital143,027,69755,490,67887,537,01939.0%61.0%
Short Term Acute Care Hospital495,809,739208,883,752286,925,98742.0%58.0%
Click to see SQL

                SELECT
                    provider_type,
                    COUNT(*) as total_records,
                    COUNT(canonical_rate) as records_with_rate,
                    COUNT(*) - COUNT(canonical_rate) as records_without_rate,
                    ROUND(1.000*COUNT(canonical_rate) / COUNT(*), 2) as coverage_percentage,
                    ROUND(1.000*(COUNT(*) - COUNT(canonical_rate)) / COUNT(*), 2) as null_rate_percentage
                FROM tq_dev.internal_dev_csong_cld_v2_1_3.prod_combined_all
                GROUP BY provider_type
                ORDER BY coverage_percentage ASC

2. Sample Analysis of Hospital Coverage Gaps​

Look for ✅ to indicate matches found in the respective tables.

Sample Record 1​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 4386
  • Billing Code Type: HCPCS
  • Billing Code: Q9995
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '4386'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q9995'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '4386'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q9995'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 2​

Sample Record Details:

  • Payer ID: 174
  • Provider ID: 1035
  • Billing Code Type: HCPCS
  • Billing Code: 71110
  • Networks: ['BLUECARD - PREFERRED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '174'
                              AND provider_id = '1035'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '71110'
                              AND product_network_label IN ('BLUECARD - PREFERRED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 174
                              AND provider_id = '1035'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '71110'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 3​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 1091
  • Billing Code Type: HCPCS
  • Billing Code: 42821
  • Networks: ['PA GROUP HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '1091'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '42821'
                              AND product_network_label IN ('PA GROUP HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '1091'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '42821'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 4​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 5877
  • Billing Code Type: HCPCS
  • Billing Code: 20103
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '5877'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '20103'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '5877'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '20103'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 5​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2555
  • Billing Code Type: HCPCS
  • Billing Code: 72197
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2555'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '72197'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2555'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '72197'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 6​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 2860
  • Billing Code Type: HCPCS
  • Billing Code: 88333
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '2860'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88333'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 8 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
6432860HCPCS88333Facility310OutpatientPPOUNITED HEALTHCARE (UHC)2,554.66d71dc3ab4e1f4d99a017b92549e1076a
6432860HCPCS88333Facility310OutpatientVA CCNUNITED HEALTHCARE (UHC)851.559a7a5b5d25cc4568a16d52f885707442
6432860HCPCS88333Facility310OutpatientPPOUNITED HEALTHCARE (UHC)2,554.66b2fc132ef6cb4677800ba73b76f9889d
6432860HCPCS88333Facility310OutpatientVA CCNUNITED HEALTHCARE (UHC)851.55b94f49a2a6a24d9d86dcca6ddd9525b2
6432860HCPCS88333Facility310InpatientPPOUNITED HEALTHCARE (UHC)370266282cbe454ab3c927e7e054c59b
6432860HCPCS88333Facility310InpatientVA CCNUNITED HEALTHCARE (UHC)43b4cefc14584f7cbfee5d8c0dd85625
6432860HCPCS88333Facility310InpatientVA CCNUNITED HEALTHCARE (UHC)570de0d476d84cbb9e5e6170e2d38367
6432860HCPCS88333Facility310InpatientPPOUNITED HEALTHCARE (UHC)b164052d5c3942288b0d038b600bf412
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '2860'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88333'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 7​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 313
  • Billing Code Type: HCPCS
  • Billing Code: 50693
  • Networks: ['PA GROUP HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '313'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50693'
                              AND product_network_label IN ('PA GROUP HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 10 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
7313HCPCS50693FacilityOutpatientPPO/SIGNATURE ADMINISTRATORSAETNA5,596.505000.0%b0667c31169a4ffe882c2f016457b4d0
7313HCPCS50693FacilityOutpatientMANAGED CAREAETNA5,596.505000.0%496a9e28976e4337a4f4ba93b3c91170
7313HCPCS50693FacilityInpatientCOMMERCIALAETNA WHOLE HEALTH3676cac8ef224edb9a7a73fc2aac5c62
7313HCPCS50693FacilityInpatientHTCAETNAcab9a1efa4264f61a06c90c2f36feb52
7313HCPCS50693FacilityInpatientMANAGED CAREAETNA2cd6d2a3dc8441ef95541e89398f0851
7313HCPCS50693FacilityOutpatientCOMMERCIALAETNA WHOLE HEALTH5,934.42e75a3679ed494a66bd403342d608dbbc
7313HCPCS50693FacilityInpatientPPO/SIGNATURE ADMINISTRATORSAETNA79ca4827aeb74b18a50f52cc17263bc9
7313HCPCS50693FacilityOutpatientPPO/SIGNATURE ADMINISTRATORSAETNA370.30dc75d7d930834d0faa77e7ce424ec2ec
7313HCPCS50693FacilityOutpatientMANAGED CAREAETNA370.30bcaa91beef8d45419e3d1a4333d72053
7313HCPCS50693FacilityOutpatientHTCAETNA5,192.619a7e021c8153449ea52b3e12927d5952
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '313'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50693'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 8​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 10478
  • Billing Code Type: APR-DRG
  • Billing Code: 0132-1
  • Networks: ['OH PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '10478'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0132-1'
                              AND product_network_label IN ('OH PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '10478'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0132-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 9​

Sample Record Details:

  • Payer ID: 628
  • Provider ID: 6202
  • Billing Code Type: HCPCS
  • Billing Code: Q4310
  • Networks: ['ALASKA HERITAGE NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '628'
                              AND provider_id = '6202'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4310'
                              AND product_network_label IN ('ALASKA HERITAGE NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 628
                              AND provider_id = '6202'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4310'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 10​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 3626
  • Billing Code Type: APR-DRG
  • Billing Code: 0427-3
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '3626'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0427-3'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '3626'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0427-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 11​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 8947
  • Billing Code Type: HCPCS
  • Billing Code: 30630
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '8947'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '30630'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '8947'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '30630'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 12​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2398
  • Billing Code Type: HCPCS
  • Billing Code: 23065
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2398'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '23065'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2398'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '23065'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 13​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 8655
  • Billing Code Type: HCPCS
  • Billing Code: 57065
  • Networks: ['KY HMO', 'KY PATHWAY X HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '8655'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '57065'
                              AND product_network_label IN ('KY HMO', 'KY PATHWAY X HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '8655'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '57065'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 14​

Sample Record Details:

  • Payer ID: 774
  • Provider ID: 811
  • Billing Code Type: HCPCS
  • Billing Code: C9055
  • Networks: ['HMO / HEALTHY NY / ESSENTIAL']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '774'
                              AND provider_id = '811'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9055'
                              AND product_network_label IN ('HMO / HEALTHY NY / ESSENTIAL')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 774
                              AND provider_id = '811'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9055'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 15​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 10493
  • Billing Code Type: HCPCS
  • Billing Code: 47539
  • Networks: ['CA HMO', 'CA PATHWAY HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '10493'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '47539'
                              AND product_network_label IN ('CA HMO', 'CA PATHWAY HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '10493'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '47539'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 16​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 10616
  • Billing Code Type: HCPCS
  • Billing Code: 54308
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '10616'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54308'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '10616'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54308'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 17​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 1659
  • Billing Code Type: HCPCS
  • Billing Code: 27054
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '1659'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27054'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '1659'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27054'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 18​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 10267
  • Billing Code Type: HCPCS
  • Billing Code: 28200
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '10267'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28200'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '10267'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28200'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 19​

Sample Record Details:

  • Payer ID: 456
  • Provider ID: 10303
  • Billing Code Type: MS-DRG
  • Billing Code: 275
  • Networks: ['PREFERRED PROVIDER NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '456'
                              AND provider_id = '10303'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '275'
                              AND product_network_label IN ('PREFERRED PROVIDER NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 456
                              AND provider_id = '10303'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '275'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 20​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 592
  • Billing Code Type: APR-DRG
  • Billing Code: 0136-4
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '592'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0136-4'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '592'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0136-4'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 21​

Sample Record Details:

  • Payer ID: 53
  • Provider ID: 10004
  • Billing Code Type: MS-DRG
  • Billing Code: 495
  • Networks: ['BLUE PREFERRED PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '53'
                              AND provider_id = '10004'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '495'
                              AND product_network_label IN ('BLUE PREFERRED PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 53
                              AND provider_id = '10004'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '495'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 22​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 6479
  • Billing Code Type: HCPCS
  • Billing Code: 0617T
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '6479'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0617T'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '6479'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0617T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 23​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6528
  • Billing Code Type: HCPCS
  • Billing Code: J2406
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6528'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J2406'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6528'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J2406'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 24​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5339
  • Billing Code Type: HCPCS
  • Billing Code: 33279
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5339'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '33279'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5339'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '33279'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 25​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 1965
  • Billing Code Type: HCPCS
  • Billing Code: C9175
  • Networks: ['GA BLUE OPEN ACCESS POS', 'BLUECARD - OPEN ACCESS POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '1965'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9175'
                              AND product_network_label IN ('GA BLUE OPEN ACCESS POS', 'BLUECARD - OPEN ACCESS POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '1965'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9175'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 26​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 3843
  • Billing Code Type: APR-DRG
  • Billing Code: 0817-4
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '3843'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0817-4'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '3843'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0817-4'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 27​

Sample Record Details:

  • Payer ID: 389
  • Provider ID: 2555
  • Billing Code Type: HCPCS
  • Billing Code: 99484
  • Networks: ['PPO PARTICIPATING PROVIDER OPTIONS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '389'
                              AND provider_id = '2555'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '99484'
                              AND product_network_label IN ('PPO PARTICIPATING PROVIDER OPTIONS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 389
                              AND provider_id = '2555'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '99484'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 28​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5590
  • Billing Code Type: APR-DRG
  • Billing Code: 0243-2
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5590'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0243-2'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5590'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0243-2'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 29​

Sample Record Details:

  • Payer ID: 299
  • Provider ID: 3050
  • Billing Code Type: HCPCS
  • Billing Code: 27295
  • Networks: ['PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '299'
                              AND provider_id = '3050'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27295'
                              AND product_network_label IN ('PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 299
                              AND provider_id = '3050'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27295'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 30​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10284
  • Billing Code Type: HCPCS
  • Billing Code: J1212
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10284'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1212'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10284'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1212'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 31​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6587
  • Billing Code Type: HCPCS
  • Billing Code: 77605
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6587'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '77605'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6587'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '77605'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 32​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9231
  • Billing Code Type: HCPCS
  • Billing Code: Q5105
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9231'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5105'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9231'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5105'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 33​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5658
  • Billing Code Type: MS-DRG
  • Billing Code: 549
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5658'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '549'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 8 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
6435658MS-DRG549FacilityInpatientUNITED HEALTHCARE CHOICE GENERIC 1025006UNITED HEALTH CARE 10259600.0%34,809.12dc5ce453cab34aaeaac8e9ff8b7a6299
6435658MS-DRG549FacilityInpatientUNITED HEALTHCARE 1025013UNITED HEALTH CARE 10259600.0%34,809.1223974173ca524456be2d68c8beb4313e
6435658MS-DRG549FacilityInpatientUHC HEALTH PLAN OF NEVADA 1025018UNITED HEALTH CARE 10259600.0%34,809.12cf884bd1cee44ac2bd695da0d5f9b9c8
6435658MS-DRG549FacilityInpatientUHC MEDICA 1028386COMMERCIAL 10289600.0%34,809.1244820d168cce40c8a93e230aee32b070
6435658MS-DRG549FacilityInpatientUNITED HEALTH ONE 1028405COMMERCIAL 10289600.0%34,809.121782e2e10cce416d886319ac4748d9ee
6435658MS-DRG549FacilityInpatientUNITED HEALTHCARE STUDENT RESOURCES 1025016UNITED HEALTH CARE 10259600.0%34,809.1224934401e32543c5b5e9d5b7c7f85fde
6435658MS-DRG549FacilityInpatientUHC SIERRA HEALTH AND LIFE 1025019UNITED HEALTH CARE 10259600.0%34,809.120c7386eb67874cf7a07904550fac7eba
6435658MS-DRG549FacilityInpatientUNITED HEALTHCARE OXFORD CHOICE PLUS 1028317COMMERCIAL 10289600.0%34,809.12f51dc322f114462abacbe01ab7c91e11
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5658'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '549'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 34​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9925
  • Billing Code Type: HCPCS
  • Billing Code: 27110
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9925'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27110'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9925'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27110'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 35​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3347
  • Billing Code Type: HCPCS
  • Billing Code: J0701
  • Networks: ['GEORGIA HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3347'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0701'
                              AND product_network_label IN ('GEORGIA HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 1 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
763347HCPCSJ0701OutpatientOAPCIGNA8.025f156762fee3426392d7df74153748c9
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3347'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0701'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 36​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 8939
  • Billing Code Type: MS-DRG
  • Billing Code: 694
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '8939'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '694'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '8939'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '694'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 37​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 6815
  • Billing Code Type: APR-DRG
  • Billing Code: 0251-3
  • Networks: ['SOUTHWEST MISSOURI HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '6815'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0251-3'
                              AND product_network_label IN ('SOUTHWEST MISSOURI HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '6815'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0251-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 38​

Sample Record Details:

  • Payer ID: 111
  • Provider ID: 1277
  • Billing Code Type: HCPCS
  • Billing Code: J2468
  • Networks: ['PPO/HMO', 'HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '111'
                              AND provider_id = '1277'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J2468'
                              AND product_network_label IN ('PPO/HMO', 'HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 111
                              AND provider_id = '1277'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J2468'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 39​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 10164
  • Billing Code Type: HCPCS
  • Billing Code: 28140
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '10164'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28140'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '10164'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28140'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 40​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9199
  • Billing Code Type: APR-DRG
  • Billing Code: 0021-3
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9199'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0021-3'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9199'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0021-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 41​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4379
  • Billing Code Type: HCPCS
  • Billing Code: J0775
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4379'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0775'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4379'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0775'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 42​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 8701
  • Billing Code Type: APR-DRG
  • Billing Code: 0347-3
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '8701'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0347-3'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '8701'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0347-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 43​

Sample Record Details:

  • Payer ID: 389
  • Provider ID: 2805
  • Billing Code Type: MS-DRG
  • Billing Code: 768
  • Networks: ['PPO PARTICIPATING PROVIDER OPTIONS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '389'
                              AND provider_id = '2805'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '768'
                              AND product_network_label IN ('PPO PARTICIPATING PROVIDER OPTIONS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 389
                              AND provider_id = '2805'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '768'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 44​

Sample Record Details:

  • Payer ID: 53
  • Provider ID: 4877
  • Billing Code Type: HCPCS
  • Billing Code: Q0168
  • Networks: ['BLUELINCS HMO', 'BLUELINCS HMO GROUP', 'BLUELINCS HMO COMMON']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '53'
                              AND provider_id = '4877'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q0168'
                              AND product_network_label IN ('BLUELINCS HMO', 'BLUELINCS HMO GROUP', 'BLUELINCS HMO COMMON')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 53
                              AND provider_id = '4877'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q0168'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 45​

Sample Record Details:

  • Payer ID: 813
  • Provider ID: 3058
  • Billing Code Type: APR-DRG
  • Billing Code: 0609-1
  • Networks: ['HMO - HAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '813'
                              AND provider_id = '3058'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0609-1'
                              AND product_network_label IN ('HMO - HAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 813
                              AND provider_id = '3058'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0609-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 46​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 8062
  • Billing Code Type: HCPCS
  • Billing Code: C9156
  • Networks: ['SOUTH TEXAS HMO', 'NORTH TEXAS HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '8062'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9156'
                              AND product_network_label IN ('SOUTH TEXAS HMO', 'NORTH TEXAS HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '8062'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9156'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 47​

Sample Record Details:

  • Payer ID: 61
  • Provider ID: 6120
  • Billing Code Type: HCPCS
  • Billing Code: J3392
  • Networks: ['PREFERRED WASHINGTON PCP/SPEC (SZ)', 'PREFERRED WASHINGTON (LZ)']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '61'
                              AND provider_id = '6120'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3392'
                              AND product_network_label IN ('PREFERRED WASHINGTON PCP/SPEC (SZ)', 'PREFERRED WASHINGTON (LZ)')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 61
                              AND provider_id = '6120'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3392'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 48​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 3955
  • Billing Code Type: HCPCS
  • Billing Code: 94450
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '3955'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '94450'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '3955'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '94450'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 49​

Sample Record Details:

  • Payer ID: 799
  • Provider ID: 3204
  • Billing Code Type: HCPCS
  • Billing Code: 25607
  • Networks: ['QUARTZ TIERED CHOICE PLUS (QHBPC WI): QUARTZ']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '799'
                              AND provider_id = '3204'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '25607'
                              AND product_network_label IN ('QUARTZ TIERED CHOICE PLUS (QHBPC WI): QUARTZ')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 799
                              AND provider_id = '3204'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '25607'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 50​

Sample Record Details:

  • Payer ID: 44
  • Provider ID: 9858
  • Billing Code Type: HCPCS
  • Billing Code: J7184
  • Networks: ['BLUECHOICE (HMO),']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '44'
                              AND provider_id = '9858'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J7184'
                              AND product_network_label IN ('BLUECHOICE (HMO),')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 44
                              AND provider_id = '9858'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J7184'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 51​

Sample Record Details:

  • Payer ID: 52
  • Provider ID: 8504
  • Billing Code Type: HCPCS
  • Billing Code: 90675
  • Networks: ['PREFERRED PROVIDER NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '52'
                              AND provider_id = '8504'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '90675'
                              AND product_network_label IN ('PREFERRED PROVIDER NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 52
                              AND provider_id = '8504'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '90675'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 52​

Sample Record Details:

  • Payer ID: 354
  • Provider ID: 9717
  • Billing Code Type: HCPCS
  • Billing Code: 27637
  • Networks: ['PREMIUM']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '354'
                              AND provider_id = '9717'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27637'
                              AND product_network_label IN ('PREMIUM')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 354
                              AND provider_id = '9717'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27637'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 53​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 541
  • Billing Code Type: HCPCS
  • Billing Code: Q4099
  • Networks: ['NEW ENGLAND HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '541'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4099'
                              AND product_network_label IN ('NEW ENGLAND HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '541'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4099'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 54​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 1804
  • Billing Code Type: HCPCS
  • Billing Code: 0200T
  • Networks: ['NORTH CAROLINA HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '1804'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0200T'
                              AND product_network_label IN ('NORTH CAROLINA HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '1804'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0200T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 55​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 7156
  • Billing Code Type: HCPCS
  • Billing Code: 50686
  • Networks: ['GEORGIA HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '7156'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50686'
                              AND product_network_label IN ('GEORGIA HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 2 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
767156HCPCS50686FacilityOutpatientLOCAL PLUSCIGNA216.35cce2d63f66e4025a7272bf8b834502b
767156HCPCS50686FacilityOutpatientOPEN ACCESSCIGNA274.2135c5995c63e14babab0b92e0d321b9cc
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '7156'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50686'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 56​

Sample Record Details:

  • Payer ID: 774
  • Provider ID: 10241
  • Billing Code Type: HCPCS
  • Billing Code: 26843
  • Networks: ['PPO/EPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '774'
                              AND provider_id = '10241'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '26843'
                              AND product_network_label IN ('PPO/EPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 774
                              AND provider_id = '10241'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '26843'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 57​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3047
  • Billing Code Type: MS-DRG
  • Billing Code: 057
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3047'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '057'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3047'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '057'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 58​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10665
  • Billing Code Type: HCPCS
  • Billing Code: 29891
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10665'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29891'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10665'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29891'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 59​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 2331
  • Billing Code Type: HCPCS
  • Billing Code: 0440T
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '2331'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0440T'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '2331'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0440T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 60​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4444
  • Billing Code Type: HCPCS
  • Billing Code: 0857T
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4444'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0857T'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4444'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0857T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 61​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 9375
  • Billing Code Type: HCPCS
  • Billing Code: 86972
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '9375'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '86972'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '9375'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '86972'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 62​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 1834
  • Billing Code Type: HCPCS
  • Billing Code: J1030
  • Networks: ['NC INDIVIDUAL HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '1834'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1030'
                              AND product_network_label IN ('NC INDIVIDUAL HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '1834'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1030'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 63​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 558
  • Billing Code Type: APR-DRG
  • Billing Code: 0612-2
  • Networks: ['ME HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '558'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0612-2'
                              AND product_network_label IN ('ME HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '558'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0612-2'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 64​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 3933
  • Billing Code Type: HCPCS
  • Billing Code: 21081
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '3933'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21081'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '3933'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21081'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 65​

Sample Record Details:

  • Payer ID: 774
  • Provider ID: 945
  • Billing Code Type: HCPCS
  • Billing Code: 92284
  • Networks: ['HMO / HEALTHY NY / ESSENTIAL']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '774'
                              AND provider_id = '945'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92284'
                              AND product_network_label IN ('HMO / HEALTHY NY / ESSENTIAL')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 774
                              AND provider_id = '945'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92284'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 66​

Sample Record Details:

  • Payer ID: 56
  • Provider ID: 949
  • Billing Code Type: HCPCS
  • Billing Code: J7188
  • Networks: ['KHPE COMMERCIAL HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '56'
                              AND provider_id = '949'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J7188'
                              AND product_network_label IN ('KHPE COMMERCIAL HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 56
                              AND provider_id = '949'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J7188'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 67​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 6293
  • Billing Code Type: MS-DRG
  • Billing Code: 933
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '6293'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '933'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '6293'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '933'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 68​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9581
  • Billing Code Type: APR-DRG
  • Billing Code: 0097-1
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9581'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0097-1'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9581'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0097-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 69​

Sample Record Details:

  • Payer ID: 628
  • Provider ID: 8740
  • Billing Code Type: HCPCS
  • Billing Code: 40805
  • Networks: ['ALASKA HERITAGE NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '628'
                              AND provider_id = '8740'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '40805'
                              AND product_network_label IN ('ALASKA HERITAGE NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 628
                              AND provider_id = '8740'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '40805'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 70​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 6744
  • Billing Code Type: HCPCS
  • Billing Code: 67820
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '6744'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67820'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '6744'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67820'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 71​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10252
  • Billing Code Type: HCPCS
  • Billing Code: 29405
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10252'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29405'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10252'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29405'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 72​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 9309
  • Billing Code Type: HCPCS
  • Billing Code: 63741
  • Networks: ['MD GROUP HMO', 'MD GROUP HMO/POS', 'DC GROUP HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '9309'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '63741'
                              AND product_network_label IN ('MD GROUP HMO', 'MD GROUP HMO/POS', 'DC GROUP HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '9309'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '63741'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 73​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 8160
  • Billing Code Type: HCPCS
  • Billing Code: 11760
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '8160'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '11760'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '8160'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '11760'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 74​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 7208
  • Billing Code Type: HCPCS
  • Billing Code: 0636T
  • Networks: ['IN BLUE ACCESS PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '7208'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0636T'
                              AND product_network_label IN ('IN BLUE ACCESS PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '7208'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0636T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 75​

Sample Record Details:

  • Payer ID: 174
  • Provider ID: 814
  • Billing Code Type: HCPCS
  • Billing Code: J0220
  • Networks: ['BLUECARD - PREFERRED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '174'
                              AND provider_id = '814'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0220'
                              AND product_network_label IN ('BLUECARD - PREFERRED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 174
                              AND provider_id = '814'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0220'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 76​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 1989
  • Billing Code Type: HCPCS
  • Billing Code: 69603
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '1989'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '69603'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '1989'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '69603'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 77​

Sample Record Details:

  • Payer ID: 774
  • Provider ID: 328
  • Billing Code Type: HCPCS
  • Billing Code: 93306
  • Networks: ['HMO / HEALTHY NY / ESSENTIAL']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '774'
                              AND provider_id = '328'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '93306'
                              AND product_network_label IN ('HMO / HEALTHY NY / ESSENTIAL')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 774
                              AND provider_id = '328'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '93306'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 78​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5953
  • Billing Code Type: APR-DRG
  • Billing Code: 0251-1
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5953'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0251-1'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5953'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0251-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 79​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3085
  • Billing Code Type: APR-DRG
  • Billing Code: 0073-1
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3085'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0073-1'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3085'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0073-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 80​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 5514
  • Billing Code Type: MS-DRG
  • Billing Code: 798
  • Networks: ['SOUTH TEXAS HMO', 'NORTH TEXAS HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '5514'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '798'
                              AND product_network_label IN ('SOUTH TEXAS HMO', 'NORTH TEXAS HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '5514'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '798'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 81​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10234
  • Billing Code Type: APR-DRG
  • Billing Code: 0364-2
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10234'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0364-2'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10234'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0364-2'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 82​

Sample Record Details:

  • Payer ID: 53
  • Provider ID: 4894
  • Billing Code Type: HCPCS
  • Billing Code: 35207
  • Networks: ['BLUE PREFERRED PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '53'
                              AND provider_id = '4894'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '35207'
                              AND product_network_label IN ('BLUE PREFERRED PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 53
                              AND provider_id = '4894'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '35207'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 83​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 2388
  • Billing Code Type: HCPCS
  • Billing Code: A9606
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '2388'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'A9606'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '2388'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'A9606'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 84​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 1838
  • Billing Code Type: HCPCS
  • Billing Code: 94626
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '1838'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '94626'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 4 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
6431838HCPCS94626OutpatientOPTIONSPPOUNITED4380.0%155.054ed7d8e055ad4f1fb58aba98cf25d43b
6431838HCPCS94626OutpatientGLOBALBENEFITUNITED4500.0%159.30f447c92aa1dd4ef1aea4ee681b7a4a4d
6431838HCPCS94626OutpatientVACCNUNITED BEHAVIORAL HEALTH53.245fb51890af984a71901269375d570839
6431838HCPCS94626OutpatientVACCNUNITED53.240bc6cc60e25c4278b5992a9a80349aac
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '1838'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '94626'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 85​

Sample Record Details:

  • Payer ID: 111
  • Provider ID: 7201
  • Billing Code Type: HCPCS
  • Billing Code: 17284
  • Networks: ['PPO/HMO', 'HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '111'
                              AND provider_id = '7201'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17284'
                              AND product_network_label IN ('PPO/HMO', 'HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 111
                              AND provider_id = '7201'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17284'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 86​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 1712
  • Billing Code Type: HCPCS
  • Billing Code: 65285
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '1712'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '65285'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '1712'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '65285'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 87​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 5830
  • Billing Code Type: HCPCS
  • Billing Code: 96020
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '5830'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '96020'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '5830'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '96020'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 88​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10654
  • Billing Code Type: MS-DRG
  • Billing Code: 089
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10654'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '089'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10654'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '089'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 89​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6646
  • Billing Code Type: HCPCS
  • Billing Code: J3120
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6646'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3120'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6646'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3120'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 90​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 610
  • Billing Code Type: HCPCS
  • Billing Code: 92353
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '610'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92353'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '610'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92353'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 91​

Sample Record Details:

  • Payer ID: 628
  • Provider ID: 6145
  • Billing Code Type: HCPCS
  • Billing Code: 43206
  • Networks: ['PBC PPO (HERITAGE) NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '628'
                              AND provider_id = '6145'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '43206'
                              AND product_network_label IN ('PBC PPO (HERITAGE) NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 628
                              AND provider_id = '6145'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '43206'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 92​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 1077
  • Billing Code Type: HCPCS
  • Billing Code: 58550
  • Networks: ['NY PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '1077'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '58550'
                              AND product_network_label IN ('NY PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '1077'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '58550'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 93​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2381
  • Billing Code Type: HCPCS
  • Billing Code: 45020
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2381'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '45020'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 1 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
762381HCPCS45020FacilityOutpatientALL COMMERCIAL PLANSCIGNA10,818.00c09a4e43eeb646218a43d2543ff6de4a
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2381'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '45020'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 94​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 4599
  • Billing Code Type: HCPCS
  • Billing Code: Q5133
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '4599'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5133'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '4599'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5133'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 95​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5832
  • Billing Code Type: HCPCS
  • Billing Code: 27409
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5832'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27409'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5832'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27409'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 96​

Sample Record Details:

  • Payer ID: 699
  • Provider ID: 1080
  • Billing Code Type: HCPCS
  • Billing Code: 93745
  • Networks: ['UNIVERA PPO SIGNATURE DEDUCTIBLE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '699'
                              AND provider_id = '1080'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '93745'
                              AND product_network_label IN ('UNIVERA PPO SIGNATURE DEDUCTIBLE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 699
                              AND provider_id = '1080'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '93745'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 97​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 8060
  • Billing Code Type: MS-DRG
  • Billing Code: 314
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '8060'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '314'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 4 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
768060MS-DRG314FacilityInpatient & OutpatientCIGNA C-9 [80559]CIGNA [60063]23,103.595460.0%23,103.595a2fdf9b8e7e4c53b76c0db7798bc4bb
768060MS-DRG314FacilityInpatient & OutpatientCIGNA ALL OTHERS [80600]CIGNA [60063]32,658.7732,658.77640eb7fdda8a4d7c87ed4a8dea6ae411
768060MS-DRG314FacilityInpatient & OutpatientCIGNA INTERNATIONAL [80368]CIGNA [60063]32,658.7732,658.77431cbc58dc3c4c99b7cf62db180c7fae
768060MS-DRG314FacilityInpatient & OutpatientCIGNA THIRD PARTY ADMINISTRATOR (TPA) [80596]CIGNA [60063]32,658.7732,658.77a6640aee7886442fa6ed383d600ddae6
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '8060'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '314'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 98​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 8457
  • Billing Code Type: HCPCS
  • Billing Code: 31785
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '8457'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '31785'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '8457'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '31785'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 99​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 8817
  • Billing Code Type: HCPCS
  • Billing Code: 37187
  • Networks: ['FL GROUP HMO', 'FL INDIVIDUAL HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '8817'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37187'
                              AND product_network_label IN ('FL GROUP HMO', 'FL INDIVIDUAL HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '8817'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37187'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 100​

Sample Record Details:

  • Payer ID: 522
  • Provider ID: 1498
  • Billing Code Type: APR-DRG
  • Billing Code: 0695-4
  • Networks: ['KPIC MID ATLANTIC', 'SELF FUNDED MID ATLANTIC']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '522'
                              AND provider_id = '1498'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0695-4'
                              AND product_network_label IN ('KPIC MID ATLANTIC', 'SELF FUNDED MID ATLANTIC')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 522
                              AND provider_id = '1498'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0695-4'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 101​

Sample Record Details:

  • Payer ID: 723
  • Provider ID: 9152
  • Billing Code Type: MS-DRG
  • Billing Code: 456
  • Networks: ['ESSENTIAL PLAN']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '723'
                              AND provider_id = '9152'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '456'
                              AND product_network_label IN ('ESSENTIAL PLAN')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 723
                              AND provider_id = '9152'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '456'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 102​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 3876
  • Billing Code Type: MS-DRG
  • Billing Code: 074
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '3876'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '074'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '3876'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '074'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 103​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10238
  • Billing Code Type: HCPCS
  • Billing Code: 36582
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10238'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '36582'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10238'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '36582'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 104​

Sample Record Details:

  • Payer ID: 354
  • Provider ID: 837
  • Billing Code Type: HCPCS
  • Billing Code: 27185
  • Networks: ['PREMIUM']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '354'
                              AND provider_id = '837'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27185'
                              AND product_network_label IN ('PREMIUM')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 354
                              AND provider_id = '837'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27185'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 105​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 1908
  • Billing Code Type: HCPCS
  • Billing Code: 24420
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '1908'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '24420'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '1908'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '24420'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 106​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 2443
  • Billing Code Type: HCPCS
  • Billing Code: J9076
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '2443'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9076'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '2443'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9076'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 107​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6852
  • Billing Code Type: HCPCS
  • Billing Code: 25391
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6852'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '25391'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 5 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
6436852HCPCS25391FacilityOutpatientALLSAVERSUNITED HEALTH CARE21,769.164cbd1e99edbe407881f76f42c9a596dd
6436852HCPCS25391FacilityOutpatientUMRUNITED HEALTH CARE38,317.0531e127278499438f9b74d576588d3890
6436852HCPCS25391FacilityOutpatientUNITED HEALTH CARE GOLDENUNITED HEALTH CARE35,396.86ea99cfeb027f4940ac1a3edc26b870ad
6436852HCPCS25391FacilityOutpatientUNITED HEALTH CARE OXFORDUNITED HEALTH CARE29,049.27db73c577f73d400293eeaa9d4fb60766
6436852HCPCS25391FacilityOutpatientUNITED HEALTH CAREUNITED HEALTH CARE34,705.33bba79b9b862d44cf89555a59e5ac8053
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6852'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '25391'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 108​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 1516
  • Billing Code Type: HCPCS
  • Billing Code: 17340
  • Networks: ['VA INDIVIDUAL HMO', 'DC GROUP HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '1516'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17340'
                              AND product_network_label IN ('VA INDIVIDUAL HMO', 'DC GROUP HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '1516'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17340'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 109​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 6429
  • Billing Code Type: HCPCS
  • Billing Code: J0122
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '6429'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0122'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '6429'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0122'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 110​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 2583
  • Billing Code Type: HCPCS
  • Billing Code: 95824
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '2583'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95824'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '2583'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95824'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 111​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3406
  • Billing Code Type: HCPCS
  • Billing Code: 54512
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3406'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54512'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3406'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54512'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 112​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 8373
  • Billing Code Type: HCPCS
  • Billing Code: J3488
  • Networks: ['FL GROUP HMO', 'FL INDIVIDUAL HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '8373'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3488'
                              AND product_network_label IN ('FL GROUP HMO', 'FL INDIVIDUAL HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '8373'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3488'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 113​

Sample Record Details:

  • Payer ID: 388
  • Provider ID: 2232
  • Billing Code Type: HCPCS
  • Billing Code: Q4176
  • Networks: ['SIMPLYBLUE HMO', 'BLUECARE HMO', 'MYBLUE HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '388'
                              AND provider_id = '2232'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4176'
                              AND product_network_label IN ('SIMPLYBLUE HMO', 'BLUECARE HMO', 'MYBLUE HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 388
                              AND provider_id = '2232'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4176'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 114​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2195
  • Billing Code Type: HCPCS
  • Billing Code: 60212
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2195'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '60212'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2195'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '60212'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 115​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 2083
  • Billing Code Type: APR-DRG
  • Billing Code: 0362-3
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '2083'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0362-3'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '2083'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0362-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 116​

Sample Record Details:

  • Payer ID: 50
  • Provider ID: 3740
  • Billing Code Type: HCPCS
  • Billing Code: 0446T
  • Networks: ['BLUE PLUS METRO MN W ALLINA', 'BLUE PLUS SE MN', 'BLUE PLUS MN VALUE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '50'
                              AND provider_id = '3740'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0446T'
                              AND product_network_label IN ('BLUE PLUS METRO MN W ALLINA', 'BLUE PLUS SE MN', 'BLUE PLUS MN VALUE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 50
                              AND provider_id = '3740'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0446T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 117​

Sample Record Details:

  • Payer ID: 305
  • Provider ID: 4131
  • Billing Code Type: HCPCS
  • Billing Code: J9228
  • Networks: ['BROAD NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '305'
                              AND provider_id = '4131'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9228'
                              AND product_network_label IN ('BROAD NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 305
                              AND provider_id = '4131'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9228'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 118​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9431
  • Billing Code Type: HCPCS
  • Billing Code: J9171
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9431'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9171'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9431'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9171'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 119​

Sample Record Details:

  • Payer ID: 44
  • Provider ID: 1428
  • Billing Code Type: HCPCS
  • Billing Code: 67950
  • Networks: ['BLUECHOICE (HMO),']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '44'
                              AND provider_id = '1428'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67950'
                              AND product_network_label IN ('BLUECHOICE (HMO),')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 44
                              AND provider_id = '1428'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67950'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 120​

Sample Record Details:

  • Payer ID: 56
  • Provider ID: 1319
  • Billing Code Type: HCPCS
  • Billing Code: 50576
  • Networks: ['QCC COMMERCIAL PPO/EPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '56'
                              AND provider_id = '1319'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50576'
                              AND product_network_label IN ('QCC COMMERCIAL PPO/EPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 56
                              AND provider_id = '1319'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '50576'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 121​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6538
  • Billing Code Type: HCPCS
  • Billing Code: 67343
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6538'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67343'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6538'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67343'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 122​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2538
  • Billing Code Type: HCPCS
  • Billing Code: J0874
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2538'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0874'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2538'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0874'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 123​

Sample Record Details:

  • Payer ID: 392
  • Provider ID: 628
  • Billing Code Type: HCPCS
  • Billing Code: 26776
  • Networks: ['BLUECARD - PREFERRED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '392'
                              AND provider_id = '628'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '26776'
                              AND product_network_label IN ('BLUECARD - PREFERRED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 392
                              AND provider_id = '628'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '26776'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 124​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6710
  • Billing Code Type: HCPCS
  • Billing Code: 28041
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6710'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28041'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6710'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28041'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 125​

Sample Record Details:

  • Payer ID: 44
  • Provider ID: 1415
  • Billing Code Type: HCPCS
  • Billing Code: J8561
  • Networks: ['PREFERRED PROVIDER NETWORK (PPO)']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '44'
                              AND provider_id = '1415'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J8561'
                              AND product_network_label IN ('PREFERRED PROVIDER NETWORK (PPO)')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 44
                              AND provider_id = '1415'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J8561'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 126​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 788
  • Billing Code Type: HCPCS
  • Billing Code: D7671
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '788'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'D7671'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '788'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'D7671'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 127​

Sample Record Details:

  • Payer ID: 383
  • Provider ID: 5654
  • Billing Code Type: HCPCS
  • Billing Code: 95027
  • Networks: ['TRADITIONAL & PREFERRED PROVIDER PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '383'
                              AND provider_id = '5654'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95027'
                              AND product_network_label IN ('TRADITIONAL & PREFERRED PROVIDER PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 383
                              AND provider_id = '5654'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95027'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 128​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 2622
  • Billing Code Type: HCPCS
  • Billing Code: 54316
  • Networks: ['KY PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '2622'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54316'
                              AND product_network_label IN ('KY PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 2 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
422622HCPCS54316FacilityOutpatientHMO/PPO/TRADITIONALANTHEM BLUE CROSS BLUE SHIELD3,529.006caf94196d144cdba2c41ab6ee1df55b
422622HCPCS54316FacilityOutpatientHMO/PPO/TRADITIONALANTHEM BLUE CROSS BLUE SHIELD3,529.002d917a71fc9542eca5a1974e3d1e59b9
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '2622'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '54316'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 129​

Sample Record Details:

  • Payer ID: 174
  • Provider ID: 1120
  • Billing Code Type: HCPCS
  • Billing Code: Q4134
  • Networks: ['BLUECARD - PREFERRED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '174'
                              AND provider_id = '1120'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4134'
                              AND product_network_label IN ('BLUECARD - PREFERRED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 174
                              AND provider_id = '1120'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4134'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 130​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 631
  • Billing Code Type: HCPCS
  • Billing Code: 29440
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '631'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29440'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '631'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '29440'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 131​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 1927
  • Billing Code Type: MS-DRG
  • Billing Code: 744
  • Networks: ['GA BLUE VALUE IND NETWORK HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '1927'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '744'
                              AND product_network_label IN ('GA BLUE VALUE IND NETWORK HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '1927'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '744'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 132​

Sample Record Details:

  • Payer ID: 813
  • Provider ID: 3026
  • Billing Code Type: APR-DRG
  • Billing Code: 0167-3
  • Networks: ['EPO/PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '813'
                              AND provider_id = '3026'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0167-3'
                              AND product_network_label IN ('EPO/PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 813
                              AND provider_id = '3026'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0167-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 133​

Sample Record Details:

  • Payer ID: 174
  • Provider ID: 1029
  • Billing Code Type: APR-DRG
  • Billing Code: 0142-2
  • Networks: ['BLUECARD - PREFERRED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '174'
                              AND provider_id = '1029'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0142-2'
                              AND product_network_label IN ('BLUECARD - PREFERRED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 174
                              AND provider_id = '1029'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0142-2'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 134​

Sample Record Details:

  • Payer ID: 50
  • Provider ID: 3826
  • Billing Code Type: HCPCS
  • Billing Code: J0893
  • Networks: ['AWARE PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '50'
                              AND provider_id = '3826'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0893'
                              AND product_network_label IN ('AWARE PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 50
                              AND provider_id = '3826'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0893'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 135​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3128
  • Billing Code Type: HCPCS
  • Billing Code: 61720
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3128'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '61720'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3128'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '61720'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 136​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 4434
  • Billing Code Type: HCPCS
  • Billing Code: J3391
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '4434'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3391'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '4434'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J3391'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 137​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 329
  • Billing Code Type: HCPCS
  • Billing Code: Q5127
  • Networks: ['PA GROUP HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '329'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5127'
                              AND product_network_label IN ('PA GROUP HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '329'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q5127'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 138​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 430
  • Billing Code Type: HCPCS
  • Billing Code: 74712
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '430'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '74712'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '430'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '74712'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 139​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10624
  • Billing Code Type: HCPCS
  • Billing Code: 88182
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10624'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88182'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10624'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88182'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 140​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6262
  • Billing Code Type: HCPCS
  • Billing Code: 70549
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6262'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '70549'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6262'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '70549'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 141​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4195
  • Billing Code Type: HCPCS
  • Billing Code: 0395T
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4195'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0395T'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4195'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '0395T'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 142​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 5652
  • Billing Code Type: HCPCS
  • Billing Code: J0642
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '5652'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0642'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '5652'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0642'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 143​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 3765
  • Billing Code Type: APR-DRG
  • Billing Code: 0351-4
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '3765'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0351-4'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '3765'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0351-4'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 144​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 610
  • Billing Code Type: HCPCS
  • Billing Code: 43232
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '610'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '43232'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 1 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
643610HCPCS43232750OutpatientCOMMERCIALUNITED9466.0%6681df9442ac4114b6274851caf7daf6
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '610'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '43232'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 145​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 10070
  • Billing Code Type: HCPCS
  • Billing Code: J9248
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '10070'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9248'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '10070'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9248'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 146​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 8338
  • Billing Code Type: HCPCS
  • Billing Code: Q4296
  • Networks: ['NORTH NEW JERSEY HMO', 'SOUTH NEW JERSEY HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '8338'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4296'
                              AND product_network_label IN ('NORTH NEW JERSEY HMO', 'SOUTH NEW JERSEY HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '8338'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4296'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 147​

Sample Record Details:

  • Payer ID: 354
  • Provider ID: 1362
  • Billing Code Type: HCPCS
  • Billing Code: 78599
  • Networks: ['PREMIUM']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '354'
                              AND provider_id = '1362'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78599'
                              AND product_network_label IN ('PREMIUM')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 354
                              AND provider_id = '1362'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78599'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 148​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 9435
  • Billing Code Type: HCPCS
  • Billing Code: J0131
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '9435'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0131'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '9435'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0131'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 149​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 6556
  • Billing Code Type: MS-DRG
  • Billing Code: 293
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '6556'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '293'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '6556'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '293'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 150​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 1694
  • Billing Code Type: HCPCS
  • Billing Code: 92997
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '1694'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92997'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '1694'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '92997'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 151​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 312
  • Billing Code Type: HCPCS
  • Billing Code: 60300
  • Networks: ['NY PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '312'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '60300'
                              AND product_network_label IN ('NY PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '312'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '60300'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 152​

Sample Record Details:

  • Payer ID: 728
  • Provider ID: 6637
  • Billing Code Type: HCPCS
  • Billing Code: J1325
  • Networks: ['SUTTER HEALTH PLUS LARGE GROUP PLANS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '728'
                              AND provider_id = '6637'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1325'
                              AND product_network_label IN ('SUTTER HEALTH PLUS LARGE GROUP PLANS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 728
                              AND provider_id = '6637'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1325'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 153​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 1002
  • Billing Code Type: HCPCS
  • Billing Code: 27580
  • Networks: ['METRO NEW YORK HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '1002'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27580'
                              AND product_network_label IN ('METRO NEW YORK  HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '1002'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27580'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 154​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 8352
  • Billing Code Type: HCPCS
  • Billing Code: 15736
  • Networks: ['CHOICE PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '8352'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '15736'
                              AND product_network_label IN ('CHOICE PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '8352'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '15736'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 155​

Sample Record Details:

  • Payer ID: 42
  • Provider ID: 774
  • Billing Code Type: HCPCS
  • Billing Code: 15833
  • Networks: ['CT HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '42'
                              AND provider_id = '774'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '15833'
                              AND product_network_label IN ('CT HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 42
                              AND provider_id = '774'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '15833'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 156​

Sample Record Details:

  • Payer ID: 169
  • Provider ID: 10612
  • Billing Code Type: HCPCS
  • Billing Code: 21246
  • Networks: ['BLUE CHOICE PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '169'
                              AND provider_id = '10612'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21246'
                              AND product_network_label IN ('BLUE CHOICE PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 169
                              AND provider_id = '10612'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21246'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 157​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4022
  • Billing Code Type: HCPCS
  • Billing Code: 99407
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4022'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '99407'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4022'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '99407'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 158​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9807
  • Billing Code Type: HCPCS
  • Billing Code: 76800
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9807'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '76800'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9807'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '76800'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 159​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 3206
  • Billing Code Type: HCPCS
  • Billing Code: 88104
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '3206'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88104'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '3206'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '88104'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 160​

Sample Record Details:

  • Payer ID: 272
  • Provider ID: 8075
  • Billing Code Type: HCPCS
  • Billing Code: 67015
  • Networks: ['SUPERMED PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '272'
                              AND provider_id = '8075'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67015'
                              AND product_network_label IN ('SUPERMED PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 272
                              AND provider_id = '8075'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67015'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 161​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 5435
  • Billing Code Type: HCPCS
  • Billing Code: J0899
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '5435'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0899'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '5435'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0899'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 162​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 1002
  • Billing Code Type: HCPCS
  • Billing Code: 23040
  • Networks: ['NORTH NEW JERSEY HMO', 'SOUTH NEW JERSEY HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '1002'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '23040'
                              AND product_network_label IN ('NORTH NEW JERSEY HMO', 'SOUTH NEW JERSEY HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '1002'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '23040'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 163​

Sample Record Details:

  • Payer ID: 54
  • Provider ID: 1331
  • Billing Code Type: HCPCS
  • Billing Code: 34520
  • Networks: ['PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '54'
                              AND provider_id = '1331'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '34520'
                              AND product_network_label IN ('PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 54
                              AND provider_id = '1331'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '34520'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 164​

Sample Record Details:

  • Payer ID: 111
  • Provider ID: 7200
  • Billing Code Type: HCPCS
  • Billing Code: Q4227
  • Networks: ['PPO/HMO', 'HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '111'
                              AND provider_id = '7200'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4227'
                              AND product_network_label IN ('PPO/HMO', 'HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 111
                              AND provider_id = '7200'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4227'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 165​

Sample Record Details:

  • Payer ID: 54
  • Provider ID: 1270
  • Billing Code Type: HCPCS
  • Billing Code: 95816
  • Networks: ['PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '54'
                              AND provider_id = '1270'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95816'
                              AND product_network_label IN ('PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 54
                              AND provider_id = '1270'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '95816'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 166​

Sample Record Details:

  • Payer ID: 272
  • Provider ID: 2358
  • Billing Code Type: HCPCS
  • Billing Code: 37224
  • Networks: ['SUPERMED PLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '272'
                              AND provider_id = '2358'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37224'
                              AND product_network_label IN ('SUPERMED PLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 272
                              AND provider_id = '2358'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37224'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 167​

Sample Record Details:

  • Payer ID: 47
  • Provider ID: 4033
  • Billing Code Type: HCPCS
  • Billing Code: 67041
  • Networks: ['PREFERREDCARE BLUE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '47'
                              AND provider_id = '4033'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67041'
                              AND product_network_label IN ('PREFERREDCARE BLUE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 47
                              AND provider_id = '4033'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67041'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 168​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 746
  • Billing Code Type: HCPCS
  • Billing Code: 67901
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '746'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67901'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '746'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67901'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 169​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10262
  • Billing Code Type: HCPCS
  • Billing Code: Q4107
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10262'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4107'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10262'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4107'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 170​

Sample Record Details:

  • Payer ID: 111
  • Provider ID: 1033
  • Billing Code Type: HCPCS
  • Billing Code: 51702
  • Networks: ['PPO/HMO', 'HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '111'
                              AND provider_id = '1033'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '51702'
                              AND product_network_label IN ('PPO/HMO', 'HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 111
                              AND provider_id = '1033'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '51702'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 171​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4389
  • Billing Code Type: HCPCS
  • Billing Code: 27111
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4389'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27111'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4389'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27111'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 172​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 1878
  • Billing Code Type: HCPCS
  • Billing Code: 76942
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '1878'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '76942'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 1 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
761878HCPCS76942Facility402OutpatientALL PRODUCTSCIGNA258003f0c61f5b946deacd011087184c7ee
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '1878'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '76942'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 173​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 8887
  • Billing Code Type: MS-DRG
  • Billing Code: 248
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '8887'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '248'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '8887'
                              AND billing_code_type = 'MS-DRG'
                              AND billing_code = '248'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 174​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10321
  • Billing Code Type: HCPCS
  • Billing Code: J9301
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10321'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9301'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10321'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J9301'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 175​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 4477
  • Billing Code Type: HCPCS
  • Billing Code: 27880
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '4477'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27880'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '4477'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27880'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 176​

Sample Record Details:

  • Payer ID: 774
  • Provider ID: 8338
  • Billing Code Type: HCPCS
  • Billing Code: C9777
  • Networks: ['HMO / HEALTHY NY / ESSENTIAL']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '774'
                              AND provider_id = '8338'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9777'
                              AND product_network_label IN ('HMO / HEALTHY NY / ESSENTIAL')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 774
                              AND provider_id = '8338'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'C9777'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 177​

Sample Record Details:

  • Payer ID: 403
  • Provider ID: 6497
  • Billing Code Type: HCPCS
  • Billing Code: Q4159
  • Networks: ['GROUP PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '403'
                              AND provider_id = '6497'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4159'
                              AND product_network_label IN ('GROUP PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 403
                              AND provider_id = '6497'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q4159'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 178​

Sample Record Details:

  • Payer ID: 56
  • Provider ID: 329
  • Billing Code Type: HCPCS
  • Billing Code: 78099
  • Networks: ['QCC COMMERCIAL PPO/EPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '56'
                              AND provider_id = '329'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78099'
                              AND product_network_label IN ('QCC COMMERCIAL PPO/EPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 56
                              AND provider_id = '329'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78099'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 179​

Sample Record Details:

  • Payer ID: 356
  • Provider ID: 10094
  • Billing Code Type: HCPCS
  • Billing Code: Q9979
  • Networks: ['ALLIANCE WPS STATEWIDE FIRST HEALTH WPS HEALTH INSURANCE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '356'
                              AND provider_id = '10094'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q9979'
                              AND product_network_label IN ('ALLIANCE WPS STATEWIDE FIRST HEALTH WPS HEALTH INSURANCE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 356
                              AND provider_id = '10094'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'Q9979'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 180​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 6852
  • Billing Code Type: HCPCS
  • Billing Code: 65820
  • Networks: ['PA GROUP HMO/POS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '6852'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '65820'
                              AND product_network_label IN ('PA GROUP HMO/POS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 7 potential matches in hospital_rates:

✅ Matches found in hospital_rates.

payer_idprovider_idbilling_code_typebilling_codebilling_classrevenue_codebilling_code_modifierssettingplan_nameraw_payer_namenegotiated_dollarnegotiated_percentageestimated_allowed_amountid
76852HCPCS65820FacilityOutpatientAETNA PPO POSAETNA15,276.56a7ccbf3f5d494269b5c77f243ca651ba
76852HCPCS65820FacilityOutpatientAETNA PPO POSAETNA15,276.5622df716280554be0bab35463338271ff
76852HCPCS65820FacilityOutpatientAETNA SOD PPOAETNA13,154.169f9e17275fab4741a971057b90c8168d
76852HCPCS65820FacilityOutpatientAETNA SOD HMOAETNA13,815.71606d4aa820ee473699edefe16e8b00b6
76852HCPCS65820FacilityOutpatientAETNA NEMOURSAETNA12,236.122b9398e6f4f9438885e938c390c79918
76852HCPCS65820FacilityOutpatientAETNA MERITAIN HEALTHAETNA16,461.74cbf27d0ab3c9492398fd35375bdc0f04
76852HCPCS65820FacilityOutpatientAETNA HMOAETNA13,338.573d94c7f2b07e47ea9a6d9e0059f96746
Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '6852'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '65820'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 181​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 2006
  • Billing Code Type: HCPCS
  • Billing Code: 53454
  • Networks: ['GEORGIA HMO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '2006'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '53454'
                              AND product_network_label IN ('GEORGIA HMO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '2006'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '53454'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 182​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4467
  • Billing Code Type: HCPCS
  • Billing Code: 37244
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4467'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37244'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4467'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '37244'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 183​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4939
  • Billing Code Type: HCPCS
  • Billing Code: 27405
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4939'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27405'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4939'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '27405'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 184​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 4870
  • Billing Code Type: HCPCS
  • Billing Code: 67041
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '4870'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67041'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '4870'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '67041'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 185​

Sample Record Details:

  • Payer ID: 813
  • Provider ID: 3016
  • Billing Code Type: HCPCS
  • Billing Code: 63663
  • Networks: ['EPO/PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '813'
                              AND provider_id = '3016'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '63663'
                              AND product_network_label IN ('EPO/PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 813
                              AND provider_id = '3016'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '63663'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 186​

Sample Record Details:

  • Payer ID: 305
  • Provider ID: 4152
  • Billing Code Type: HCPCS
  • Billing Code: 28001
  • Networks: ['BROAD NETWORK']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '305'
                              AND provider_id = '4152'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28001'
                              AND product_network_label IN ('BROAD NETWORK')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 305
                              AND provider_id = '4152'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28001'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 187​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 6723
  • Billing Code Type: APR-DRG
  • Billing Code: 0111-3
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '6723'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0111-3'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '6723'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0111-3'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 188​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 9258
  • Billing Code Type: APR-DRG
  • Billing Code: 0591-1
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '9258'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0591-1'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '9258'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0591-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 189​

Sample Record Details:

  • Payer ID: 624
  • Provider ID: 5627
  • Billing Code Type: HCPCS
  • Billing Code: J1500
  • Networks: ['NAVIGATOR GOLD']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '624'
                              AND provider_id = '5627'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1500'
                              AND product_network_label IN ('NAVIGATOR GOLD')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 624
                              AND provider_id = '5627'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J1500'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 190​

Sample Record Details:

  • Payer ID: 151
  • Provider ID: 1569
  • Billing Code Type: HCPCS
  • Billing Code: 78433
  • Networks: ['AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '151'
                              AND provider_id = '1569'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78433'
                              AND product_network_label IN ('AMBETTER TX', 'AMBETTER GA', 'AMBETTER FL', 'AMBETTER OH', 'AMBETTER MI', 'AMBETTER AR', 'AMBETTER AZ', 'AMBETTER MS', 'AMBETTER WA', 'AMBETTER KS', 'AMBETTER NC', 'AMBETTER TN', 'AMBETTER SC', 'AMBETTER CA', 'AMBETTER NE', 'AMBETTER IL', 'AMBETTER MO', 'AMBETTER IN', 'AMBETTER PA', 'AMBETTER LA', 'AMBETTER AL', 'AMBETTER OK', 'AMBETTER KY', 'AMBETTER NV')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 151
                              AND provider_id = '1569'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '78433'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 191​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10407
  • Billing Code Type: HCPCS
  • Billing Code: 21452
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10407'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21452'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10407'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '21452'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 192​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 10340
  • Billing Code Type: HCPCS
  • Billing Code: 77091
  • Networks: ['LOCALPLUS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '10340'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '77091'
                              AND product_network_label IN ('LOCALPLUS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '10340'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '77091'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 193​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10370
  • Billing Code Type: HCPCS
  • Billing Code: 17272
  • Networks: ['COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10370'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17272'
                              AND product_network_label IN ('COMPASS HMO', 'SIERRA HEALTH HMO', 'HMO GATED', 'CORE ESSENTIAL HMO', 'HMO NONGATED')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10370'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '17272'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 194​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 10665
  • Billing Code Type: HCPCS
  • Billing Code: 55530
  • Networks: ['NAVIGATE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '10665'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '55530'
                              AND product_network_label IN ('NAVIGATE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '10665'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '55530'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 195​

Sample Record Details:

  • Payer ID: 389
  • Provider ID: 2840
  • Billing Code Type: HCPCS
  • Billing Code: 28288
  • Networks: ['PPO PARTICIPATING PROVIDER OPTIONS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '389'
                              AND provider_id = '2840'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28288'
                              AND product_network_label IN ('PPO PARTICIPATING PROVIDER OPTIONS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 389
                              AND provider_id = '2840'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '28288'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 196​

Sample Record Details:

  • Payer ID: 7
  • Provider ID: 317
  • Billing Code Type: HCPCS
  • Billing Code: 31785
  • Networks: ['OPEN ACCESS MANAGED CHOICE']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '7'
                              AND provider_id = '317'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '31785'
                              AND product_network_label IN ('OPEN ACCESS MANAGED CHOICE')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 7
                              AND provider_id = '317'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = '31785'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 197​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 2112
  • Billing Code Type: HCPCS
  • Billing Code: J0598
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '2112'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0598'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '2112'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0598'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 198​

Sample Record Details:

  • Payer ID: 643
  • Provider ID: 8689
  • Billing Code Type: APR-DRG
  • Billing Code: 0226-1
  • Networks: ['NEXUS ACO OAP']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '643'
                              AND provider_id = '8689'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0226-1'
                              AND product_network_label IN ('NEXUS ACO OAP')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 643
                              AND provider_id = '8689'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0226-1'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 199​

Sample Record Details:

  • Payer ID: 76
  • Provider ID: 3078
  • Billing Code Type: HCPCS
  • Billing Code: J0475
  • Networks: ['NATIONAL OAP', 'NATIONAL PPO']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '76'
                              AND provider_id = '3078'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0475'
                              AND product_network_label IN ('NATIONAL OAP', 'NATIONAL PPO')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 76
                              AND provider_id = '3078'
                              AND billing_code_type = 'HCPCS'
                              AND billing_code = 'J0475'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

Sample Record 200​

Sample Record Details:

  • Payer ID: 728
  • Provider ID: 6287
  • Billing Code Type: APR-DRG
  • Billing Code: 0092-2
  • Networks: ['SUTTER HEALTH PLUS LARGE GROUP PLANS']

Core Rates Lookup Results​

Found 0 potential matches in core_rates:

No matches found in core_rates.

Click to see SQL

                            SELECT payer_id, provider_id, billing_code_type, billing_code,
                                   product_network_label, billing_class,
                                    billing_code_modifier,
                                    negotiation_arrangement, negotiated_type,
                                   negotiated_rate, id
                            FROM tq_production.public_2025_07.core_rates
                            WHERE payer_id = '728'
                              AND provider_id = '6287'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0092-2'
                              AND product_network_label IN ('SUTTER HEALTH PLUS LARGE GROUP PLANS')
                              AND billing_class IN ('Inpatient', 'Outpatient')
                            LIMIT 20

Hospital Rates Lookup Results​

Found 0 potential matches in hospital_rates:

No matches found in hospital_rates.

Click to see SQL

                            SELECT
                                payer_id, provider_id, billing_code_type, billing_code,
                                billing_class, revenue_code, billing_code_modifiers,
                                setting, plan_name, raw_payer_name,
                                negotiated_dollar, negotiated_percentage,
                                estimated_allowed_amount, id
                            FROM tq_production.hospital_data.hospital_rates
                            WHERE payer_id = 728
                              AND provider_id = '6287'
                              AND billing_code_type = 'APR-DRG'
                              AND billing_code = '0092-2'
                              AND payer_class_name = 'Commercial'
                              AND COALESCE(billing_class, '') != 'Professional'
                            LIMIT 20

3. Sample Analysis Summary​

Analyzed 200 sample records:

  • Total Core Rates matches: 0 (avg: 0.000)
  • Total Hospital Rates matches: 13 (avg: 0.065)

This analysis provides insights into the potential for filling coverage gaps by integrating data from core_rates and hospital_rates tables.

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