It's really not malicious. What you are seeing here is essentially part of the claims adjudication process output. This takes as input the procedure (ie the I

It's really not malicious. What you are seeing here is essentially part of the claims adjudication process output. This takes as input the procedure (ie the ICD/CPT code) and the provider, and runs it against the 'plan design' (which essentially is what includes the provider networks and the associated negotiated rates per procedure) and outputs the resultant cost. Same can be done on the PBM side, just substitute drug for procedure, and 'formulary' for 'plan design'. The interesting question when you look at cross plan, cross provider, and cross carrier variances, is why :) Many companies, careers, and lawsuits, are being born from this data drop. Will be fun times the next decade or so to see how this plays out.