How Numbers Are Calculated

Median Rate

The median rate is the middle value when all negotiated rates for a given scope (ZIP code, provider, or market area) are sorted in ascending order. For an even number of values, the median is the average of the two middle values.

The Explorer uses the median rather than the mean (average) because negotiated rate datasets frequently contain outliers - rates that are either extremely high (e.g., billed charges mistakenly included) or extremely low (e.g., zero-dollar placeholder entries). The median is resistant to these extremes and better represents the "typical" rate a payer is paying for a service in a given area.

Example: If a ZIP code has five rate records of $80, $95, $100, $105, and $400, the median is $100 — not the mean of $156, which is skewed by the outlier.

Map Marker Color Tiers

Marker colors are calculated relative to the current query results, not against a fixed national benchmark. The Explorer sorts all ZIP code median prices in the current result set and divides them into three equal thirds:

• Bottom 33% → Green (low cost)
• Middle 33% → Amber (mid cost)
• Top 33% → Red (high cost)

This means the color scale recalibrates every time you apply new filters. A "green" ZIP code in a high-cost specialty may still have rates significantly above national averages — the color only indicates relative position within the current filtered dataset.

Provider Count vs. Rate Count

The Explorer distinguishes between two counts that are often confused:

Provider Count (shown on map markers) is the number of distinct NPIs found in the filtered dataset for that ZIP code. One provider may have many rate records across different payers, billing codes, or places of service — all of those records count as one provider.

Rate Count (shown in the rate table) is the total number of individual rate rows for a given provider within the filtered scope. A provider with 12 payer contracts for the same billing code would show a rate count of 12.

Medicare Percentage

When your dataset includes a column expressing rates as a percentage of the Medicare physician fee schedule, the Explorer displays this as Medicare %. The value shown is the median Medicare percentage across all rate records for that provider, calculated the same way as the median dollar rate. A value of 110% means the median negotiated rate is 10% above what Medicare would pay for the same service.

Benchmark Positioning

In the Benchmark View, positioning is determined by comparing the provider's median rate (across all entered NPIs) to the market median for the same billing code and payer. Market statistics are calculated from all rate records in the dataset that match the selected taxonomy codes, billing code, payer, and geographic area — excluding the provider's own NPI(s).

Heatmap Intensity

The density heatmap weights each ZIP code by its raw provider count. The maximum intensity (the point at which the heatmap color reaches full saturation) is set to the 75th percentile of provider counts across all visible ZIP codes. This prevents a single extremely dense ZIP code from compressing the color scale for the rest of the map.