Score Reference
Each rate column on each ROID row receives one of these scores. Scores are additive: the integer tier reflects data source and validation status; the decimal component breaks ties within the same tier.
Score Breakdown
7.x Validated — Counterparty Agreement
Both payer MRF and hospital MRF independently report similar rates for this ROID. Agreement is within ±5%.
- Decimal:
rate / 1e8— among validated rates, slightly prefer the higher dollar amount - Canonical rate score: 5
- Condition:
ABS(payer_rate - hospital_rate) ≤ 0.05 × payer_rateAND rate within outlier bounds
6.x Raw, Not Outlier — Single Source
Rate comes from a single MRF (payer or hospital) and is within outlier bounds. No counterparty validation.
- Decimal: CDF value (0–0.999) — prefer rates that are more "common" for this code
- Canonical rate score: 4
- Condition: rate within
[medicare_lower, medicare_upper]bounds; no counterparty match
The majority of payer MRF and hospital MRF rates score 6.x. Score 7 requires an independent source to corroborate — uncommon for rare codes or small providers.
5.x Benchmark-Validated
Transformed rate (e.g. pct-to-dollar) falls within 95–1000% of Medicare. Applies to specific transformation columns where Medicare comparison is most meaningful.
- Decimal: CDF value
- Canonical rate score: 3
4.x Not Outlier — No Validation
Rate is within bounds but has no counterparty validation. Used for certain raw and transformed columns that don't meet the counterparty match threshold.
- Decimal: CDF value
- Canonical rate score: 2
3.x Imputation — Benchmark-Backed
Imputed rate grounded in a benchmark source: hospital MRF gross charge with percentage-of-charge, or state-level Medicare benchmark.
- Decimal: CDF value
- Canonical rate score: 3 (same as 5.x — benchmark-backed imputations are treated as moderate confidence)
2.x Imputation — Not Outlier
Estimated rate from tier aggregation (provider + code + payer combinations). Within bounds but fully estimated, no MRF source.
- Decimal: CDF value
- Canonical rate score: 2
Score 2 (or 3) is always below score 6 or 7. An imputed rate only becomes canonical if no raw or transformed rate exists for the ROID.
1.x Outlier
Rate falls outside the Medicare-anchored bounds for its code type. Almost always a data error — wrong units, typo, or mis-classified rate.
- Decimal: CDF value (computed but rarely relevant — outliers almost never win selection)
- Canonical rate score: 1
- Common causes: APR-DRG averaging bias pushing above IP bound; drug rate in wrong units (per mg vs per vial); capitation rate mistakenly included
A ROID whose only rate is an outlier will still have canonical_rate set and canonical_rate_score = 1. Filter with canonical_rate_score > 1 to exclude outliers from analysis.
0 No Rate
No non-NULL rate column exists for this ROID, or the column scored 0 by default (e.g. a drug code's CDF column, which is always set to 0).
- Canonical rate score: 0
- The ROID row still exists in the output — a 0-score ROID means a confirmed coverage gap, not a missing row
The Decimal Tiebreaker
When many rates share the same integer tier, the decimal component determines the winner:
| Integer tier | Decimal = | Effect |
|---|---|---|
| 7 | rate / 1e8 | Higher dollar amount wins — among validated rates, prefer the larger value |
| 6, 5, 4, 3, 2, 1 | CDF score (0–0.999) | More common rate wins — prefer rates that cluster near the center of the observed distribution for that code |
The CDF is computed as the probability mass under a log-normal curve centered on the code's observed median rate. A rate of $150 for CPT 99213 (common value) might score 0.78; a rate of $500 for the same code might score 0.05.
is_drug_code = true → CDF is set to 0, not computed. Drug pricing distributions are highly bimodal (brand vs generic), making the log-normal model unreliable. Drug tiebreaking falls back to array position ordering.