The codes we price, and the rule behind every number.

We show the rate for care in your office (place of service 11). Where a payer publishes a rate that isn’t specific to a setting, that counts as your office rate. A few payers never use 11 at all and publish office visits under other codes; for those we use the payer’s own codes and name the setting on the row. A rate a payer publishes only for hospital or facility settings is never shown as your office rate. When a payer publishes one rate for office settings and a lower one for every setting, hospitals included, you get the office rate.

Professional rates only: what the clinician is paid. Institutional and facility claims, and per-diem arrangements, are not what a practice bills, so they are left out.

A payer often publishes the same code more than once: plain, and again with a modifier such as 95 for telehealth. You bill the plain code, so that is the rate we show. If a payer publishes only a modified variant, we show it and name the modifier.

A dollar amount the payer published — negotiated, or its own fee-schedule amount. Where the file marks a rate “derived” we flag it as an estimate. Where a payer publishes a percentage of charges instead of a dollar, we say so rather than invent one.