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Methodology

Every figure on SharedRates comes from data insurers have already published. Here is where it comes from, what we do with it, and where it has limits.

Source · The federal rule

The Transparency in Coverage rule.

Since July 2022, federal rules have required most US health insurers to publish the rates they have negotiated with providers. Every figure in a report traces back to one of these public files. Read more

Pipeline · What we extract

From enormous files to the codes you bill.

The machine-readable files cover every kind of medical service and are enormous. We pull out the behavioral-health billing codes (90837, 90834, 90847 and similar) and match each rate to a provider by their NPI from the federal NPPES registry.

Cleaning · What we leave out

Raw files are messy. We tidy them first.

Insurer files contain errors, repeats and quirks. Before a rate reaches a report, we:

  • drop rates that are clearly wrong, such as $0 or implausible amounts;
  • set aside rates far from the local norm, so one unusual contract can’t skew a comparison;
  • count each provider once, even when a rate appears in several files;
  • mark rented networks, where a plan uses another carrier’s network and rates;
  • replace older filings as newer ones arrive.

These screens rely on statistical thresholds. They are judgment calls, not exact science.

Peers · How we compare

Similar providers, nearby, billing the same code.

We compare you with providers who share your credential (psychologist, LCSW, LPC, MFT and so on) and a similar practice size, near you, for the same code. If there aren't enough nearby peers, we widen the area, up to statewide, and say so. If there still aren't enough, we hold the comparison back. Every comparison shows how many peers it uses.

Numbers · What they mean

Medians, percentiles, and Medicare.

The median is the middle rate among your peers. A percentile places you in the spread: at the 75th, you're paid more than three in four peers. Percent of Medicare compares a rate with Medicare's fee for the same code in your area.

Estimates · Covered lives

The Panel Opportunity Map uses estimates.

The map estimates an insurer's members in your area per local provider in your specialty. It uses federal enrollment filings where they exist and modelled estimates where they don't, and marks estimates as such (today, most of the chart). It places each insurer in one of three bands and never prints the member count.

Public pages · Rates by code

Public rate pages: statewide, per credential.

Our public pages show what insurers pay each credential in each state, per billing code, and how many providers stand behind each figure. They use the same cleaning as reports but are coarser: statewide, not narrowed by practice size, and with no national dollar figure. A figure appears only when enough providers stand behind it.

Coverage · Which insurers, how fresh

Major commercial payers, plus regionals.

We cover the major commercial insurers and a growing set of regional plans; coverage varies because some publish more completely than others. Insurers update their files on their own schedules, and federal rules are moving toward quarterly updates. We bring new files in as they are published, so figures may hold steady for months between filings.

See the current insurer list and freshness notes.

Limitations · What we can't tell you

Published is not the same as paid.

  • Files show contracted rates, not what you are paid after modifiers, copays, place-of-service adjustments or denied claims.
  • Files can be incomplete or wrong, and we can’t fix what an insurer never published correctly.
  • “No published rate” does not mean “not in network”. The insurer may not have published it, or we couldn’t match it to you.

Read reports as a guide to where you stand among peers, not a guarantee of exact amounts.

Privacy · Your searches

Insurers can't see what you look up.

We don’t share who searched for what. The data flows one way: from insurers’ filings to you. See our Privacy Policy for details.

Sources · Credits

Public data we build on.

  • Insurers’ Transparency in Coverage files, the CMS NPPES registry, Medicare fee schedules, and federal enrollment filings.
  • The US Census Bureau’s ZIP Code Tabulation Area Gazetteer, to place providers by ZIP code.
  • The GeoNames postal database, used under the Creative Commons Attribution 4.0 licence, for ZIP codes the Census file leaves out, such as PO boxes. Those locations are approximate.