Sample Reviews

Background:

Medicare Advantage plans are generally a flat percentage of Medicare. Can we use Hospital MRF data to infer this percentage?

Conclusion:

Using inpatient rates, we have a reliable way of estimating Medicare Advantage percent of Medicare. Outpatient is much noisier using MRF data, but we can probably assume a single percent of Medicare across both IP/OP settings and use the percentage inferred from IP rates to estimate OP rates.

Historic CMS weight schedules are useful, but we only need 2025 and 2024.

Does this make sense?

Inferred percentages are generally in the expected 100-125% range relative to the federal portion of Medicare, but less than 100% of total_operating_and_capital_pay (which adjusts for things like DSH, wage-index, geographic, capital-specific factors)

Methodology:

Inpatient:

1. Sample a provider, payer, and network type
2. Pull inpatient rates from Hospital MRF data
3. Divide inpatient rates by CMS weights (using CMS weight schedules from each of the past 10 years)
   • it's important to use historic weights because the contract may not have updated with more recent weights
4. Once we have inferred a base rate, we need to compute its relativity to the Medicare base rate. We divide by both the total operating and capital inpatient base rate (e.g. adjusted for geography, DSH, etc) and also the federal portion.
   • To get the 2025 Medicare base rate, use DRG '863' since its weight is 1.000

Outpatient:

1. Sample a provider, payer, and network type
2. Pull outpatient rates from Hospital MRF data
3. Divide outpatient rates by most recent OPPS payment rates (historic is not yet available)
4. Evaluate distribution of percentages to determine if a single percentage of Medicare can be inferred.

Code

# %%
from IPython import get_ipython

if get_ipython() is not None:
    get_ipython().run_line_magic("load_ext", "autoreload")
    get_ipython().run_line_magic("autoreload", "2")
from dotenv import load_dotenv
import pandas as pd
from tqds.sql import db, sql

import pandas as pd
import numpy as np

import warnings
warnings.filterwarnings("ignore")

pd.options.display.max_columns = None
pd.options.display.max_rows = 100
pd.options.display.max_colwidth = None
pd.set_option('display.float_format', lambda x: '%.3f' % x)
trino_conn = db.TrinoClient().conn
redshift_conn = db.RedshiftClient().conn
query = sql.Query()

def get_percentile(s, p):
    return s.quantile(p)


# %%
samples = pd.read_sql(f"""
SELECT 
    hr.provider_id, 
    hr.payer_id,
    count(*) as n
FROM glue.hospital_data.hospital_rates hr
JOIN tq_production.spines.spines_provider_hospitals h
    ON hr.provider_id = h.provider_id
JOIN tq_production.spines.spines_provider_healthsystems phs
    ON h.provider_healthsystem_id = phs.provider_id
WHERE hr.payer_class_name = 'Medicare Advantage'
AND hr.payer_id IN (643, 7, 510, 522, 42) -- UHC, Aetna, Humana, Kaiser, Anthem
AND phs.provider_id IN (
    '100039','100815','100041','100224','100037','100038','100040',
    '100771','100052','100482','100681','100160','100876','100230',
    '100247','100312','100582','100419','100371','100269','101033','101235'
)
AND COALESCE(hr.billing_class, '') != 'Professional'
AND hr.billing_code_type = 'MS-DRG'
AND hr.negotiated_dollar IS NOT NULL
GROUP BY hr.provider_id, hr.payer_id
""", con=trino_conn).sample(20)

# %%
for i, sample in enumerate(samples.itertuples()):
    print(f'## Sample {i + 1}')
    print('\n')
    df = pd.read_sql(f"""
    WITH 
    provider_payers AS (
        SELECT
            hr.*,
            negotiated_percentage * gross_charge AS perc_to_dol,
            h.provider_name_short,
            phs.provider_id AS provider_healthsystem_id,
            phs.provider_name_short as provider_healthsystem_name
        FROM glue.hospital_data.hospital_rates hr
        JOIN tq_production.spines.spines_provider_hospitals h
            ON hr.provider_id = h.provider_id
        JOIN tq_production.spines.spines_provider_healthsystems phs
            ON h.provider_healthsystem_id = phs.provider_id
        WHERE hr.payer_class_name = 'Medicare Advantage'
        AND hr.payer_id IN (643, 7, 510, 522, 42) -- UHC, Aetna, Humana, Kaiser, Anthem
        AND phs.provider_id IN (
            '100039','100815','100041','100224','100037','100038','100040',
            '100771','100052','100482','100681','100160','100876','100230',
            '100247','100312','100582','100419','100371','100269','101033','101235'
        )
        AND COALESCE(hr.billing_class, '') != 'Professional'
        AND hr.billing_code_type = 'MS-DRG'
        AND hr.provider_id = '{sample.provider_id}'
        AND hr.payer_id = {sample.payer_id}
    ),
    medicare AS (
        SELECT DISTINCT
            fy,
            msdrg AS billing_code,
            weights
        FROM tq_intermediate.cld_utils.msdrg_weights_by_year
    ),
    final AS (
        SELECT
            pp.*,
            CASE
                WHEN plan_name LIKE '%HMO%' THEN 'HMO'
                ELSE 'PPO'
            END AS network_type,
            m.*,
            1.000 * pp.negotiated_dollar / m.weights AS base
        FROM provider_payers pp
        LEFT JOIN medicare m
            ON pp.billing_code = m.billing_code
    ),
    medicare_rates AS (
        -- USE 863 since it has 1.000 weight in FY 2025
        SELECT provider_id, total_operating_and_capital_pay, federal_portion
        FROM tq_production.reference_legacy.ipps_reference_pricing
        WHERE 
            msdrg = '863'
    )
    SELECT 
        final.*,
        mr.total_operating_and_capital_pay,
        mr.federal_portion
    FROM final
    JOIN medicare_rates mr
        ON final.provider_id = CAST(mr.provider_id AS VARCHAR)
    WHERE network_type = 'PPO'
    """, con=trino_conn)

    print(df[[
        'provider_id',
        'payer_id',
        'provider_name',
        'health_system_name',
        'network_type',
        'payer_name'
    ]].drop_duplicates().to_markdown(index=False))
    print('\n')

    df_summary = (
        df
        .groupby(["fy"])
        .agg({
            "base": [
                "min",
                lambda s: s.quantile(0.10),
                "median",
                lambda s: s.quantile(0.90),
                "max",
                "std"
            ]
        })
        .set_axis([
            "min", "p10", "median", "p90", "max", "std"
        ], axis=1)
        .sort_values("std")
    )

    df_medicare = df[[
        'total_operating_and_capital_pay',
        'federal_portion'
    ]].drop_duplicates()

    df_medicare['base_rate'] = df_summary['median'].values[0]
    df_medicare['percent of total operating and capital'] = df_medicare['base_rate'] / df_medicare['total_operating_and_capital_pay']
    df_medicare['percent of federal portion'] = df_medicare['base_rate'] / df_medicare['federal_portion']

    df_medicare = df_medicare[[
        'total_operating_and_capital_pay',
        'federal_portion',
        'base_rate',
        'percent of total operating and capital',
        'percent of federal portion'
    ]]

    print(df_summary.reset_index().to_markdown(index=False))
    print('\n')
    print(df_medicare.to_markdown(index=False))

    print('\n\n')

    # %%

Inpatient

Sample 1

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2117	7	Baptist Medical Center Nassau	Baptist Health (FL)	PPO	Aetna

Below, we can see that the 2025 CMS weight schedule works best. After dividing MRF rates by the CMS weights, we almost get a flat 6652 base rate.

fy	min	p10	median	p90	max	std
2025	6186.93	6652.6	6652.6	6652.61	6652.61	28.9355
2024	5987.26	6435.17	6668.25	6840.97	8962.31	237.595
2023	5683.29	6393.5	6685.28	6980.17	8267.73	282.246
2022	5464.52	6241.16	6686.22	7029.66	8073.98	346.419
2021	5473.13	6249.09	6695.99	7094.36	8110.36	365.563
2020	5308.49	6274.08	6729.22	7176.57	9103.65	411.341
2019	4724.49	6226.62	6697.14	7241.97	8273.79	469.79
2018	4697.08	6040.18	6744.84	7451.95	9230.6	631.942
2017	4080.52	6012.89	6761.87	7622.81	9711.59	725.575
2016	3815.91	6001.16	6787.7	7753.71	9676.2	788.466
2015	4105.39	5986.74	6795.08	7950.21	10304.3	890.482
2014	4397.33	5919.79	6886.93	8082.64	11044.9	955.477

Compared to total operating and capital pay, our estimated percent of Medicare would be 80 percent. Compared to the federal portion, it's exactly 100%.

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8349.94	6651.94	6652.6	0.796725	1.0001

Sample 2

warning

These samples also include cases where a base rate should NOT be inferred. Below, there is too much variability in the calculated base rates.

One approach would be to filter using std, e.g. std < 500

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4729	7	St. Charles Parish Hospital	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2019	506.692	6990.6	8314.41	9638.32	10255.1	1980.11
2022	497.158	7100.31	8349.91	9470.76	10638	1982.79
2021	498.081	7073.74	8375.83	9534.46	10664.6	1988.84
2024	497.773	7115.72	8289.47	9412.84	10331.9	1990.84
2020	514.677	6934.28	8370.14	9581.35	10215.5	1994.18
2018	541.108	6874.24	8342.51	9641.35	10660.2	2002.6
2023	504.152	7148.99	8414.12	9490.3	10458.5	2008.59
2025	497.018	7006.17	8221.03	9550.61	10512.4	2011.37
2017	549.814	6611.44	8406.91	9838.63	10831	2063.46
2016	564.543	6479.99	8371.18	9957.37	11462.3	2090.08
2015	580.615	6505.31	8361.58	10222.6	12455.3	2175.85
2014	584.372	6473.84	8341.77	10513.6	12450.4	2217.43

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8818.56	5909.98	8314.41	0.942831	1.40684

Sample 3

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3461	643	Vanderbilt Bedford Hospital	Vanderbilt University Medical Center	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	6243.39	8127.64	8127.64	8127.64	8127.65	153.694
2024	6050.94	7725.61	8129.03	8522.7	11598.8	479.876
2023	5057.22	7510.96	8113.56	8608.76	11595	531.98
2022	5528.64	7494.2	8116.18	8674.02	15540.9	623.648
2021	5500.96	7482.06	8134.62	8712.44	15577.4	640.203
2020	4372.27	7428.18	8193.75	8876.32	11273.3	670.002
2019	5431.31	7441.46	8223.18	9015.65	14768.2	764.87
2018	5510.14	7320.15	8255.19	9222.86	13679.3	873.377
2017	4985.26	7309.55	8414.94	9497.49	17509.7	1057.32
2016	4661.98	7356.9	8475.57	9739.21	16748.5	1108.65
2015	5015.64	7313.91	8513.95	9950.84	17617.4	1262.25
2014	5134.76	7348.76	8551.62	10212.3	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
10016	6239.75	8127.64	0.811466	1.30256

Sample 4

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4741	7	Ochsner LSU Health – Monroe Medical Center	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	7503.48	7951.49	8899.13	10391.9	18770.7	1064.88
2025	6885.05	7884.6	8849.69	10466.2	18949.2	1112.45
2023	7198.43	7922.49	9004.79	10416.9	18705.8	1122.88
2021	7019.87	7974.36	9050.51	10399.1	19874.3	1138.69
2022	7017.44	7957.51	9020.18	10390.2	19853.4	1140.49
2020	7012.15	7952.06	9146.58	10554.8	20213.8	1163.58
2019	6953.02	8021.73	9131.45	10659.9	20531.7	1204.08
2018	7065.95	8000.83	9169.51	10637.8	20813.9	1242.98
2017	6550.36	7889.69	9329.76	11040.4	21378	1402.57
2016	6645.59	7949.37	9374.65	11199	21536.1	1433.64
2015	6363.31	7912.62	9393.88	11462.4	21960.8	1607.91
2014	6632.55	7884.95	9477.8	11720.8	22376.2	1768.28

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
9463.31	5783.49	8899.13	0.940383	1.53871

Sample 5

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
1495	643	Twin County Regional Hospital	LifePoint Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	6988.25	8104.63	8104.64	8266.72	8266.73	119.859
2024	6728.02	7888.59	8217.05	8538.11	11136.8	392.805
2023	5660.4	7863.18	8270.21	8633.75	10273.7	399.305
2022	6657.23	7695.27	8241.54	8756.66	9996.62	476.05
2021	6667.72	7713.87	8256.78	8816.74	10015.8	495.657
2020	6467.14	7727.54	8292.33	8952.9	11312.5	547.732
2019	5755.67	7595.33	8251.08	9036.81	10481.1	634.025
2018	5722.29	7393.85	8335.54	9367.86	12428.7	852.797
2017	4971.15	7468.78	8370.87	9473.34	11799	940.382
2016	4648.79	7414.75	8423.86	9700.14	13362.8	1063.5
2015	5001.45	7355.94	8433.18	9892.24	12804.5	1160.05
2014	5357.11	7334.93	8488.92	10010.6	13724.7	1275.03

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8648.53	6314.49	8104.64	0.937111	1.2835

Sample 6

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3622	7	Ochsner Medical Center - Hancock	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	8140.13	9011.52	10097.7	11833	13112.9	1139.81
2025	7950.29	8936.56	10173.6	11840.4	13335.2	1173.9
2023	8086.1	8945.62	10155.3	11814.9	13233.8	1177.57
2020	7471.97	8805.42	10406.8	11927.4	12965.2	1188.44
2021	7707.66	8770.54	10273.8	11878.3	13543.1	1210.27
2022	7651.03	8734.3	10266.9	11876.7	13506.1	1221.29
2019	7440.88	8931.66	10330.4	12045	14344.8	1222.4
2018	7382.9	8905.25	10355.9	12098.3	14139.7	1254.07
2017	7365.63	8681.96	10557.6	12455.4	15282	1433.18
2016	7325.28	8879.27	10565.6	12523.9	15260	1484.49
2015	7048.54	8688.59	10615.2	12957.2	16662.6	1742.85
2014	7262.97	8652.39	10673.2	13306.8	16444.6	1861.05

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
12334.4	5909.98	10097.7	0.818664	1.70859

Sample 7

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
6857	643	Memorial Hermann Cypress Hospital	Memorial Hermann Healthcare System	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2024	8424.04	8424.05	8845.25	9266.46	9266.47	421.477
2025	6253.06	8211.92	8817.9	9424.22	10296.1	533.394
2023	6069.47	8183.54	8829.84	9516.23	10856.4	568.963
2022	6492.13	8089.57	8819.76	9609.96	11431.2	633.931
2021	6499.03	8064.73	8833.82	9639.26	11482.7	659.31
2020	6525.16	8085.51	8874.24	9754.8	11321.4	705.523
2019	5762.22	8035.43	8910.08	9928.05	12152.2	811
2018	5845.85	7935.64	8983.35	10117.9	13608	947.154
2017	5342.2	7844.55	9070.62	10357.2	14549.8	1109.51
2016	5028.01	7835.3	9111.89	10534.6	14177.7	1158.52
2015	5409.44	7815.44	9106.56	10906.9	15098.1	1293.73
2014	5794.11	7744.62	9161.33	11061.5	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6623.73	0	8845.25	1.33539	inf

Sample 8

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2082	510	Doctors Hospital	Baptist Health South Florida	PPO	Humana

fy	min	p10	median	p90	max	std
2025	8271.86	8440.43	8841.04	9622.38	13654	583.521
2024	7706.82	8299.51	8938.24	9662.15	13629.8	670.55
2023	7479.75	8267.81	8967.95	9698.88	13693.2	700.983
2022	7484.94	8209.39	8992.57	9817.94	13805.6	769.944
2020	7313.82	8266.25	9071.68	9874.17	14056	775.1
2021	7511.15	8214.55	9017.1	9847.13	13836.1	779.54
2019	7122.47	8256.7	9083.58	10007.6	14120.7	834.266
2018	6462.19	8279.69	9119.6	10128.6	14595	877.479
2017	6151.64	8147.61	9200.96	10506.2	15077	1073.21
2016	5752.74	8163.08	9216.55	10644.3	15122.7	1127.81
2015	6189.14	8078.3	9224.01	10897.7	15144.3	1267.69
2014	6334.23	8005.75	9230.24	11199.2	15019.2	1369.27

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8520.97	6651.94	8841.04	1.03756	1.32909

Sample 9

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2959	7	Henry Ford Hospital	Henry Ford Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	7551.92	7851.15	9872.63	10786.2	14409.4	1204.23
2025	5489.12	7753.91	9258.26	10968.8	14546.4	1292.62
2023	5722.88	7690.9	9273.18	10985.2	14359.6	1312.72
2022	5802.6	7615.92	9236.06	11099.4	15240.6	1376.75
2021	5819.16	7629.55	9230.5	11136.6	15256.6	1386.75
2020	5893.7	7680.2	9280.12	11220.2	15517.2	1404.23
2019	5348.11	7695.88	9319.84	11338.2	17627.3	1487.29
2018	5425.73	7722.67	9379.16	11465.6	16747.8	1572.88
2017	4825.8	7713.8	9559.65	11818.5	20899.5	1750.7
2016	4896.87	7710.08	9655.52	12022.7	19991	1793.26
2015	5036.15	7708.6	9800.07	12301.3	21028.1	1916.18
2014	5259.63	7667.88	9879.4	12524.2	21956.1	2026.32

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
11286.1	6485.33	9872.63	0.874761	1.5223

Sample 10

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4673	643	Ochsner Lafayette General Surgical Hospital	Lafayette General Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2024	6639.38	6675.4	6770.01	6940.78	8372.98	144.1
2025	5137.18	6479.54	6783.03	7133.57	7894.69	306.049
2023	6002.36	6369.08	6764.26	7162.33	8329.88	332.048
2022	5511.22	6295.15	6769.41	7254.23	9291.73	430.775
2021	5336.42	6278.51	6782.68	7283.31	9308.47	448.315
2020	4881.65	6330.52	6841.1	7358.74	8449.98	464.056
2019	4578.27	6275.77	6855.61	7470.48	11500.2	573.176
2018	4644.72	6188.52	6909.08	7632.26	10652.3	673.131
2017	4211.21	6143.51	6950.5	7850.01	13635.1	846.847
2016	4194.92	6109.83	7006.4	7990.63	13042.3	885.228
2015	4394.77	6131.65	7036.66	8199.68	13719	991.14
2014	4589.79	6063.32	7053.82	8428.4	14016.4	1064.34

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6623.73	0	6770.01	1.02208	inf

Sample 11

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4779	510	Slidell Memorial Hospital East	Slidell Memorial Hospital	PPO	Humana

fy	min	p10	median	p90	max	std
2024	6527.01	6562.23	6659.2	6830	8228.78	159.013
2025	5046.72	6404.59	6677.03	6987.37	7744.84	280.667
2023	5928.78	6315.86	6665.55	7029.7	7817.62	302.972
2022	5508.37	6271.71	6677.04	7108.8	8835.24	384.429
2021	5244.61	6263.69	6690.9	7139.18	8859.23	405.002
2020	4796.82	6265.37	6733.13	7202.37	8261.72	431.316
2019	4499.51	6217.27	6741.17	7333.02	8841.67	513.05
2018	4564.81	6150.04	6787.9	7430.5	10504.6	629.598
2017	4139.17	6122.44	6841.64	7699.16	10586.1	746.326
2016	4120.28	6085.01	6886.54	7767.69	11294.1	799.427
2015	4319.6	6092.98	6909.53	8016.19	10815.5	869.812
2014	4511.27	6036.85	6929.58	8181.39	13770.9	993.552

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6911.92	5927.64	6659.2	0.963438	1.12342

Sample 12

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
5390	643	Memorial Hermann Texas Medical Center	Memorial Hermann Healthcare System	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2024	8424.04	8424.05	8845.25	9266.46	9266.47	421.378
2025	5903.01	8176.27	8831.12	9485.17	10296.5	585.441
2023	6069.47	8076.24	8775.64	9564.65	12867.4	654.736
2022	6197.88	8003.83	8803.2	9693.29	12734.7	733.037
2021	6217.76	8000.08	8825.22	9722.11	12757.6	749.433
2020	6058.24	8028.29	8869.81	9831.32	13001.9	781.576
2019	5762.22	7999.29	8955.09	10030	15761.5	905.886
2018	5845.85	7910.09	9000.22	10188	14764.9	1065.71
2017	5342.2	7865.53	9091.33	10518.1	18687.4	1257.45
2016	5028.01	7848.68	9153.73	10759.1	17875	1300.98
2015	5409.44	7862.63	9191.5	11027.9	18802.4	1433.02
2014	5794.11	7799.11	9269.93	11219.4	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
13612.8	6635.82	8845.25	0.649776	1.33296

Sample 13

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4704	7	Lafayette General Medical Center	Lafayette General Health	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	313.137	6670.16	6768.66	6939.38	8372.98	831.474
2025	297.351	6444.54	6778.98	7120.69	7894.69	877.154
2023	365.57	6327.1	6756.34	7130.58	8231.63	877.369
2022	357.549	6226.13	6757.88	7212.62	8991.47	905.028
2021	358.284	6218.06	6767.61	7252.58	9015.89	914.641
2020	321.008	6246.83	6822.51	7315.86	8421.57	938.567
2019	353.932	6207.1	6840.46	7422.06	8999.23	971.087
2018	332.897	6103.24	6890.7	7557.67	10185.3	1051.95
2017	341.728	6038.14	6922.15	7792.15	11224.5	1133.07
2016	378.869	5995.35	6975.19	7900.65	10576.8	1166.2
2015	348.454	5955.57	7000.35	8138.31	11163.3	1235.91
2014	414.763	5946.48	7016.01	8307.25	14016.4	1309.21

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6999.8	5797.05	6768.66	0.966979	1.1676

Sample 14

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3461	510	Vanderbilt Bedford Hospital	Vanderbilt University Medical Center	PPO	Humana

fy	min	p10	median	p90	max	std
2025	6555.56	8534.02	8534.02	8534.02	8534.03	161.378
2024	6353.48	8111.89	8535.49	8948.83	12178.7	503.87
2023	5310.08	7886.51	8519.25	9039.19	12174.7	558.579
2022	5805.07	7868.91	8521.99	9107.72	16317.9	654.831
2021	5776.01	7856.16	8541.35	9148.06	16356.2	672.213
2020	4590.88	7799.59	8603.44	9320.14	11836.9	703.503
2019	5702.87	7813.53	8634.34	9466.43	15506.6	803.113
2018	5785.64	7686.15	8667.95	9684.01	14363.3	917.046
2017	5234.52	7675.03	8835.68	9972.37	18385.1	1110.19
2016	4895.08	7724.75	8899.35	10226.2	17585.9	1164.08
2015	5266.42	7679.6	8939.64	10448.4	18498.3	1325.36
2014	5391.49	7716.2	8979.2	10722.9	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
10016	6239.75	8534.02	0.85204	1.36769

Sample 15

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2117	643	Baptist Medical Center Nassau	Baptist Health (FL)	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	6652.6	6652.6	6652.6	6652.61	6652.61	0.00276799
2024	5987.26	6435.53	6668.87	6840.98	8962.31	236.019
2023	5683.29	6393.76	6692.81	6982.27	8267.73	280.368
2022	5464.52	6239.32	6689.44	7037.76	8073.98	344.914
2021	5473.13	6248.37	6696.87	7109.55	8110.36	364.062
2020	5308.49	6274.72	6729.22	7187.41	9103.65	409.388
2019	4724.49	6225.18	6699.41	7244.38	8273.79	468.433
2018	4697.08	6038.59	6746.92	7453.96	9230.6	631.37
2017	4080.52	6008.14	6762.48	7624.43	9711.59	724.097
2016	3815.91	6000.16	6789.23	7755.61	9676.2	786.964
2015	4105.39	5986.36	6795.08	7953.45	10304.3	888.285
2014	4397.33	5919.61	6886.93	8086.32	11044.9	953.607

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8349.94	6651.94	6652.6	0.796725	1.0001

Sample 16

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
1760	643	Wilson Medical Center	LifePoint Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	5663.98	7373.36	7373.36	7373.36	7373.37	138.676
2024	5489.38	7132.8	7397.97	7652.14	9933.32	344.516
2023	4587.89	7087.23	7457.06	7851.81	9704.21	434.393
2022	5044.54	6955.19	7438.43	7915.41	10824.7	505.357
2021	4990.45	6957.14	7446.17	7970.66	10844.2	526.213
2020	3966.5	6959.79	7491.77	8058.82	10227	573.687
2019	5004.1	6897.59	7484.83	8197.52	13397.6	702.607
2018	5205.98	6785.83	7542.82	8424.52	12409.8	797.297
2017	4522.61	6708.08	7646.72	8583.29	15884.7	992.357
2016	4229.34	6771.49	7636.99	8800.19	15194.1	1033.56
2015	4550.17	6677.54	7683.36	8947.81	15982.4	1147.84
2014	4658.23	6653.15	7722.57	9215.69	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8666.15	6303.4	7373.36	0.850823	1.16974

Sample 17

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
6856	7	Memorial Hermann Pearland Hospital	Memorial Hermann Healthcare System	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	7060.23	7060.24	7060.24	7060.24	7060.25	0.00247068
2025	6231.8	6826.02	7044.44	7287.67	7844.77	223.313
2023	5496.58	6786	7081.94	7388.76	8271.64	291.65
2022	5280.98	6624.75	7062.9	7513.52	8709.56	389.698
2021	5280.98	6592.3	7073.03	7558.41	8748.81	414.618
2020	5468.77	6624.37	7127.39	7668.07	8625.97	445.158
2019	4829.35	6521.67	7110.25	7736.47	9202.57	536.12
2018	4899.44	6431.77	7178.33	7905.92	10049.5	668.089
2017	4506.21	6381.46	7219.22	8099.31	10554	785.058
2016	4214	6296.3	7255.72	8255.1	10802.2	829.341
2015	4533.67	6271.43	7227.96	8433.65	11503.4	916.943
2014	4856.07	6242.95	7247.66	8558.09	inf	nan

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6623.73	0	7060.24	1.0659	inf

Sample 18

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2640	42	Baptist Health Floyd	Baptist Healthcare System	PPO	Anthem

fy	min	p10	median	p90	max	std
2019	990.794	6573.07	7669.1	15342	53379.2	5317.31
2015	974.011	6472.74	8270.57	15935	63518.2	5348.06
2018	932.394	6516.93	7838.91	15609.3	49557.3	5351.63
2021	1000.36	6628.87	7491.57	15106	52341.8	5371.47
2022	994.672	6633.32	7478.14	15086.3	52264	5383.01
2017	964.589	6477.07	8016.83	15789.7	58801	5389.86
2020	934.718	6637.2	7613.25	15250.7	51093	5392.61
2025	940.633	7136.1	7137.41	15200.1	54974.5	5399.25
2014	996.559	6460.71	8294.91	15875.8	65670.8	5420.32
2016	921.057	6490.8	8111.83	16008.6	60749	5450.51
2023	887.639	6734.3	7414.66	15090.2	52681.5	5507.08
2024	1037.92	6804.18	7358.03	15208.8	53573.8	5572.78

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6623.73	0	7669.1	1.15782	inf

Sample 19

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2181	7	Baptist Hospital	Baptist Health South Florida	PPO	Aetna

fy	min	p10	median	p90	max	std
2019	6012.71	8855.3	10111.1	12086.6	194229	9943.51
2022	7356.6	8725.12	9941.51	11818.7	197593	9996.47
2021	6999.03	8753.25	9977.15	11911.2	197884	10019.8
2020	6484.69	8733.44	10080	11859.8	196078	10043.3
2018	6099.97	8810.29	10169.8	12184.8	192066	10052.7
2024	7781.39	8905.99	9889.7	11827	199132	10109
2023	7418.01	8826.79	9883.94	11847.4	201049	10188
2025	8496.58	8934.6	9796.19	11728.2	200587	10200.5
2016	6029.89	8820.46	10399.6	13136.5	188885	10245.4
2017	5889.18	8792.99	10319.6	12833.7	191174	10296.9
2015	5766.08	8694.7	10449.9	13551.1	188549	10339.3
2014	6293.08	8665.89	10487.7	13939.4	188501	10374.5

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
6623.73	0	10111.1	1.52649	inf

Sample 20

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3059	7	Henry Ford Wyandotte Hospital	Henry Ford Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2024	7084.44	7220.25	7531.22	7834.14	9435.75	236.829
2025	5052.07	7014.75	7512.34	8050.58	9525.48	449.043
2023	5229.68	6921.93	7488.86	8057.29	10283.5	498.863
2022	4971.73	6845.42	7512.88	8170.73	10493.1	590.362
2021	4985.92	6839.01	7520	8198.3	10512	603.735
2020	5300.73	6892.12	7576.16	8284.42	10831.4	618.903
2019	4927.09	6858.65	7618.33	8449.11	12987.1	730.42
2018	4998.6	6786.93	7644.53	8561.04	12163.9	844.593
2017	4508.99	6729.65	7741.73	8864.26	15398	1023.19
2016	4575.4	6713.62	7801.82	9031.56	14728.6	1060.59
2015	4705.54	6692.5	7818.24	9286.53	15492.7	1178.45
2014	4914.34	6675.79	7852.75	9539.54	15946.3	1277.99

total_operating_and_capital_pay	federal_portion	base_rate	percent of total operating and capital	percent of federal portion
8230.63	6485.33	7531.22	0.915023	1.16127

Outpatient

Sample 1

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2117	7	Baptist Medical Center Nassau	Baptist Health (FL)	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.165706	0.165706	0.165706	0.17818	0.181299	0.00900255

Sample 2

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4729	7	St. Charles Parish Hospital	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.13355	0.92168	0.950392	1.01294	2.3709	0.155804

Sample 3

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3461	643	Vanderbilt Bedford Hospital	Vanderbilt University Medical Center	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	1.79133e-07	0.0243623	0.194472	1.071	7500	102.404

Sample 4

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4741	7	Ochsner LSU Health – Monroe Medical Center	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.130198	0.913865	0.941764	1.02754	396.273	9.28691

Sample 5

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
1495	643	Twin County Regional Hospital	LifePoint Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	nan	nan	nan	nan	nan	nan

Sample 6

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3622	7	Ochsner Medical Center - Hancock	Ochsner Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.229281	0.904228	0.92543	0.983074	106.842	2.98235

Sample 7

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
6857	643	Memorial Hermann Cypress Hospital	Memorial Hermann Healthcare System	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	nan	nan	nan	nan	nan	nan

Sample 8

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2082	510	Doctors Hospital	Baptist Health South Florida	PPO	Humana

fy	min	p10	median	p90	max	std
2025	0.138964	1.08324	1.09	1.09007	6.78747	0.214708

Sample 9

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2959	7	Henry Ford Hospital	Henry Ford Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.164028	0.919484	0.997371	1.05327	127.552	2.09269

Sample 10

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4673	643	Ochsner Lafayette General Surgical Hospital	Lafayette General Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	0.00356861	0.10315	0.913865	1.04373	396.273	6.45108

Sample 11

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4779	510	Slidell Memorial Hospital East	Slidell Memorial Hospital	PPO	Humana

fy	min	p10	median	p90	max	std
2025	0.00354477	0.0840206	0.232042	0.97153	396.273	4.56206

Sample 12

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
5390	643	Memorial Hermann Texas Medical Center	Memorial Hermann Healthcare System	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	nan	nan	nan	nan	nan	nan

Sample 13

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
4704	7	Lafayette General Medical Center	Lafayette General Health	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.00356487	0.103041	0.912902	1.04264	396.273	6.45106

Sample 14

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3461	510	Vanderbilt Bedford Hospital	Vanderbilt University Medical Center	PPO	Humana

fy	min	p10	median	p90	max	std
2025	1.79133e-07	3.29384e-06	4.38289e-05	48.603	7875	316.636

Sample 15

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2117	643	Baptist Medical Center Nassau	Baptist Health (FL)	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	0.179494	0.179494	0.179494	0.179494	0.179494	0

Sample 16

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
1760	643	Wilson Medical Center	LifePoint Health	PPO	United Healthcare

fy	min	p10	median	p90	max	std
2025	nan	nan	nan	nan	nan	nan

Sample 17

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
6856	7	Memorial Hermann Pearland Hospital	Memorial Hermann Healthcare System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	nan	nan	nan	nan	nan	nan

Sample 18

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2640	42	Baptist Health Floyd	Baptist Healthcare System	PPO	Anthem

fy	min	p10	median	p90	max	std
2025	0.00386761	0.972196	2.07262	29.6541	41812.9	901.337

Sample 19

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
2181	7	Baptist Hospital	Baptist Health South Florida	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.142804	1.06052	1.06055	1.09813	18.9758	0.552298

Sample 20

provider_id	payer_id	provider_name	health_system_name	network_type	payer_name
3059	7	Henry Ford Wyandotte Hospital	Henry Ford Health System	PPO	Aetna

fy	min	p10	median	p90	max	std
2025	0.0108668	0.919531	0.997371	1.05327	127.552	2.28666